Dr. Mikulak’s MIS Hip Replacement (MIS THA):
Dr. Mikulak has worked with the engineers at Zimmer to develop instrumentation to not only allow us to perform minimally invasive Total Hip Replacement through a small (usually 3 inches, as opposed to the larger, often upwards of 12 inches or longer!) incision, but to do it without cutting through the piriformis or gluteal muscles. This makes for a much more stable hip replacement. Other surgeons require their patients to avoid a set of restricted motions (also known as hip precautions). Most hip precautions forbid the patient from bending at the waist past 90 degrees (for example, no bending forward from a seated position) or from crossing their legs. With Dr. Mikulak’s minimally invasive Total Hip Replacement, you have no such hip precautions save one (and it is an uncommon position to get into anyway). We don’t allow the patient to do a combination of three things (any one of these by themselves is fine): Technically speaking, no adduction and internal rotation past 90 degrees of flexion. Don’t worry if you don’t know what this is, we will show you as many times as you need.
In minimally invasive Total Hip Replacements, we cut the head and neck off of the femur and use an instrument to resurface the socket, or acetabulum. We also remove any bone spurs that would inhibit motion or jeopardize stability. We then evaluate the geometry of your joint and compare this to the template that we used to measure your x-ray before the procedure. At this point, we put in a trial prosthesis based on these measurements. Then, we put your hip through a rigorous range-of-motion test. If your range-of-motion, stability, leg length, and tissue tension are all good we implant your final prosthesis.
The prosthesis that we usually use is a tried-and-true design using state-of-the-art materials. We use a titanium stem and cup, a cobalt chromium head, and a highly cross-linked polyethylene liner. (For further information on this prosthesis, go to www.zimmer.com). We use a press-fit prosthesis instead of a cemented. The titanium surface interfacing with your bone is porous. Your body will recognize this porous titanium as its own bone and your bone and blood vessels will actually grow into the prosthesis. It becomes a part of you! This press-fit design is also much gentler on your bone and soft tissues than cement, should the need for a revision surgery ever arise. We have had patients return to competitive tennis, golf, surfing, spear fishing, and basketball with little or no impact on their polyethylene. We simply monitor the thickness of it on annual x-rays. If the polyethylene starts to look worn (usually a matter of decades), we simply pop out the old one and implant a new one. Presently, this is a simple out-patient surgery.
After surgery, we get you up walking with physical therapy on the same day. As a matter of fact, most of our patients are able to go home the next day! On occasion, we even do this surgery on an out-patient basis. It is about as minimally invasive as a hip replacement can get.
Dr. Mikulak’ Minimally Invasive Total Knee Replacement (MIS TKA):
Minimally invasive surgery is all about doing as little to disrupt the surrounding tissue as possible. Collateral damage is unacceptable. This concept is what led Dr. Mikulak to develop his unique approach to Minimally Invasive Total Knee Replacement. While most other TKA techniques (MIS or otherwise) cut down the front of the knee and therefore through muscle and tendon, we approach the knee from the inside, or medial side of the leg. Instead of cutting through delicate and difficult to heal tissue with reckless abandon, we gently approach the knee joint by going in between the medial muscles (namely, the adductor and the vastus medialis obliquus), thereby leaving the entire mechanism intact. We then gently retract the muscle and kneecap over to the lateral side of the knee without invasively inverting the kneecap, as most other techniques do.
Once we have gained our exposure to the bone, we use a series of precision cuts on the arthritic surfaces of the joint where all the exposed nerve endings are. This removes the source of the arthritic pain and prepares the joint to accept the prosthesis. At this point we remove all the bone spurs, including the hard to reach ones far in the back. These are usually so hard to reach that many surgeons leave them in, which diminishes your knee motion after surgery.
At this point, we use a trial prosthesis to check your motion, alignment, and stability. When we have achieved excellent motion and stability and have restored your anatomic alignment, we implant the final prosthesis. What this all means is less pain and more functionality after surgery!