BOSTON -- In surgery, the biggest advances usually involve smaller incisions -- lessening the pain and recovery time for the patient -- but not everyone agrees that the newer approach is better in the field of hip replacement.

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Minimally Invasive Hip Surgery Best Bet?

By the time Linda Janscy was in her mid-40s, the pain from her childhood rheumatoid arthritis had returned. She had trouble hiking, playing with her granddaughter and doing daily tasks.

"If I were to sit in the car a long time, I have a long commute, I would become so stiff that I couldn't stand up straight when I got out of the car," Janscy said.

In December, Janscy had her right hip replaced, and in April, doctors at Newton Wellesley Hospital in Newton, Mass., did her left hip -- but this time with a minimally invasive technique. Instead of a 12-inch incision, they used two 2-inch cuts.

"There's less soft tissue cut in order to get to the hip joint. As well, there may be benefits in recovery as regard to muscle strength," Dr. John Siliski said.

Siliski is one of those doing the procedure. He acknowledges it's difficult to learn. The hardware that is used is quite large, and precision is critical.

"There are many aspects of the placement of the implants that affect whether the implant will be stable, whether it will last a long time, whether the joint will be stable and not dislocate, whether the leg lengths will be similar in length or different after surgery," he said.

Some hospitals are starting to use computer navigation systems, similar to a Global Positioning System on a car, to help they better fit the implants with the smaller incisions.

Some research has shown that 80 percent of people who need a new hip would be good candidates for the minimally invasive procedure, but there is growing concern that it may not always be the best technique.

In a study published this month, researchers at Stanford found that of 135 hip replacements they did, those with the mini-incision had no greater benefit, but did have a higher incidence of wound complications and greater risk of a poor fit.

Dr. James Bono, of New England Baptist Hospital in Boston, said that the trend toward very small incisions can be dangerous, especially since the procedure involves drilling into the femur bone in the leg.

"It's as if you took your car to the mechanic and he tried to repair the engine through the grill of the car without opening the hood. I say open the hood, but only open it as far as you need to get to the part that needs to be fixed," he said.

But for Janscy, the newer technique meant less pain and less pain medication, and it cut her recovery time in half.

"I was able to go from a walker to crutches in two weeks' time, versus the first surgery it took four weeks," Janscy said.