Hip replacement technology is considered by many to be one of the top medical marvels of the last century, with phenomenal patient satisfaction rates and continued technological improvements to this day. It involves taking a hip joint that is worn out from arthritis or other degenerative condition and resurfacing the socket and replacing the head creating a new joint. This predictably relieves the deep pain in the hip with very low complication rates in the vast majority of patients.
The parts used to replace the hip involve the use of a stem into the femur with a metal or ceramic ball and a plastic lined shell into the socket of the pelvis. The materials used in hip replacements have evolved to have very low wear rates with the majority of them doing well even after 20 or more years. The plastic technology has improved over the past decade and given the even lower wear rates, we anticipate them to last longer than ever. There are five major manufacturers for these implants and dozens of smaller ones. Most implants currently used have very good long term success rates, but there may be subtle differences that may be desirable when considering patient specific needs. The surgeons at Florida Joint Care Institute have an extensive knowledge of the implants and materials available and can help patients to understand which one may be most appropriate.
Hip replacement surgery is performed typically through one of three surgical approaches – the posterolateral approach (PL), the anterolateral approach (AL), and the direct anterior approach (DA). All of these approaches are perfectly appropriate ways of replacing a hip, but there may be specific benefits of one over another depending upon patient specific factors. All of the surgeons at Florida Joint Care Institute are well trained in the utilization of these different approaches.
The posterolateral approach (PL) has been used for decades and considered by many to be the historical gold standard, as it offers the best visualization of bony anatomy, and is almost always used for revision surgeries. It involves an incision on the side or slightly to the back side of the hip, with detachment of some of the short muscles in the back of the hip. With proper component placement and repair of these muscles, it offers very good success rates.
The anterolateral approach (AL) has also been used for decades and involves an incision on the side of the hip, with detachment of a portion of the muscle in the front of the hip. With proper component placement and repair of this muscle, it likely offers decreased dislocation rates to 1% or less compared to the PL approach.
The direct anterior approach (DA) has been popularized because of the ability to replace the hip through the front without detaching or cutting through any major muscles about the hip. This is usually performed using a specialized table to facilitate the exposure and proper placement of components. The advantage of this approach is the accelerated recovery after surgery and it also has demonstrated an extremely low dislocation rate being a fraction of 1%.
All hip replacement surgeries require careful planning. This begins from the moment a patient is seen in consultation. There are many health factors that are taken into consideration before surgery in order to minimize the chance of complications and improve outcomes. There are often medical conditions that require further treatment by an internist or specialist prior to surgery. We believe that a comprehensive approach to patient care is the best way to achieve a healthy and functional recovery.
The surgeons at Florida Joint Care Institute use cutting edge digital X-rays calibrated to each patient as well as specialized computer software to plan the surgery. This ensures appropriate component selection to match each patient’s anatomy and that the leg lengths are calculated to restore normal alignment and length which may have been altered from the degenerative joint disease. During the surgery there is additional instrumentation that measures anatomy directly to ensure sizing is exact. There is no more precise way to measure size and restore anatomy than planning the surgery appropriately and verifying using this direct technology during the operation.
Rehabilitation after surgery reflects the extensive planning given to each patient’s surgery. The majority of patients will start physical therapy to stand or even walk the same day of surgery. This improves early functional recovery and lowers the risks of blood clots from forming. All patients recover in a private room and work with the orthopaedic and nursing teams within the joint care program. Most patients are able to walk and transfer independently by the second or third day after surgery and many patients are discharged home with a home visiting nurse and therapist to perform visits for the first few weeks after surgery. If additional needs are required, a patient may elect to go to a rehabilitation facility to work aggressively with physical therapy until enough independence is reached to be discharged home.
Recovery occurs as a stepwise process. Within the first few weeks, independence is reached and patients progress away from a walker and cane. 75% of the recovery occurs within the first six weeks. The last 25% occurs in the subsequent couple of months as strength improves. The vast majority of recovery is therefore completed within four months of surgery, but endurance will continue to improve as activities are resumed.
Although hip replacement technology has been refined over several decades, and outcomes are better than ever, there are unique risks inherent to the operation. With careful planning these risks are minimized but it is important to have this discussion with your surgeon prior to the operation to be appropriately informed. By understanding these risks and expectations of benefits, our patients are able to achieve the best outcomes possible.