Both traditional and minimally-invasive hip replacement surgeries use the same implants. In research studies it has been found that for most patients the likelihood that the implant will still be functioning well 10 years after the operation is about 90 percent; fewer data are available at 20 years but some studies suggest that the likelihood the implant will still be in service after two decades is between 75 and 80 percent.
Hip replacement surgery is rarely urgent. It is an elective procedure performed when the patient decides the pain and discomfort is such that he or she no longer wishes to endure it.
For most patients the likelihood of having a major complication — defined as a complication that could leave the patient worse off after the procedure than s he was before it — is extremely low. The best way to treat complications is to avoid them; specific precautions are taken to try to avoid all of the above complications as well as others that might occur.
Patients may be required to discontinue certain prescriptions that may increase likelihood of bleeding. Some patients also donate blood in advance of surgery. In addition patients are also asked to:. It can be delayed until it is convenient for the patient. It is best to plan the surgery so that the patient is prepared to be out of action or inconvenienced for four to 8 weeks depending upon the surgery approach.
Hip replacement surgery should be performed by a board certified or board eligible orthopedic surgeon who specializes in the procedure has received special training and performs them on a regular basis. Hip replacements should be performed in an operating room of a hospital or medical center with the various support services needed for major surgery.
The surgical and post-surgical team should include nursing staff an anesthesiologist plus occupational and physical therapists. There is good evidence that the experience of the surgeon performing total hip replacement affects the outcome. It is important that your surgeon not only is an experienced orthopedic surgeon; s he also should have a high level of skill and experience with total hip replacements.
You may also visit the American Association of Orthopedic Surgeons web site at www. It is recommended that hip replacement surgery be performed in an operating room of a hospital or medical center. It done is on an inpatient basis as it is a complex procedure and requires specialized nursing and support staff. In both traditional and minimally-invasive hip replacement surgery the old arthritic hip joint must be removed and replaced with new ball and socket titanium implants.
At the end of the surgery the surgeon must repair the divided muscle and tissues. In a minimally-invasive surgery the surgeon uses a two-inch incision on the front of the hip and a two-inch incision on the back of the hip.
It is thought that this approach may cause less injury to the muscles around the hip. As a result the recuperation period is less painful and the recovery more rapid than with the conventional approach. Through the small incision on the front of the hip the surgeon places a cup about the size of half a peach and is made of plastic.
The cup is covered with a layer of titanium with a web pattern that will allow the bone of the pelvis to grow into it keeping the cup in place. Through the other small incision on the back of the hip the surgeon places a titanium ball and stem into the femur or thighbone. The bone grows into the stem over the six weeks following surgery holding it securely in place.
The components are placed using x-ray guidance to help insure accuracy. Once the ball and cup are in place the surgeon puts the new ball into the new socket and closes the surgical incisions. Anesthesia for hip replacement surgery can either be general or regional spinal nerve block. It is advisable that patients discuss the anesthesia with an anesthesiologist before surgery to ensure their comfort and safety. Some fluid might drain from your incision. This is normal during the first few days after surgery.
Also contact the office if your pain is not improving. Most patients do well with hip replacement. As with any surgical procedure, there are some risks during and after a hip replacement:. In very, very rare cases of bone surgery, particularly procedures using cement, an embolism blockage can occur if fat from the bone marrow enters the bloodstream.
A fat embolism can raise the risk of a heart attack or stroke. There may be other risks depending on your medical condition. Be sure to discuss any concerns with your doctor before the procedure and ask which risks are highest for you. Your hip implant may wear out or loosen over time. It might also become damaged if you have an injury or dislocation.
You may need a revision surgery to replace the damaged parts of the prosthesis. Most hip prostheses last 20 years or longer. You might be able to extend the life of your implant by doing regular low impact exercise, avoiding high impact exercise such as jogging and taking precautions to avoid falls.
A rare risk of hip replacement is infection, which can happen if bacteria circulating in the bloodstream get caught in the prosthetic pieces. An infection may require a revision surgery to remove the infected tissues, and a course of antibiotics to kill the bacteria.
When the infection is gone, a new prosthetic can be put back in. If you had a partial hip replacement only the ball part of the joint , you may need a revision down the road to replace the socket as well. Health Home Treatments, Tests and Therapies. What is a hip replacement? Who can benefit from a hip replacement? Your doctor may recommend hip replacement if you have significant pain, inflammation and damage to your hip joint due to conditions such as: Osteoarthritis most common Rheumatoid arthritis Osteonecrosis avascular necrosis Injury such as hip fracture Tumor in the hip joint.
How do you know if you need a hip replacement? Signs of declining quality of life include: Inability to get restful sleep because of pain Difficulty doing simple tasks such as getting dressed or climbing stairs Inability to fully participate in the activities you enjoy At first, your doctor may recommend other treatments such as medicine for pain or inflammation, walking aids, joint injections and physical therapy.
Types of Hip Replacement Surgery Several factors help determine the type of hip replacement you may need. Total and Partial Hip Replacement: Which parts need to be replaced? Three common ways to access the hip joint are: From the front anterior approach to hip replacement From the side lateral approach to hip replacement From the back posterior approach to hip replacement.
Approaches to Hip Replacement Surgery Dr. Savya Thakkar. Minimally Invasive Hip Replacement Minimally invasive hip replacement aims to minimize the impact of surgery on healthy tissues, such as muscles and blood vessels. This approach may have advantages, such as: Lower risk of muscle damage Less pain Quicker and easier recovery Less limping Shorter hospital stay Lower chance of hip dislocation Minimally invasive hip replacement is not appropriate for all patients.
The most common form of arthritis is degenerative arthritis or osteoarthritis which is secondary to a combination of genetics, possible "wear and tear", and age. Rheumatoid arthritis is an example of an inflammatory arthritis, wherein the lining of the joint synovium becomes inflamed and thickened, resulting in direct damage to the cartilage.
Avasular necrosis of the hip is a condition which results in the bone underneath the cartilage losing its blood supply and collapsing resulting in the overlying cartilage becoming damaged.
The most common causes of avasular necrosis of the hip are chronic steroid use e. Other causes of hip arthritis include hip dysplasia, post-traumatic arthritis, hip impingement, and rarely, infection. The direct anterior approach is generally an option for any type of arthritis, although in patients with abnormal anatomy e.
The direct anterior approach may also not be suitable in very obese patients, particularly in patients where the stomach rests over the top of the thigh where the incision is made. Hip impingement and labral tears may also result in pain in the hip area. This is typically secondary to abnormal femur anatomy CAM lesion. This is typically due to abnormal anatomy of the pelvis Pincer lesion. The mismatch between the size of the ball and socket results in tears of the labrum, and typically small areas of cartilage damage.
Pain from hip impingement typically only occurs with extremes of motion. Pain at rest is typically consistent with more advanced arthritis, or pain from another source.
Pain which is isolated to the buttock is often more suggestive of nerve irritation e. Pain on the outside of the hip is often suggestive of hip bursitis. Rotation or movement of the hip should not exacerbate these symptoms.
Total hip replacement is one of the most common operation performed in the United States, with over , procedures performed yearly. This number is expected to likely double in the next 20 years, partly due to patients living longer, having higher expectation as to quality of life and function than previous generations, and having better access to health care. The direct anterior approach is performed by a relatively small minority of surgeons performing hip replacement.
This is largely due to the fact that this approach has only gained popularity in the last 10 years, primarily due to more active patients wanting a less invasive technique allowing for a quicker recover.
As such, many surgeons were not trained in this advanced technique. It is generally considered more technically difficult than the other approaches, so specialized trained is often necessary. The diagnosis of hip arthritis is typically made in combination with a history of pain localized to the hip area usually slowly progressive in nature , a physical examination which reproduces pain with motion of the hip, and x-ray finding showing narrowing of the joint space between the ball and socket.
Because cartilage is a soft tissue like tendons and ligaments , it does appears on a xray. However, if cartilage is functioning normally, the space between the ball femoral head and socket acetabulum , which do appear on xray, should be thick roughly mm and symmetrical throughout.
Once this space is obliterated, we call this severe, or "bone-on-bone arthritis". Patients with severe arthritis are typically the best candidates for total hip replacement. Medications may be helpful in managing degenerative arthritis, although no medications currently exists that can reverse the process of osteoarthritis.
Although glucosmaine and chondroitin sulfate have been marketed as effective for the treatment of arthritis, studies which have looked at these medications have not demonstrated a difference in comparison to placebo. Injections within the hip of steroid cortisone or lubricants hyaluronic acid have not been studied to the same extent as they have in knee arthritis, and are generally discouraged.
Injections in the hip joint typically involve xray or ultrasound guidance, are fairly invasive, and have limited benefit. In the case of rheumatoid arthritis, specific drugs may treat the inflammation that destroys the cartilage, and potentially halt progression. Some of these medications are administered by injection and others by mouth.
Some individuals take anti-arthritic medications for their entire lives. These medications can be quite helpful, but there may be side effects. These medications should be taken under the close supervision of a rheumatologist or other physician experienced in their use. Gentle exercises for the hip, as long as they do not exacerbate pain, may be beneficial to maintain flexibility and range of motion.
Formal physical therapy for muscle strengthening, gait training, local massage, etc. Physical therapy after direct anterior total hip replacement is individualized based on a patients recovery. Because no muscles or tendons are cut, there are no specific muscles which "need" to be rehabilitated because of the trauma of surgery.
Some patients who continue to feel stiff or weak after the first 6 weeks of surgery may benefit from either home exercises or formal physical therapy. Total hip arthroplasty is one of the most effective operations available in the field of orthopedic surgery. Surgery first involves removing the arthritic ball and socket using specialized instruments.
A metal stem is placed within the femur and a metal socket is placed within the pelvis. A ceramic or metal ball is then placed on the stem and a dense plastic bearing is placed within the socket. The artificial ball and plastic bearing are extremely smooth, which allows the hip to function and move similar to a normal hip. The major advantages of direct anterior hip replacement in comparison to traditional approaches include a more rapid recovery, less pain in the immediate post-operative period, more normal gait mechanics, and a more stable artificial hip without the need for hip precautions.
Regardless of surgical approach, the most important factor in terms of technical success involve placing the hip replacement components in a optimal position. The most effective and reliable surgical treatment of severe arthritis remains total hip replacement. The other surgical option for severe arthritis is hip resurfacing, which may also be very effective and has the advantage of being more bone conserving i.
Hip resurfacing has fallen largely out of favour recently in the United States because the bearing surfaces used are "metal-on"metal". It is the most common approach and provides the greatest patient safety. Anterior Candidates for this approach are not significantly overweight, have no femur deformities, and normal pelvis anatomy The patient is positioned on his or her back on a special surgical table so the surgeon can manipulate the leg during surgery.
The surgeon makes a inch incision on the upper thigh. This is a technically challenging procedure. Patients should find a surgeon very experienced in this approach. Intraoperative Visualization and Precision Posterior Technique allows the surgeon full visualization if the hip cup and femur.
No intraoperative x-rays needed. Very low risk of fracture due to easier exposure. Anterior Technique allows excellent visual exposure of hip cup, but challenging exposure of femur requiring muscle and capsule release. Higher risk of femur fracture due to more difficult exposure.
Intraoperative x-rays are often used to confirm placement of the implant due to less visual exposure.
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