Hip replacement surgery in young patients – McMinns sparing technique

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Hip replacement surgery in young patients requires special skills from orthopedic surgeons. Long-term treatment outcomes and complete restoration of joint function are essential for people in this age group. In addition, professional athletes, who are planning to resume their careers, may also need a replacement surgery after injuries during competitions.

During the search for the optimal treatment method for young patients, the sparing surface hip replacement using McMinn's technique was developed. Unlike classical replacement surgery, McMinn's operations do not require extensive resection of the patient's femur. Due to the unique and very durable material of the prosthesis in combination with the sparing technique of its implantation, the prosthesis successfully performs its function within 15-25 years and can be comfortably replaced after this period.

Despite the novelty of the technique, it is actively used by experienced specialists in clinical practice. As of today, more than 200,000 such operations have already been performed worldwide. According to the results of control examinations, McMinn's prosthesis completely retains its function ten years after the implantation in 97% of patients.

Content

1. Types of the replacement surgery
2. Peculiarities of McMinn's sparing hip resurfacing
3. Indications for McMinn's hip replacement surgery
4. The advantages of McMinn's sparing replacement technique
5. Where is it possible to undergo treatment by McMinn's technique?

Types of the replacement surgery

There are two basic methods of hip replacement surgery in modern orthopedics. These are the total joint replacement and surface replacement surgery.

The total hip arthroplasty includes correcting all the articular elements – the head and the neck of the femur, the articular cartilage, and the surface of the acetabulum (an excavation in the pelvic bone to which the femoral head attaches). The endoprosthesis completely replaces the upper part of the femur, forming an artificial joint. This technique is suitable for patients with dysplastic coxarthrosis, aseptic necrosis of the femoral head, and severe acetabular deformity, namely, for patients with destruction or clinically significant hip joint deformity.

In the surface replacement surgery, the surgeon preserves the patient’s femoral head. The damaged cartilage and bone growths (osteophytes) are removed from the joint surface of the bone. After that, a special cap is placed on it. New wear-resistant coating restores the normal structure of the femur, reduces the friction in the joint, and improves its function. If the acetabulum is not damaged, the surgeon does not process it. In the opposite case, the doctor also removes the damaged cartilage from the acetabular surface. At the same time, the patient’s bone tissue is maximally preserved.

Peculiarities of McMinn's sparing hip resurfacing

McMinn's sparing replacement surgery is an innovative procedure developed by Prof. Derek McMinn, an orthopedic surgeon at the BMI Edgbaston Hospital in Birmingham.

During the operation, the unique material created and patented by the hospital specialists is used – very durable cross-linked polyethylene. In addition to high strength and plasticity, the material does not cause any allergic reactions. It is successfully used in patients with bronchial asthma, atopic dermatitis, and hypersensitivity to various allergens.

McMinn's replacement procedure is called Polymotion Hip Resurfacing or Birmingham Hip Resurfacing. During the operation, the damaged articular surface of the femur is carefully processed to perfectly match the prosthesis. After that, the implant is thoroughly fixed on the prepared surface. If necessary, the damaged cartilaginous lining of the acetabulum is additionally replaced; it ensures maximum conformity of the articular surfaces.

It is crucial to preserve the full volume of own bone tissue in young and physically active patients. Even the most reliable endoprostheses have a limited lifespan. Depending on the level of physical activity, the endoprosthesis wears out in 15-25 years, and the patient needs a second operation to replace it. In the case of classic total replacement surgery, the head and neck of the femur are removed; therefore, it is difficult to replace a worn prosthesis because it simply cannot be attached properly.

Single replacement surgery with the implantation of a qualitative prosthesis is usually sufficient for elderly patients, while young and middle-aged patients often need repeated intervention. According to McMinn's technique, the operation creates favorable conditions for revision replacement surgery using both total and surface prostheses.

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Indications for McMinn's hip replacement surgery

Any type of hip replacement surgery is a technically challenging and quite invasive procedure. Therefore, it is carried out when conservative treatment and physiotherapy cannot improve a patient's condition. McMinn's surface replacement surgery is effective in such pathologies as:

• Avascular necrosis of the femoral head.
• Dysplastic coxarthrosis of ІІІ-ІV degree (or II degree in severe pain syndrome and functional disorders).
• Idiopathic coxarthrosis of ІІІ-ІV degree (or II degree in severe pain syndrome and functional disorders).
• Posttraumatic coxarthrosis.
• Hip impingement syndrome.

The sparing hip replacement using the McMinn technique is the best way of treatment in the following clinical cases:

• The young age of the patient (men under the age of 65 and women under the age of 55).
• Active lifestyle and intensive physical activity, including professional sports activity.
• The need for rapid recovery.
• Diagnosed impaired kidney function (at the early stages or in kidney failure).
• Burdened allergological anamnesis (in particular, metal allergy).

In certain clinical cases, the hip replacement surgery using McMinn's technique is inferior to the classic total replacement surgery. Particularly, relative contraindications to the operation are:

• Age over 65 years in men and over 55 years in women.
• The need for the correction of the lower limb's length (the surface prosthesis will not be able to align the length of the legs).
• Clinically relevant osteoporosis, joint instability.
• Destruction of more than 30% of the femoral head.
• Severe deformity of the femoral head or acetabulum.

The advantages of McMinn's sparing replacement technique

Due to the unique characteristics of the prosthetic material and the specifics of the operation, McMinn's replacement surgery provides the patient with a number of significant advantages, such as:

• Use of minimally invasive posterior surgical access to the hip joint.
• Low risk of hemorrhage, infection, or embolism. During McMinn's surgery, the integrity of the femoral epiphysis, where the bone marrow is located, and large blood vessels pass, is not affected.
• Low risk of dislocation or displacement of the prosthesis. The prosthesis is stable even in intensive physical activity, and the natural biomechanics of the joint is preserved.
• Early mobilization, short rehabilitation period. The patient can move with a crutch or two canes for a few days after the intervention.
• Unlimited load on the joint. There is no need to "spare" the operated leg or limit the usual physical activity since the joint retains its natural anatomical shape and range of motion. In 3 months after the surgery, the patient can return to sports, and after six months – engage in contact sports (for example, boxing).
• Preservation of all reflexes, including proprioceptor sensitivity. The patient feels the implanted joint as his own; this effect is called "forgotten hip."
• Increasing the bone mineral density. According to the results of densitometry, the density of the operated femur increases after 1-2 years by 5-11%, which is vital for the prevention of fractures and the normal functioning of the prosthesis.
• Possibility of revision replacement surgery (replacement of the implant at the end of its service life).

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Where is it possible to undergo treatment by McMinn's technique?

Hip replacement surgery using McMinn's sparing technique is possible if the following three conditions are fulfilled:

1. Good technical equipment of the hospital.
2. Availability of the endoprosthesis made of the patented material.
3. Experience of an orthopedic surgeon in performing such operations.

These conditions can be met in leading European hospitals, particularly in university hospitals and orthopedic centers in Germany. Foreign patients can also undergo an operation here if they obtain permission for treatment and prepare medical documents correctly. You should also plan your trip in advance because, after the operation, the patient will move with a cane or crutch for a while.

Specialists of the company Booking Health will help you receive treatment with maximum comfort and safety. Booking Health is the only medical tourism operator in the world which provides full support at all stages of treatment. Booking Health offers help in such important aspects:

• Choosing the right clinic based on the annual qualification profile
• Establishing communication directly with your doctor
• Preparing medical program in advance, without repeating previous examinations
• Providing favorable costs without overpricing and additional coefficients for foreign patients (saving up to 50%)
• Booking the appointment on the necessary date
• Independent monitoring of the medical program at all stages
• Help in buying and forwarding medicines
• Communication with the clinic after treatment completion
• Control of invoices and return of unspent funds
• Organization of orthopedic rehabilitation
• Offering service of the highest level: booking hotels and plane tickets, transfer organization

Should you leave the request with basic medical information on our company's website, doctors of Booking Health will select the most appropriate treatment option for you, and medical coordinators will accompany you 24/7 at all stages of your trip.

 

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Choose treatment abroad and you will for sure get the best results!

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See the interview for more information:

JOINT RESTORATION AND ARTHROPLASTY IN GERMANY – interview with Prof. Dr. med. Oliver Hauschild

Authors:

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova, Alexandra Solovey. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

 

Sources:

Medscape

Healthline

Cochrane Rehabilitation

 

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