Making the decision to have a total joint replacement is a life-changing decision for all involved. In the past 40 years, millions of people have suffered from arthritic hip pain and experienced relief and restored mobility through total hip replacement. Most patients report that pain experienced after surgery pales in comparison to the pain they were living with on a daily basis.
Hip replacement surgery, or hip arthroplasty, provides pain relief and restores movement to people who have hip pain or stiffness.
Most hip replacements are performed to remedy hip arthritis. This is where cartilage between the bones of the hip joint wears down. The bones then scrape together, causing more damage, as well as pain and stiffness. Arthritis of the hip can make it painful for a person to walk or even to get in or out of a chair.
Hip replacement surgery is also used to fix injuries such as bone breaks, hips that grow incorrectly, and other conditions. An athlete with a hip impingement may get a hip replacement to continue playing a sport. Most people who get a hip replacement have these symptoms:
- Severe pain that gets in the way of their work and everyday activities
- Pain that is not relieved by taking anti-inflammatory medications, or by using canes or walkers
- Stiffness in the hip that slows them down
Hip Joint Anatomy
The hip joint is a ball-and-socket joint. The ball, at the top of the femur (thighbone) is called the femoral head. The socket, called the acetabulum, is a part of the pelvis. The ball rotates in the socket, allowing the leg to move forward, backward, and sideways.
Soft tissue called cartilage covers the ball and the socket to help them glide together smoothly. If this cartilage wears down or gets damaged, the bones scrape together and become rough. This causes pain and can make it difficult to move the leg.
Our philosophy is to partner with our patients to help them claim victory over their condition or injury. The first step when making the decision about a hip replacement is for the patient to schedule an appointment with us to see if they are a candidate for total hip arthroplasty. During the initial visit, we take the patient’s medical history, perform a physical examination, and x-ray the hip.
Even if the pain is significant and the x-rays show advanced arthritis of the joint, the first line of treatment is nearly always non-operative. This may include weight loss if appropriate, modifying certain activities, medication, or injections. If the symptoms persist despite these measures, then we recommend that the patient consider a total hip replacement.
The decision to move forward with surgery is not always straight forward and usually involves a thoughtful conversation between our surgeons, the patient, and their loved ones. The final decision rests with the patient based on how limited they are by hip pain. We often tell patients that when they have tried non-operative measures, but continue to have to order their lives around what their hip pain will allow them to do, it is time to consider hip replacement.
Types of Hip Replacement Surgeries
The most common type of hip replacement surgery is called a total hip replacement. In this surgery, worn-out or damaged sections of the hip are replaced with artificial implants. The socket is replaced with a titanium metal shell and a ceramic or plastic liner. The ball and a section of the upper femur are removed. A new ball, made from a metal alloy, is attached to a metal stem that is inserted into the top of the femur. To begin the operation, the hip replacement surgeon will make incisions (cuts) on the back or side of the hip, or on the front of the thigh.
Accessing the hip joint from the front of the thigh is called the anterior approach. Anterior hip replacement surgery does not require the surgeon to cut the thigh muscle. For this reason, it can reduce pain and offer even shorter recovery times. However, it requires special tools and training, and is not suitable for all patients.
Direct Superior Total Hip Arthroplasty
The Direct Superior approach is the latest of these and may be more muscle sparing than the direct anterior approach that became popular again a few years ago. We have also refined our physical therapy protocols and the way we manage post-operative pain. All of these measures allow patients to get back on their feet and back to the activities that they enjoy more quickly.
Posterior Total Hip Arthroplasty
Accessing the hip joint from the back of the hip is called the posterior approach. This is the most common method used in the United States.
How Long Does A Hip Replacement Last?
On average, a total joint replacement lasts approximately 15-20 years. However, a more accurate way to think about longevity is via the annual failure rates. Most current data suggests hip replacements have an annual failure rate between 0.5-1.0%. This means that if a patient has a total joint replaced today, they have at least a 90-95% chance that joint will last 10 years, and a better than 80-85% that it will last 20 years.
With continual improvements in technology, these numbers will likely improve. Despite such improvement, we communicate to all our total hip replacement replacements that it is important for them to maintain long-term follow-up with their surgeon to assure their replacement is functioning appropriately.