HIP REPLACEMENT SURGERY

anterior approach comparisonHip Replacement Surgery is a highly successful surgery that is recommended for patients with severe arthritis of the hip joint and have pain and discomfort that significantly impacts daily life. Hip arthritis typically occurs in adults aged 45 and older, when the cartilage that cushions the joint breaks down and eventually wears away. Characterized by pain and stiffness, severe cases can be profoundly debilitating.

If conservative treatments for hip joint pain fail to bring relief; if pain is impacting normal daily functioning and the ability to get a good night’s sleep, total hip replacement surgery (arthroplasty) may be recommended.

PROCEDURE

Surgeons approach the joint through an incision at the buttocks (posterior), the side of the leg  (lateral) or through the front of the thigh (anterior). Many factors are considered when determining which approach is most appropriate for an individual patient. The surgery can often be safely performed under spinal anesthesia. However, minimal general anesthesia medication may be administered in consideration of a patient’s individual condition. 

During surgery, the surgeon removes damaged cartilage and bone, and implants the new prosthesis to reconstruct the joint. The artificial joint has three main components: the socket (typically made of a metal alloy with a plastic insert), the ball (which is typically made of ceramic), and a metal stem which is implanted into the upper portion of the femur and keeps the ball securely attached to the femur

The surfaces of the metal stem and socket are specially processed to encourage surrounding bone growth into and onto the metal. This provides long-term stability of the implants. For some older patients with osteopenia or osteoporosis, the surgeon may use a special bone cement to attach the stem to the femur bone.

The plastic insert is a high-density, highly cross-linked polyethylene. The plastic is estimated to last more than 20 years.

Anterior Hip Replacement

Anterior hip replacement is a technique to replace worn ends of the bones in the hip joint. Anterior hip replacement differs from a later or posterior hip replacement procedure in that it requires a minimal incision in the front of the hip. The surgeon then accesses the damaged joint through the natural spaces between the muscles and tendons.  For some patients, recovery from this approach is quicker and less painful than from surgeries using other approaches that require the muscles and surrounding soft tissue to be surgically detached.

What is Right for You?

Anterior hip replacement is not appropriate for all patients and, as with any surgery. Ideal candidates for this procedure are slender in build and motivated to follow a pre- and post-operative conditioning program. This procedure is not recommended for people with brittle bones or those who are obese or extremely muscular because the excess soft tissue decreases the space in the front of the hip.

Some patients may be good candidates for a same-day outpatient anterior hip procedure, which allows them to begin recovery in the comfort and safety of home.

What Are the Benefits of Anterior Hip Replacement?

In other hip replacement procedures, surgeons replace the damaged hip cartilage and bone with a prosthesis through an incision in the back (posterior) or the side (lateral) of the hip. In both of these procedures, surrounding muscles need to be cut or detached from the bone to provide access to the joint and then repaired at the end of the procedure. With anterior hip replacement surgery, the front of the hip has fewer and smaller muscles, enabling surgeons to use a small incision and work through the spaces between them.

Since anterior hip replacement surgery does not disrupt the surrounding muscles or soft tissues, patients have fewer postoperative restrictions and are often able to go home on the same day of the procedure. Patients are typically walking with crutches or a walker on the same day as the procedure and usually are able to walk unassisted five to seven days earlier than patients who have had a procedure using the lateral or posterior approach.

What Are the Limits and Risks of Anterior Hip Replacement?

Any successful hip replacement surgery depends on many factors beyond surgical approach, including the surgeon’s training and skill, the patient’s overall health and fitness, and the patient’s level of commitment to pre-surgical conditioning and post-surgical rehabilitation.

The anterior hip replacement procedure requires a high level of training and precision because surgeons are working with a restricted view of the hip joint. With the anterior approach, the surgical area is near the lateral cutaneous femoral nerve, which extends from the front of the pelvis to provide sensation to the outer thigh. If the nerve is affected during surgery, the thigh could become numb and, in rare cases (less than 1%), patients develop a painful skin condition.

Individuals considering hip replacement surgery should consult with a hip replacement specialist to understand which approach is best suited for his or her personal circumstances and lifestyle goals.

Hip Revision Surgery

Surgeons perform hip revision surgery to repair an artificial hip joint that has become damaged through normal wear and tear or from infection. Most artificial hip joints last between 10 – 15 years.

Over time, the implant may not fit as securely to the bone, causing pain from abnormal motion.  In some cases, infection to the muscle, tendon and ligament tissues will cause the joint to weaken. Infection can also damage the hip bone.

Pain relief is the primary reason for hip revision surgery. However, it can also improve mobility, strength, and coordination in the torso and leg.