• Hip Replacement

    Total Hip Replacement

    Total hip replacement or total hip arthroplasty is perhaps one of the most successful orthopedic surgery procedures in modern practice. In the United States, more than a quarter of a million total hip replacement procedures are performed each year. Total hip replacement can eliminate hip pain, restore the ability to bend and walk, and substantially improve a person’s quality of life.

    For the procedure to be effective, however, one needs to find a competent total hip replacement doctor. New York City is home to many good hip pain doctors. In fact, Regional Orthopedics boasts some of the best total hip replacement surgeons in New York City, Staten Island, and Jersey City.

    Anatomy of the Hip

    The hip joint is a “ball-and-socket” joint, which means the “ball” of the upper leg (femur) fits into the “socket” of the pelvis. Under normal circumstances, the femoral head (“ball”) is free to move in any number of ways within the socket (acetabulum). The hip joint allows a person to lift the knee nearly to the chest and rotate the foot inward and outward. The joint operates smoothly because the surfaces are covered by cartilage and a cushion called a labrum. It is also held tightly in place by surrounding ligaments and tendons.

    Over time, however, the joint surfaces can break down, leading to chronic hip pain. Doctors in New York have estimated the prevalence of hip pain as high as 15% in adults in NYC and the surrounding areas such as Staten Island and Jersey City.

    Symptoms and Causes of Hip Pain

    Many conditions cause hip pain. The most common causes of hip pain include:

    • Osteoarthritis – Age-related breakdown of the joint surfaces, allowing the “ball” to grind against the “socket.”
    • Rheumatoid arthritis – Chronic inflammatory condition that can affect the hip joint.
    • Posttraumatic arthritis – Arthritis that occurs after an injury to the hip, either a single major injury or several less intense injuries.
    • Avascular necrosis – Blood does not reach the upper leg bone, causing the bone tissue to die.
    • Bursitis – Caused by an inflamed fluid-filled sac (bursa) in the hip.

    Your hip pain doctor or total hip replacement surgeon will take a thorough history, perform a physical examination, and order radiological studies to determine the precise cause of your hip pain.

    Am I a Candidate for Hip Replacement Surgery?

    Anyone with substantial hip pain and disability is a potential candidate for hip replacement surgery. This usually means hip pain or stiffness limits your ability to walk or bend, and more conservative hip pain treatments have failed to provide adequate relief. Your total hip replacement surgeon in New York City, Staten Island, or Jersey City will perform an evaluation to determine if you are eligible for hip replacement surgery.

    How to Prepare for Hip Replacement Surgery

    Your total hip replacement surgeon will perform the procedure when you are under general anesthesia. The procedure will take about three hours, and you will most likely need to stay in the hospital for at least a day or two after the procedure.

    Hip replacement surgery is a major surgery, so you will be given pain-relieving medications to help you manage pain during recovery. You will also participate in physical therapy to help regain your strength and mobility after surgery.

    How is Total Hip Replacement Surgery Performed?

    Prior to surgery, your total hip replacement doctor will provide you with a list of ways you can prepare for surgery. The process starts by having a medical evaluation in which your overall health will be assessed. You may need several blood tests, radiological studies, and an electrocardiogram. You may need to stop certain medications prior to surgery, but most should be continued.

    Remember to speak with your total hip replacement surgeon about your medications prior to surgery. Likewise, you may (or may not) be asked to “donate” your own blood to be infused during your procedure. Lastly, you should have a plan in place that serves your needs after hip replacement surgery. Specifically, you should have the appropriate help from caregivers and loved ones during your recovery.

    What to Expect From Hip Replacement Surgery

    Total hip replacement involves the surgical implantation of synthetic materials that are engineered to replace the ball and socket joint. The femoral head (ball) is replaced with an artificial substitute. This is achieved by removing the damages femoral head by making a surgical cut in the femoral neck (where the ball meets the main portion of the femur bone).

    With the femoral head removed, the interior of the femur bone is prepared to accept a femoral implant which will assume a position inside the femur bone. This main portion of the femoral implant which is designed to bond with the skeleton has a terminal point which is engineered to mate with a femoral head. The femoral stem mated with the femoral head becomes the reconstructed proximal femur.

    To reconstruct the socket, the labrum is removed and the interior of the socket is surgically prepared to accept a metal implant (acetabular shell). The acetabular shell is designed to bond to the pelvis. There is then a modular liner which is engaged into the shell and has a locking mechanism. The acetabular shell with the engaged liner is the reconstructed socket. The reconstructed joint, ball, and socket – together is called a total hip replacement.

    Total Hip Replacement Bearing Surface

    There are many different manufactured brands of total hip replacement systems. They vary in terms of their engineering as it relates to shape of the implants, tolerance and size, materials and composition as well as skeletal preparation methods.

    The ‘bearing surface’ which is the interface between the ball and socket and relates to the materials used and size also is a point of variation. Cobalt chrome is a common metal alloy used to manufacture the femoral head and this can is often mated with a polyethylene acetabular insert. This interface of cobalt chrome and polyethylene becomes the bearing surface. Cobalt chrome paired with highly cross-linked polyethylene is a standard bearing. Other metals with less abrasive properties, such as oxinium, can be paired with a highly cross-linked plastic. This achieves better wear properties and potential improved durability of the bearing.

    Another type of bearing surface is ceramic. Ceramic surfaces can be paired together achieving a ‘hard on hard’ interface or can be paired with polyethylene. Ceramic femoral heads paired with a highly cross-linked polyethylene surface is a common ‘hybrid bearing’ which has beneficial features of ceramic with some potential disadvantages of ceramic eliminated by cross pairing it.

    Metal on metal is another type of bearing surface. This is also a ‘hard on hard’ bearing with some potential advantages of reduced wear however potential disadvantages related to metal ion generation and metal hypersensitivity. There are potential relative advantages and disadvantages of all hip systems compared to others and the proper selection of a hip implant system should take into account a variety of factors that are client centered.

    Total Hip Replacement Surgical Technique

    There are a variety of different surgical approaches to total hip replacement surgery.

    Posterior Approach

    The posterior or ‘southern’ approach is a traditional approach to hip arthroplasty. This places the incision over the buttocks and lateral side of the hip. The size of the incision is variable and depends on a number of factors not least of which is the size of the patient.

    The approach uses natural muscle planes to reach the short external rotators which insert on the posterior aspect of the greater trochanter. These short rotators are then surgically taken off the bone to expose the posterior hip capsule which is then opened to access the joint. The benefits of this approach is that it affords excellent surgical exposure of the hip which is critical for achieving the critical goal of preparing the skeleton and placing the implants in proper alignment and orientation with appropriate sizing and tolerance to achieve skeletal union to the implant.

    Improperly aligned or incorrectly sized implants can lead to a poor outcome with early failure and revision. In addition, this approach is extensile meaning that it can be easily extended to expose more of the hip and femur if complications are encountered during the procedure such as femur or acetabular fracture. Also, in the event the implants require revision at any point in time the posterior approach is a typical approach for revision procedures whereby the same surgical incision and approach can be utilized.

    The location of the incision on the buttocks and side of the hip also allows for an easier recovery to the extent that sitting does not crease the incision and lying on the back or unaffected side also does not compress or stress the incision.

    Anterior Approach

    This is in contradistinction to the anterior approach to the hip. This is a recently popularized approach and is marketed as having the advantages of being an approach that facilitates a quicker recovery based on the ability to avoid fully releasing the short external rotators which are removed and repaired in the posterior approach.

    The studies currently published looking at this question seem to suggest that on average the recovery time of the anterior approach is accelerated in the first few weeks following the procedure, however, the benefit no longer exists by approximately 6 weeks. The potential disadvantages are the location of the incision.
    Because of its location over the front of the hip in the crease of the skin, it increases the potential for wound healing complications.

    In addition, the vascular supply to the hip is largely from anterior vessels as branches of the femoral artery, which is also in close proximity to the surgical dissections, and these arterial branches can lead to excessive bleeding which has the potential to increase the risk of a variety of complications including surgical site infection.

    This approach is not extensile and can present a problem if complications are encountered during the procedure and more visibility is required. The revision implants, such as long femoral stems, are not often able to be achieved through this approach necessitating an additional posterior surgical dissection.
    At Regional Orthopedics we recommend the posterior approach as a safe and effective method for performing this procedure. We believe that the anterior approach to the hip, although it may offer an early advantage of quicker recovery, this benefit is absent by weeks 4-6 and the potential advantage is outweighed by the potential disadvantages associated with the approach.

    Recovery and Results from Hip Replacement Surgery

    Recovery from hip replacement surgery may take up to six weeks or more, so it is essential to follow the recommendations provided by your total hip replacement doctor. These recommendations will include ways to properly care for your surgical wound, what foods to eat to help with healing, and the appropriate amount of activity to make sure you are building strength and flexibility.

    Once you have recovered, you will most likely be free of pain and have excellent range of motion in your hip. Over 90% of people who undergo total hip replacement surgery are pain-free and have no long-term complications for 10 to 15 years after the procedure. In fact, some people continue to enjoy their hip replacement without further incident for a quarter of a century or more. Indeed, most people are extremely satisfied with the total hip replacement surgery.

    If you are considering this life-changing procedure, contact Regional Orthopedic to speak with a total hip replacement surgeon in New York City, Staten Island, or Jersey City.