Offering the Stanford Health Care experience with the convenience of
a local community clinic, our doctors specialize in diagnosis and
treatment of sports injuries and arthritis, and joint replacement.
Whether you're meeting with your physician for the first time or
heading in for your follow-up, you likely have many questions about
your procedure, recovery and health.
What should I know about my upcoming procedure?
Many surgeons advertise minimally invasive approaches, but change
nothing but the size of the skin incision. A true minimally invasive
surgery is a much more technically demanding procedure than
traditional approaches. Without appropriate training, equipment and an
experienced surgical team, patients could experience complications
that affect the long term function of the treated joint. Your surgeon
will describe what is needed for your specific procedure, but here are
a few general questions to start with.
Is minimally invasive hip or knee replacement right for me?
Because of advancements in instrumentation and surgical technique, a
vast majority of patients can now elect to undergo a minimally
invasive joint replacement. There is no weight, size or age limit for
these procedures. However, more complicated hip and knee replacements
with significant joint deformity and revision (re-do) joint
replacements often require larger incisions with a more traditional approach.
How big will my incision be?
In a minimally invasive surgery, the incision is usually 3-4 inches
in length—less than half of the 8-12 inches usually required for a
traditional hip or knee replacement. In some cases the incision may be
lengthened to allow for adequate visualization to do the surgery
properly. Ultimately, the size of the incision will be as long as it
needs to be for your surgeon to safely and accurately perform your procedure.
What are the benefits of minimally invasive surgery?
Currently, long-term outcome data for minimally invasive surgeries
are limited, because the techniques and instruments used to perform
these surgeries have been evolving over the last 10 years. There are
many short-term benefits to patients, including:
Faster recovery in the first 2-4 weeks after surgery
Less blood loss at the time of surgery
Less pain and
pain medication usage
Shorter hospital stays
Faster return to walking with a cane or without any assistive
Faster return to work
It is important to remember that by 3 months, all joint replacement
patients generally achieve 90% of their ultimate recovery regardless
of whether they have a traditional or minimally invasive surgery.
Current studies of long-term results of hip and knee replacements
suggest that 90-95% of reconstructed joints are still successful 20
years after surgery.
What are the risks of minimally invasive surgery?
Minimally invasive approaches to joint replacement are more difficult
to perform correctly than standard approaches to hip and knee
replacement, so it is extremely important to select a surgeon with
experience and appropriate training to perform these procedures.
Specific modifications to surgical instrumentation and technique must
be made to safely and reliably perform a minimally invasive approach.
Simply making a shorter incision without significant surgical
adaptations can result in poor results and severe complications.
Without appropriate surgical exposure or visualization, errors in
alignment and sizing of components, damage to nerves and arteries, and
poor soft tissue balancing can compromise the end result for the
patient. It is important to talk to your surgeon about their training
and experience performing minimally invasive procedures.
What about newer alternatives, like the anterior approach for hip replacements?
There are many approaches a surgeon can take to a hip replacement.
When done properly by an experienced hip surgeon, both anterior and
posterior approaches to hip replacement should have a less than 1%
risk of dislocation. Unfortunately, marketing efforts have implied
that there is no need for hip precautions after an anterior approach
and that the risk of dislocation is lower.T his is not supported by
While trained in anterior, antero-lateral, direct lateral, and
posterior approaches to the hip joint, Dr. Miller recommends a
mini-posterior approach for almost all primary hip replacements. No
matter what approach is used, all patients undergoing a total hip
replacement need to avoid specific movements for a period of 6 weeks
to avoid dislocations while the soft tissue around the hip heals.
After this time, most patients can return to full range of motion
activities without worry of dislocation.
What injuries or conditions are treated with arthroscopy?
Arthroscopic surgery is a minimally invasive surgery most often used
to treat a sports injury to a joint. The majority of the surgery is
done with the assistance of a microscopic camera that is placed into
the joint through a small incision. This allows your physician to both
see and evaluate the entire joint while treating any injured parts,
such as the ACL (anterior cruciate ligament) ormeniscus in the knee,
the labrum or rotator cuff in the shoulder, and pain due to a FAI
(femoroacetabular impingement) or a labral tear in the hip.
Is arthroscopic surgery right for me?
It is important that you thoroughly discuss any discomfort, pain or
injuries with your physician. Together, you and your trained
orthopaedic surgeon will be able to determine the best course of
treatment. The most critical step to take before beginning any
treatment is ensuring that you have the proper diagnosis. Keep in mind
that not all injuries require surgery and not all surgical procedures
can be done arthroscopically.
However, if a qualified orthopaedic specialist determines that there
is serious damage to your joint, or if you are experiencing pain that
prevents you from engaging in your normal level of activity,
arthroscopic surgery may be a good option for you.
What are the benefits of arthroscopic surgery?
Arthroscopic surgery offers several key benefits to patients who need
a damaged or injured joint repaired. Years ago arthroscopy was used
only to diagnose a joint injury and help plan for open surgery.
Advances in technology now allow surgeons to view, evaluate and
operate on injured joints simultaneously, so there are fewer
procedures for a patient to endure.
Arthroscopy is generally an outpatient procedure. Depending on the
location and extent of the injury, the surgery generally takes about 1
to 2 hours to complete. Patients can typically return home to begin
their recovery the same day as their surgery. In addition to a faster
procedure and shorter hospital stay, people usually recover from
arthroscopic surgery much faster than open joint surgery.
What are the risks of arthroscopic surgery?
There are risks associated with any surgery, including the risk of
infection, complications from anesthesia and bleeding. Arthroscopy is
less invasive than open surgery and, when performed correctly by a
trained orthopaedic surgeon, it is often extremely successful.
When can I expect to return to my normal level of athletic activity?
Rehabilitation takes place over the course of several months. Your
recovery and rehabilitation time can vary based on the surgeon,
surgical technique, kind of graft used and type of activity you are
trying to resume. Because of this variability, the timing of surgery
is often very important for many athletes to be able to return to play
in a timely manner.
What should I ask my physician?
Do you have specific training in minimally invasive surgery or arthroscopic surgery?
Minimally invasive surgical procedures are fundamentally different
than open surgery in both technique and instrumentation. This
technique is not something a surgeon can learn at a weekend course and
immediately incorporate into their practice. Without appropriate
training, the surgery can lead to poor outcomes with serious complications.
Dr. Miller completed an additional year of training at Rush
University Medical Center to learn minimally invasive orthopaedic
surgical techniques from the innovators of the procedures.
Dr. Vaughn completed a fellowship for subspecialty training in
Sports Medicine at Stanford University, where he received extensive
training in minimally invasive and arthroscopic surgical techniques.
This included experience in arthroscopy of the hip, knee, shoulder,
elbow, ankle and wrist.
How many minimally invasive surgeries have you performed?
The amount of experience a physician has with minimally invasive and
arthroscopic surgeries can directly impact the success of the surgery,
as well as the comfort and recovery time for the patient.
Additionally, as the number of cases a surgeon performs grows, the
more reliable patient outcome data will be.
Dr. Miller has performed more than 2,500 orthopaedic surgeries. More
than 400 have been minimally invasive hip and knee replacements.
Dr. Vaughn has performed more than 3000 orthopaedic surgeries, the
majority of which are arthroscopic surgeries.
What kind of anesthesia do you use with patients?
For many years, general anesthesia was the most commonly administered
form of anesthesia for orthopaedic surgeries. One drawback to general
anesthesia is that it can take patients longer to recover from general
anesthesia than it would to recover from a local or regional
anesthesia, delaying the start of physical therapy and ultimately
prolonging your overall recovery time.
At the Stanford Orthopaedic Surgery Clinic – Los Gatos, we use a
spinal anesthetic when possible for our joint replacement surgery,
combined with regional techniques that allow patients to participate
with therapy right after surgery. For arthroscopic surgery, a very
limited general anesthetic is often given. This limited general
anesthetic allows for the surgery to take place effectively and with
minimal risk of common side effects from prolonged deep general anesthesia.
What kind of implants will you be using to replace my damaged joint?
It is important that your surgeon chooses implants with a proven
track record of clinical success. Your surgeon should have access to
registries that demonstrate which implants have the best outcomes.
At our Clinic, we routinely use a knee prosthesis that has the
lowest rate of revision in large total joint registries. The hip
implants we select are based on individual variations in anatomy.
These are fine tuned to adjust for gender differences and patient size
to best recreate a patient's anatomy. The arthroscopic implants are
highly variable and will depend upon the specific requirements of your
injury. These can be discussed in detail with you during the planning
of your surgery.
What will my recovery look like?
How long will I need to be in the hospital?
Arthroscopic surgeries are usually performed on an outpatient
basis—you will be able to return home and begin your recovery on the
same day as your surgery.
Patients undergoing minimally invasive joint replacement stay in the
hospital 1-3 days before going home. The length of stay depends on
your medical conditions and your level of physical fitness before
surgery. Usually, even the most fit and healthy patients need to stay
at least one night after joint replacement surgery for medical
observation. Despite advancements in recent years, minimally invasive
joint replacement is still a major orthopaedic surgery and can have
significant complications that your medical team will be watching for
during your hospital stay. The majority of these complications are
observed within the first 72 hours after surgery.
How long before I can drive?
This is highly variable based on the type of surgery performed. It
may be as quickly 1 day after surgery, but may be several
weeks.Most patients can drive safely in as few as 2-6 weeks
after minimally invasive joint replacement surgery. Each patient's
recovery is different after joint replacement. To be able to safely
drive, you must discontinue narcotic pain medication and have the
strength and reaction time to safely operate a vehicle without
How long will I need to be in physical therapy?
Rehabilitation takes place over the course of weeks or months. Your
recovery and rehabilitation time will vary depending on the surgeon,
surgical technique, kind of graft or implant used and type of activity
you are trying to resume.
Stanford Health Care provides comprehensive services
to refer and track patients, as well as the latest information and
news for physicians and office staff. For help with all referral needs
and questions, visit Referring Physicians.
HOW TO REFER
Fax a referral form with supporting documentation to
Track your patients' progress and communicate with Stanford providers