The Röttinger approach: A less invasive technique for hip replacement

Hip replacement surgery is a well-established procedure for relieving pain and restoring mobility in patients with severe hip arthritis or other joint conditions. However, advancements in surgical techniques now allow for less invasive options, like the Röttinger approach, a technique designed to spare muscles for better post-operative outcomes.

In this article, Dr Kristian Kley, a consultant knee and hip surgeon at Orthopaedic Innovation, explores what the Röttinger approach is, its benefits, and how it compares to traditional hip replacement techniques.

What is the Röttinger approach and how does it differ from traditional hip replacement?

The Röttinger approach is a minimally invasive hip replacement technique that allows surgeons to access the hip joint through an anterolateral (front-side) approach.

Unlike traditional surgery, which requires cutting through major muscles like the gluteus medius, this approach allows surgeons to access the hip joint by working between muscle layers, preserving soft tissue and reducing trauma.

As a result, this technique helps maintain joint stability, shortens recovery time, and reduces the risk of complications.

Benefits of the Röttinger approach

This technique offers several advantages over traditional hip replacement methods:

Faster recovery time

Since the muscles remain intact, patients often experience a quicker rehabilitation process. Many individuals are able to walk unaided sooner than with traditional surgery.

Reduced pain and discomfort

Minimising muscle trauma results in less post-operative pain, which can reduce the need for strong painkillers.

Lower risk of hip dislocation

Because the surrounding muscles remain largely untouched, they continue to provide stability to the hip joint, reducing the likelihood of hip dislocation.

Smaller incision and less scarring

A smaller surgical incision means less scarring and a more aesthetically pleasing result.

Improved long-term functionality

Patients often experience better joint stability and mobility in the long run due to the preservation of muscle integrity.

Dr Kristian Kley’s modified Röttinger approach

Consultant knee and hip surgeon Dr Kristian Kley has developed his own modification of the Röttinger approach, further enhancing the benefits of this technique.

Faster recovery and early mobility

The majority of patients are able to walk without crutches within two to three hours after surgery, with almost all able to do so by the next day.

Over 95% of patients are discharged within 24 hours, and many go home on the same day. This allows for a significantly quicker return to daily activities.

Many patients even resume work within two to three weeks after surgery.

Zero dislocation rate and no movement restrictions

The national dislocation rate for hip replacements in the UK is 2%, according to the National Joint Registry (around 140.000 hip replacements per year). However, Dr Kley has achieved a 0% dislocation rate in his procedures.

With traditional hip replacement surgery, patients must avoid low sitting for six weeks, requiring modifications such as a raised toilet seat. They are also advised not to lie on the operated side and must sleep on their back for six weeks.

With Dr Kley’s modified Röttinger approach, there are no such restrictions. Since it is muscle-sparing, patients can sit and sleep however they feel comfortable, including lying on the operated side the minute they feel comfortable enough to do so, which for many is within a few days.

While he advises taking precautions for the first six weeks, he does not impose strict limitations.

Lower risk of complications

With quicker mobilisation, the risk of deep vein thrombosis (DVT) and pulmonary embolism is significantly reduced.

His precise surgical technique also contributes to a much lower risk of infection, with only 3 cases in 7.000 joint replacements performed over the last 15 years.

In comparison, the national statistic is between 1-5% for a deep infection.

Reduced risk of nerve injury

Since the location as far away as possible from major nerves, such as the femoral nerve at the front and the sciatic nerve at the back, the risk of nerve injury is significantly lowered.

In fact, Dr Kley has never encountered a nerve injury in the thousands of cases he has performed.

Is the Röttinger approach suitable for everyone?

While this technique offers many advantages, it may not be suitable for all patients.

Factors such as bone structure, muscle condition, and previous surgeries may influence whether this method is the best option.

A thorough consultation with an orthopaedic specialist is necessary to determine the most appropriate surgical approach based on individual needs.

By preserving muscle integrity, the Röttinger approach is a significant advancement in hip replacement surgery, offering a less invasive alternative to traditional techniques.

If you are considering hip replacement surgery, consult with Dr Kley via his Top Doctors profile to determine whether the Röttinger approach is the right option for you.