Lee Young-kyun, a professor of orthopedic surgery at Seoul National University Bundang Hospital (SNUBH), has developed a new hip replacement procedure called "PAICO (posterior approach and inferior capsulotomy)" to reduce the risk of dislocation after hip surgery.
Professor Lee Young-kyun (Courtesy of SNUBH)
The hip joint, where the femur meets the pelvis, is crucial for mobility. Injuries or conditions such as fractures and arthritis can severely impair basic functions like standing and walking. For older adults, hip fractures caused by falls are particularly dangerous, carrying a higher mortality rate than some cancers. Hip fractures in older adults typically involve femoral neck fractures, weakened by osteoporosis. To address this, surgeons often remove the damaged bone and replace it with an artificial joint -- a partial hip replacement process known as hemiarthroplasty.
This differs from a total hip replacement, which replaces both the femoral head and the cartilage in the pelvis. However, despite advances in surgical techniques, partial hip replacements carry the persistent risk of complications, particularly dislocation.
To address this issue, Lee and his team developed the PAICO technique, which involves making an incision in the lower part of the joint capsule, rather than the upper, to reduce damage to the weight-bearing tissues and prevent upward dislocation.
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Conventional surgery with an incision in the upper femoral neck (left), and PAICO surgery with an incision in the lower border of the femoral neck (Courtesy of SNUBH)
A study conducted at SNUBH in 2021 found that the dislocation rate among PAICO patients was zero within a year of surgery, compared to 1.5 percent for patients undergoing conventional surgery. No cases of osteolysis, periprosthetic fractures, or infections were observed. Additionally, the average hospital stay for PAICO patients was 11.4 days, about a week shorter than the 18.4 days for the control group. SNUBH said that the PAICO method offers a new approach that reduces the risk of dislocation and could be adopted by experienced surgeons as a standard treatment.
"The key to preventing dislocation in hip replacements is enabling the muscles and soft tissues around the joint to recover quickly after surgery," Lee said. "This new method minimizes damage to these tissues, significantly reducing the risk of dislocation." The full study detailing these findings is published in Clinics in Orthopedic Surgery, the international journal of the Korean Orthopaedic Association.
Source: https://www.koreabiomed.com/news/articleView.html?idxno=25072
