Total Hip Replacement

m2a_hip.jpgTotal Hip Replacement has proven to be one of medicine's most successful treatments, allowing people to return to an active life without pain. Many patients feel as if their hip is normal after a hip replacement. It is well proven that quality of life improves and productivity improves with total hip replacement. It is well established that patients with total hip replacement stay in the workplace longer and improve their contribution to society compared with those with arthritis not undergoing the procedure. Many patients state “ I wish I had done this sooner.” 

The Normal Joint

A healthy hip has layers or smooth cartilage that covers the ball-shaped end of the femur and socket part of the pelvis. The cartilage acts as a cushion and allows the ball of the femur to glide easily within the socket of the pelvis. The muscles around the joint support your weight and help move the joint smoothly so that you can walk without pain. Everyone recovers differently, this is a guide you may accelerate your rehab faster if you desire, or slower depending on your physical strength and your surroundings.

Total Hip Replacement

Total hip replacement removes damaged cartilage from the hip and replaces it with a new ball and socket.This creates a smoothly functioning joint free of pain. The prosthesis has a femur (thigh bone) and a pelvis component made of metal, ceramics, and polyethylene or plastic. The ball replaces the worn end of your femur and is attached to a stem that fits into our femur. The cup replaces the worn hip socket of your pelvis. The metal portion of the implant has a porous surface that bone will grow into and create a tight fit. In select patients, these devices may be be cemented in place.

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Minimally Invasive Hip Replacement

We utilize two approaches to the hip, the anterior and posterolateral muscle sparing approaches. Both result in equal early recovery and overall excellent results. 

Direct Anterior Approach:  We started using the anterior approach in 2003 using a small two incision approach. We now use a single anterior incision approach using the HANA table. We have found that patients can recover quickly while preserving the small muscles of the hip. This approach is also known as a Direct Anterior Approach or Approach from the front. 

Posterolateral Approach:  We utilize the minimally invasive lateral approach in some patients. The recovery is very similar to the anterior approach and utilizes a small incision in most patients.

In both approaches, the patients should expect to walk with full weight the day of surgery and to go home either the same day or after one night in the hospital. Approxiately 50% of our hip replacements go home the same day of surgery.  Most patients are walking near normal by 2-3 weeks and resuming significant activities including golfing, hiking, hunting and long walks by 4-6 weeks.

The type of implant most commonly used is an uncemented type which relies on your body to grow into the surface of the implant. In special circumstances, a cemented device is used and relies on the the cement to adhere to the bone and implant. Both devices work well with long term (greater than 20 year ) excellent results reported. We currently utilize bearing surfaces such as VERILAST  which minimize wear and lead to longer life of the implant. 

Results

The results of total hip replacement are excellent with over 95% of patients experiencing a dramatic relief of pain and demonstrating significant improvements in activity. These excellent results can last over 15 years depending on the patients activity level and size.

Though the results are excellent, a certain percentage will fail over time requiring a second surgery. The most common cause of failure is loosening of the implant. Loosening is most frequently caused by wearing of the joint surface. With loosening the patient experiences pain and in some instances bone loss. The treatment is another more complicated operation than the first surgery but often is successful leading to pain relief and improvements in activity.

Most surgeries proceed without complication. Serious complications though rare do occur and include infection, loosening of the implant, fracture of the bone, and blood clots. Other complications reported by joint replacement surgeons but far less common include nerve or vascular injury, excessive bleeding, leg length problems, and dislocation of the prosthesis.

 

In selected patients with hip pain, other surgical treatment options are used by our team including hip arthroscopy, arthroscopic hip debridement for FAI or Femoroacetabular Impingement and labral repair, and hip resurfacing. (see web site www.mountainwesthipresurfacing.com) see hip resurfacing video.