Muscle-Sparing Joint Replacements May Feel More Natural

A muscle-sparing joint replacement may be the right fit for you. Compared to traditional joint replacements, muscle-sparing surgical techniques may help you recover faster, experience less pain and help you move more naturally.

What are the benefits of muscle-sparing surgery?

Traditional joint replacement surgery requires cutting through muscles and tendons to get to the joint. This tissue damage can lead to longer recovery times, more post-operative pain and temporary weakness. Muscle-sparing techniques work differently by going around muscles rather than through them, preserving the musculoskeletal system's natural structure.

Daniel Gehling, MD, an orthopaedic surgeon with ProMedica Physicians, uses muscle-sparing techniques for joint replacements. He says patients who undergo muscle-sparing surgery may experience:

• Less pain after surgery and reduced need for pain medication

• Faster recovery and mobility

• Improved range of motion

• Earlier return to normal activities

Which Joint Replacements Have Muscle-Sparing Techniques?

Surgeons use different muscle-sparing techniques depending on whether you need hip or knee replacement surgery. Both approaches focus on preserving muscle tissue while still providing full access to the damaged joint.

Anterior Approach for Hip Replacement

The anterior approach to hip replacement has become increasingly popular over the past 10–15 years. Unlike traditional methods that come in through the side of the hip and cut through muscle, the anterior approach goes through the front of the hip. The surgeon accesses the joint between muscles rather than through them.

"There are multiple different approaches to hip replacement," Dr. Gehling says. "But I personally find that with the anterior hip replacement, because no muscles are cut, most of the time people forget they ever had a hip replacement. It feels like a regular hip."

With the anterior approach, patients lie on their backs during surgery, and the surgeon accesses the hip through a smaller incision on the front of the thigh. This preserves the muscles and tendons that support the hip joint, leading to faster recovery and reduced risk of hip dislocation.

Traditional approaches may also cause patients to have a slight limp after surgery. While others don’t typically notice it, a muscle-sparing surgery may feel more natural for the patient.

Muscle-Sparing Knee Replacement

Muscle-sparing techniques for the knee also deliver impressive results. Traditional knee replacement surgery requires cutting through the tendon or muscle of the quadriceps (the thigh muscles) to expose the knee joint. The muscle-sparing approach goes underneath the muscle instead.

Dr. Gehling has about ten years of experience performing muscle-sparing knee replacements and has performed them exclusively for the past twelve months. He has seen great outcomes.

"Usually two weeks after muscle-sparing knee surgery, patients are just using a cane or nothing, and they can go up and down stairs easier right after surgery. In general, the pain is much easier to tolerate.”

He adds, “We're starting to see that a few patients with knee replacement will even forget that they had knee replacement, and that really is a change that I did not anticipate seeing."

Who is a good candidate for muscle-sparing surgery?

Most people who need joint replacement surgery are good candidates for muscle-sparing techniques. The decision depends on several factors, including your overall health, your bone structure and your surgeon's assessment of risks and benefits.

"For the knee joint, I don't really see a lot of limitations to muscle-sparing surgery," Dr. Gehling says.

Some surgeons have concerns about performing muscle-sparing knee replacements on patients with very large bone structures. According to Dr. Gehling, the approach is more difficult but can still be used.

For hip replacements, most patients are suitable candidates for the anterior approach. However, there may be increased risks for patients who are significantly overweight.

Finding the Right Surgeon

Muscle-sparing techniques require certain surgical skills and experience, so choosing an orthopaedic surgeon is an important decision. Dr. Gehling recommends having an open conversation with your surgeon about their preferred surgical approaches and their experience with muscle-sparing techniques.

When evaluating surgeons, consider asking:

• How many muscle-sparing joint replacements do you perform each year?

• What training and fellowship experience do you have with this approach?

• What are the potential risks and benefits for my specific situation?

• What can I expect during recovery?

Most fellowships now include training in anterior hip exposure and muscle-sparing techniques, though this was not always the case. The approaches have gained significant popularity over the past 10–15 years as outcomes data have demonstrated their benefits.

Traditional Joint Replacement

It’s important to remember that traditional joint replacements are very successful and can lead to life-changing results.

“The goal of joint replacement surgery is to get someone who is struggling back to relatively full function, and that’s a tremendous change overall with any approach,” stresses Dr. Gehling.