Hip

Hip replacement surgery involves removing the diseased femoral head (ball) and replacement of the bearing surfaces. This includes placement of a titanium shell within the native acetabulum. A polyethylene liner is placed within the shell. On the femoral side, a titanium stem is placed within the existing bone and a ceramic ball is placed on the end of the stem. These four parts comprise the hip replacement. Implants are intended to relieve hip pain and improve hip function however they may not produce the same feel or function as the original hip. Longevity of the implants depend on many factors including patient factors such as body mass index (BMI), implant design and position, and activity level. Ultimately, more than 340,000 hip replacements are performed in the US each year. The US Department of Health and Human Services considers total hip replacement to be one of the most successful and cost effective interventions in medicine. The success rate for hip replacements 10 years after surgery is 90-95%.

Like any condition, surgery is felt to be the last option in the treatment process. Initially, nonoperative measures such as weight loss, activity modification, exercise plans and anti-inflammatory medications are initiated to decrease the symptoms of hip disease and restore function. When these measures fail, corticosteroid injections are considered but ultimately, surgery is contemplated.

Total hip replacement involves a soft tissue approach to the hip. Historically this involved an incision over the side of the hip and cutting through some muscle/ tendon to access the hip joint. This resulted in slowed recovery and protective activities to include precautions or limitations during the first 6 weeks. Today, due to extensive work on muscle sparing approaches, we are pleased to offer the Direct Anterior option. This is a minimally invasive surgical technique which simply put changes the direction from which the surgeon accesses your hip joint. This technique utilizes a much smaller incision placed strategically between two large muscle groups (Hip abductors and Hip flexors). This natural “space” minimizes the potential of damaging the muscles that make up the primary support system for the joint. In addition, since you are in a supine (flat on your back) position during the surgery, the use of x-ray during the procedure is utilized and has been shown to improve the position of the implants and thus the success of the procedure. This will aid in comfort and a natural range of motion after the surgery. In addition, because the muscles are spared, the anticipated hospital stay and rehabilitation is significantly shortened without affecting the ultimate quality of the procedure. With this minimally invasive technique, preservation of the soft tissues allows for immediate stability and the removal of any additional precautions or restrictions allowing the patient to progress at their own rate without artificial limitations.

• Ask questions. Talk to someone who has had a hip replacement to get a basic idea but remember that individual patients all heal / recover at different rates. Look around your house for fall risks. Remove slip rugs or cords that could result in tripping. Allow time to rest. Although you will not be given specific precautions, remember surgery is a major insult to your body and your body needs time to recover. It is likely that your appetite will be affected. Make sure you have groceries stored at home as you will most likely not feel well enough for restaurants. • Decide on where and how you will rehab. It is often very possible for you to recover from hip replacement surgery at your own home. You will however need some assistance despite how well you do. Set up this help ahead of time. If you live alone and don’t have anyone to help, make sure to discuss options with your surgeon for in-patient rehabilitation options. Pre-surgery scheduling of these facilities is preferred. • You will go through a preoperative assessment known as “surgical home”. During this your medical issues will be reviewed and optimized so that your surgery is as successful as possible. If you have any issues felt to require improvement prior to surgery, you will be postponed until these issues can be resolved as your ultimate health and success is our number one priority. • Smoking is a serious contraindication to surgery due to the impact on healing. If you are a smoker, you should plan on quitting at least 6 weeks prior to your procedure to optimize your results. Continued smoking may result in postponement of your surgery. • Body Mass Index (BMI) is a measure of appropriate weight for your height. If your BMI is > 40 you will be required to lose weight prior to the procedure if possible. Discussions with your surgeon will help identify possible strategies to lose weight. Morbid obesity or BMI > 40 has been shown to have significantly higher risks of operative wound healing issues including infection.

Revisions are recommended for several reasons. If a prosthesis has been in place for a long time, the bearing surface may have worn, requiring a simple exchange. This is the easiest type of revision with the shortest recovery period, as the critical components are not changed. Loosening of the components (either the socket or stem) can occur independently or simultaneously, and require removal of one or both. Depending on the difficulty of the removal, the recovery can be short (six weeks) or long (six months). The hip components can dislocate. This may be remedied with a single “reduction” maneuver, but if this becomes chronic, revision surgery may be necessary. Finally, an infection around the prosthesis may require removal of the prosthesis. Once the infection has resolved, new components can be placed.

The components are very similar. This typically involves a larger diameter socket and a longer stem or rod. For enhanced fixation, screws are commonly used for increased contact with the native bone. Finally, augments, which are metallic bone substitutes, can be used to rebuild any prior bone loss.

Functional rehabilitation is similar in that often the “anterior approach” can be utilized enabling early and quick recovery. Specific hip limitations or precautions are sometimes needed to allow the soft tissues to heal. Usually, full weight-bearing is allowed, with the exception of revisions that necessitate osteotomies or bone cutting for implant removal. In these uncommon cases, a period (typically six weeks) of partial weight-bearing is required to allow the bone to heal properly. The usual time for resolution of most of the symptoms is three to six months.

X-rays are obtained which most often reveal the fracture. Occasionally a CT scan may be obtained as well.

Surgery is required to repair most hip fractures and restore hip function. There are several different ways to surgically treat the fracture. The treatment will depend on the nature of the fracture, degree of displacement, age and function of the patient. The bones are aligned back in place and held together with either screws, metal pins, plates, or rods. With some types of hip fractures, a partial or total hip replacement will be required to repair the fracture.

This varies based on the age of the patient and type of fracture. Most people will require a couple nights in the hospital after surgery for monitoring and physical therapy. Once stable for discharge from the hospital, patients will either go home with a physical therapist coming to their home, or will go to a short term rehabilitation hospital. At two weeks after surgery, you will follow up in the office for x-rays and have your staples or sutures removed. Physical therapy will continue for 6-12 weeks after surgery, but may take longer. Full recovery usually occurs between 3 and 6 months after surgery, but can take up to one year.