Total Hip Replacement (Arthroplasty)
More than 300,000 total hip replacements are performed in the U.S. each year. That number is expected to increase to 500,000 by the year 2030. The hip and knee replacement specialists at Orthopaedics at Rogers Park Surgery perform more of these procedures than any other group in the Chicago area.
Total hip replacement (arthroplasty) is performed when the hip is causing significant pain, a compromised lifestyle and has deteriorated past the point where more conservative procedures might be effective.
During the procedure, the surgeon removes the damaged cartilage along with some bone and replaces this with an artificial hip joint (prosthesis). The prosthesis consists of two parts; a round ball (femoral head – secured into the center of the upper femur with a stem), which rests in the cup-like acetabular component (socket) placed in the pelvis.
Total Hip Replacement Overview (video length 1:49 min)
Common Causes of Hip Pain
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
- Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
- Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed “inflammatory arthritis.”
- Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
- Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis (also commonly referred to as “osteonecrosis”). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.
- Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
WHO IS A CANDIDATE?
Ninety percent of the hip replacement patients have osteoarthritis. This occurs when the cartilage that lines the hip’s ball-and-socket joint deteriorates, often due to progressive wear-and-tear. As healthy cartilage deteriorates, the bone rubs against bone, which causes pain.
The remaining ten percent of patients require hip replacements due to other types of arthritis, bone tumors, trauma and other conditions, such as osteonecrosis.
Children are not candidates for hip replacements because their bones are still growing. While doctors recommend children wait until age 18, occasionally younger individuals may require hip replacement.
WHAT ARE THE DIFFERENT WAYS TO PERFORM A TOTAL HIP REPLACEMENT?
As part of a hip replacement surgery, a surgeon will need to access the hip joint to replace the ball and socket. There have been many different surgical approaches described for accessing the hip joint and surgeons use different surgical approaches based on their own experience and preferences.
Basically, there are two ways of performing hip replacements – via the posterior and anterior approach. The posterior approach involves entering the hip socket from the back (posterior) of the hip area. During the anterior approach to surgery, the doctor enters through the front of the hip area.
There are advantages and disadvantages to both approaches. However, the most important aspect of a surgical approach to the hip is that it allows the surgeon to safely insert the hip components so that a hip replacement will function well for a long time.
Anterior Approach to the Hip
While popular recently, the anterior approach to hip replacement has been used by qualified surgeons for many years. The main advantage to the anterior approach to hip replacement is that it results in a smaller incision scar and carries a lower risk of dislocation (the hip popping out of the socket). The main disadvantages are a higher risk of damaging the muscles that stabilize the hip joint, which can lead to a limp, and the possibility of a patch of numbness on the thigh. When performed by a skilled surgeon, this approach is compatible with a rapid recovery.
Posterior Approaches to the Hip
The posterior approach is the one used most commonly by surgeons in North America. The main advantages are its simplicity and a lower risk of damaging the muscles that stabilize the hip joint. Its main disadvantage is that it carries a higher risk of dislocation. When performed by a skilled surgeon, this approach is compatible with a rapid recovery
Much of this material may be confusing and it can be controversial among surgeons. All of the Orthopaedics surgeons at Rogers Park Surgery Center have the experience and skill to allow for a rapid and safe recovery with as little pain as possible. They have performed thousands of hip replacements, have trained hundreds of other joint replacement surgeons from across the country and are experts in these procedures.
To determine which approach is best, patients should discuss this issue with their doctor.
Deciding to Have Hip Replacement Surgery
Talk With Your Doctor at Rogers Park Surgery Center. Call us today at 773-761-0500 or contact us online to schedule your appointment.
Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.
In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, hip replacements can last for many years.
Preparing for Surgery
If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.
Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.
Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.
If you live alone, your orthopaedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:
- Securely fastened safety bars or handrails in your shower or bath
- Secure handrails along all stairways
- A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
- A raised toilet seat
- A stable shower bench or chair for bathing
- A long-handled sponge and shower hose
- A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
- A reacher that will allow you to grab objects without excessive bending of your hips
- Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
- Removal of all loose carpets and electrical cords from the areas where you walk in your home
You will most likely be admitted to Rogers Park Surgery Center early in the morning on the day of your surgery.
After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.
Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic or metal, which may have an outer metal shell).
The prosthetic components may be “press fit” into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on a number of factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.
Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.