Total Hip Replacement has proven to be one of medicines 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. Total hip replacement removes damaged cartilage from the hip and replaces it with a ball and socket. This creates a smoothly functioning joint free of pain. Many patients state “ I wish I had done this sooner.”
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.
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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.
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.
Minimally Invasive Hip Surgery (Techniques)
We utilize two approaches to the hip, the anterior and posterolateral muscle sparing approaches. Both result in equal early recovery and overall excellent results. Both techniques allow for near normal ambulation by 2-3 weeks, participation in most activities including golf, hiking, hunting, long walks, and even skiing by 3-5 weeks.
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 fast 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 many patients. The recovery is similar for most patients as the anterior approach and utilizes a small 3-4 inch incision in most patients.
In both approaches, the patients should expect to walk with full weight the day of surgery and to go home after one night in the hospital. We used to send many patients home the same day but found it was safer and more convenient for the patient and their family to stay one night. Most patients are walking near normal at 3 weeks and resuming significant activities including golfing and hiking by 4-6 weeks.
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.