As we get older, we want to be active and live full lives. Joint pain, however, can interfere with simple everyday activities such as sleeping, standing up and walking.
When hip pain interferes with everyday life and decreases mobility, it’s time to consider treatment. If medicine or therapy no longer help with chronic pain, total hip replacement might be an option.
With hip replacement, the orthopedic surgeon removes the damaged area of the hip joint and replaces it with an artificial joint. This is done using a posterior or anterior approach.
The anterior approach goes between muscles, which avoids cutting or splitting muscle tissue. Also avoided is cutting through soft tissue and structural parts of the posterior, such as tendons. It’s a more stable approach with less post-operative pain, usually faster recovery time and rehabilitation, and more mobility.
It’s a great approach and is my favorite way to replace hips. If I have an otherwise healthy, active, mobile and energetic individual with a relatively normal body size, I will take the anterior approach almost every time. I learned the procedure and performed numerous surgeries during an adult reconstruction fellowship at Wake Forest Baptist Medical Center in Winston-Salem, N.C., before joining Mercy Clinic Orthopedics in Joplin.
The anterior approach isn’t available for all hip-replacement candidates and can be influenced by a person’s body build around and below the abdomen. In those cases, it may be safer for a posterior approach.
Why consider surgery?
A hip is made of two basic parts that move and work together to ensure smooth motion and function. The ball-and-socket joint is comprised of the thigh bone, which has a rounded shape like a ball that fits into a bowl-shaped depression (socket) in the pelvis.
Hip pain is caused for a variety of reasons:
- Osteoarthritis, a degenerative process where the cartilage wears away over time.
- Medical conditions such as rheumatoid arthritis that cause joint inflammation and can speed up cartilage loss. As cartilage disappears, causing bone to rub against bone, the result can be pain, stiffness and swelling.
- Damage from injuries such as a hip fracture from falls or other trauma.
- Developmental conditions that can affect the hip anatomy and result in a malformed hip joint known as hip dysplasia, which can predispose patients to early arthritis.
Hip-replacement candidates typically are referred from primary care after conservative management methods don’t improve the condition. This includes anti-inflammatory medications, rest and activity modification.
A typical patient complaint is the inability to bend to put on socks and shoes. Anterior pain is in the groin area and down the leg, but not past the knee. Pain on the side or back of the hip usually is another problem.
The orthopedic surgeon will verify the condition by matching symptoms with X-ray and exam findings. If conservative treatment isn’t making enough of an improvement after a reasonable amount of time, surgery is an option. The only person who ultimately can make that decision is the patient.
From surgery to recovery
Total hip replacement surgery involves replacing the hip joint with a joint made of metal, plastic or ceramic materials, which are very strong and designed to last a long time. The surgeon will consider factors such as age, bone density and joint shape to determine which type of artificial hip and procedure are best for the patient.
Most hip replacement surgeries last about 1½ to two hours and most often result in a hospital stay of one to two days. It’s important to participate in therapy while in the hospital and after discharge as mobility helps reduce the risk of blood clots.
While full recovery time can take as long as three months, patients who have a hip replacement tend to recover a little faster with the anterior approach and typically see more improvement in the first four to six weeks. While the chance of dislocation is small with artificial hips, it’s even less likely using the anterior approach.
Ninety percent of hip replacement patients and 85 percent of knee replacement patients say they’re satisfied with their new joint and notice improvement right away. About 2.5 million people in the U.S. live with artificial hips.