When To Consider Hip Replacement
It may be time for you to consider a total hip replacement if:
- You have intense hip or groin pain that keeps you awake at night or wakes you up.
- You have hip pain that limits your daily activities, like walking, climbing stairs, or going to work.
- You have hip pain that causes you difficulty getting in and out of chairs.
- You have tried conservative treatment options for hip pain with no success.
The bottom line is that hip replacement surgery is a last resort for dealing with hip pain due to arthritis. However, if you have tried conservative treatment options with no success and persistent arthritic hip pain is interfering with your life and limiting your daily activities, it is time to talk with your doctor about a hip replacement.
Dr. Daniel C. Valdez, board certified orthopedic surgeon, demonstrates hip replacement implants and discusses the surgical process.
Dr. Sergio Viroslav, board certified orthopedic surgeon, discusses the different surgical approaches to total hip replacement.
with a TSAOG Hip Replacement Specialist
What is Hip Replacement?
When the articular cartilage surrounding the ball and socket of your hip joint (where the femur meets the pelvis) is damaged beyond repair, most often due to osteoarthritis (or degenerative joint disease), hip replacement surgery seeks to remove the damaged portion of the hip and replace it with an artificial component.
TOTAL HIP REPLACEMENT
A total hip replacement (or total hip arthroplasty) involves six main steps:
- Preparation of the Hip Socket – The damaged cartilage, as well as a small amount of the bone, is removed from the hip socket (acetabulum) and the new surface is shaped to fit the designated implant.
- Preparation of the Femur – The ball at the end of the femur, along with the damaged cartilage, is removed and the hollow center of the femur is reamed to fit the designated femoral stem implant.
- Positioning of Hip Socket Implant – A cup-shaped metal implant is positioned in the hip socket. It can be secured with screws or press fit into place.
- Positioning of Femoral Stem Implant – A metal stem is inserted into the femur bone to a depth of around 6 inches. It can be cemented or press fit into place.
- Positioning of Femoral Head – A metal or ceramic ball is positioned on top of the femoral stem, taking the place of the damaged end of the femur, which was removed.
- Spacing – A plastic spacer is inserted into the hip socket implant, creating a smooth surface for gliding (acting in place of cartilage for the artificial hip).
APPROACHES TO HIP REPLACEMENT
When people talk about different approaches to hip replacement, they are referring simply to how the surgeon gains access to the hip joint for the surgery.
The 3 most common approaches are as follows:
- Posterior Approach – Posterior approach (also known as the Moore or Southern approach) is the most traditional approach to hip replacement. It involves an incision from the back of the hip joint.
- Anterolateral Approach – Anterolateral approach (also known as the Watson-Jones approach) involves accessing the hip from the side.
- Anterior Approach – Anterior approach (also known as the Smith-Petersen approach or Direct Anterior Approach (DAA)) involves accessing the hip from the front.
The anterior approach has gotten a lot of press lately as it tends to offer a faster recovery time than the other two approaches. However, there are advantages and disadvantages to consider with each of the approaches and outcomes are relatively similar for all three approaches 6 months to a year down the road.
The approach a surgeon chooses is based on patient-specific hip anatomy as well as the size and shape of the patient. Speak with your surgeon to learn more about the different approaches to hip replacement and which might be most appropriate for you.
What to Expect After Surgery
Hip replacement surgery has evolved significantly over the years, a trend that is likely to continue. Advances in surgical techniques as well as implant technology have allowed surgeons to perform total hip replacement surgeries through smaller incisions and with less injury to the surrounding muscles.
Most patients will stay 2-4 days in the hospital and then begin physical therapy (either with a physical therapist coming to their home or in outpatient physical therapy sessions). Physical therapy progresses from walking with a walker to walking with a cane over the course of 2-3 weeks. Post-operative pain management will be provided through medication and/or injections, but most patients are pain free 2-3 weeks after surgery.
After hip replacement surgery, you can reasonably expect to return to work in an office setting within 2-3 weeks, routine activities like driving within a month, work in an industrial setting involving heavy lifting within 2-3 months, and leisure activities such as golfing and swimming within 3 months.
After recovering from hip replacement, you can expect to live a normal lifestyle, including activities like walking, hiking, biking, hunting, and fishing. Most total hip replacement patients experience a significant reduction in pain as well as a vastly increased ability to perform daily activities.