Anyone who has arthritis of the hip knows that the pain can be debilitating. Many times, non-operative measures, such as anti-inflammatory medications and low-impact exercise, can be helpful. However, when your quality of life is diminished due to constant severe pain in the hip joint, it may be time to consult with a physician about your options. One of those options is often a hip replacement, one of the most predictably successful surgeries available today.
I've been replacing painful joints for patients in Coweta and Fayette counties for over 20 years and have performed hundreds of hip replacements. Yet, about a year ago, I changed the way I go about hip replacement surgery. Why would I change something that’s been working for years? Because a new approach creates a better experience for my patients.
You may have heard about anterior hip replacements in the news. In the past few years, I have traveled to various training centers throughout the United States to receive specific training in this new approach. Over the past year, I have been able to transition to the direct anterior approach to the hip as my preferred approach.
The great benefit about the anterior approach to a hip replacement is that it is generally less invasive for the patient than more traditional approaches. The incision is generally not much wider than the width of one’s hand. Through this new approach, surgeons are able to replace the painful hip through a natural space between certain muscles on the front of the hip. The muscles are not split or fully detached as is commonly done in other approaches to the hip. In my experience, my patients have encountered much less postoperative discomfort and have enjoyed a quicker return to normal activity.
Another great advantage to this innovative approach is that the hip is much more stable. Preserving the short rotator muscles of the hip greatly enhances the stability of the hip and greatly decreases the chance of dislocation after surgery. In fact, the risk of dislocation is felt to be less than 1% and postoperative range of motion restrictions are felt to be unnecessary. It is quite possible to walk the day of surgery. It is common for patients to go home after a 1 or 2 day stay in the hospital. I would not be surprised if we are able to offer this procedure on an outpatient basis in the near future.
The implants available for this procedure have continued to improve to the point that, for most people, we can offer a hip replacement that is likely to last for the rest of their lives. The breakthrough in recent years has been the plastic used in the implants. The plastic is now treated in a way that greatly increases its durability. In fact, these technological advances allow younger patients to have the procedure, knowing that they have an excellent chance of 20 or more years of pain-free function of the hip.
Candidates for surgery are patients that have exhausted conservative measures to control the pain from hip arthritis. As the cartilage of the ball and socket joint of the hip wears out with progression of arthritis, pain increases as the underlying bone structure becomes stressed and the joint lining becomes inflamed. Typically, my patients come to me when the hip pain interferes with their lifestyle. Common statements are: “I can’t play golf like I would like”, “I can’t go for walk in the neighborhood with my spouse”, “the pain wakes me up at night” and “I think twice about vacations or seeing my grandchildren”.
Hip replacement patients can expect to get back to very active lifestyles. Many patients return to vigorous walking and hiking. Golfers and tennis players can return to those activities. Many of my patients return to the gym and get back on the elliptical trainer, treadmill or stair climber with great success.
Total hip replacement is one of the great success stories in medicine. In fact, knee and hip replacement are considered to be two of the most successful surgeries done today. Hip replacement through the direct anterior approach builds upon that success. Enthusiasm for the anterior approach continues to grow, and I am excited to be able to provide this service to our community. This procedure perfectly reflects my philosophy of orthopedic care, which includes the sports medicine principles of less invasive surgery, rapid recovery and restoration of function to both the aging athlete and non-athlete. It has been exciting to implement this new approach, and I look forward to continued advancements in this improving area of orthopedics.