Don’t schedule this procedure until you read about the latest advances
If you suffer from hip pain due to arthritis or some other condition that damages the joints, you may at some point find yourself among the roughly 200,000 adults in the US who opt for a hip replacement each year. This procedure is considered only when other options, such as pain medications, physical therapy and/or the use of a cane or walker, don’t provide adequate relief.
Before you or a loved one contemplates a hip replacement: Be sure you’re well-informed about several recent advances that can help give you the best possible results…*
IS MINIMALLY INVASIVE BETTER?
Most people who are considering hip replacement now assume that minimally invasive surgery, which is reported to cause less pain and allow faster recovery than a traditional operation, is preferable.
With a minimally invasive procedure, the surgeon uses special instruments and one or two incisions (one to six inches long) rather than the one 10- to 12-inch incision most commonly used in the past. It’s logical to think that a large incision causes more discomfort than a smaller one. It’s not true, however, that hip-replacement patients who undergo minimally invasive procedures automatically do better.
Latest thinking: Studies comparing minimally invasive with traditional hip-replacement procedures have failed to show that one approach is consistently superior to the other. Researchers speculate that other factors, including the choice of painkillers and the type of physical therapy used after surgery, make a bigger difference.
People who are relatively lean are generally the best candidates for a minimally invasive approach… obese patients often require a larger incision because subcutaneous fat makes it difficult for the surgeon to see within the joint. Regardless of the size of the incision, most patients leave the hospital in roughly the same amount of time — minimally invasive, two to three days… and traditional, three to five days. Those who are relatively fit usually resume most of their normal activities within four to six weeks. Older or frailer patients might take three months or more to fully recover.
As the materials used in hip replacements have become more durable — and now that a significant amount of time has passed since the earliest surgeries — it appears that many artificial joints can last the rest of a person’s life (20 or more years). In the past, artificial joints generally lasted no more than 10 to 15 years.
In the past, there also was greater concern that vigorous activities and movements could cause the artificial ball to pop loose (dislocate) from the artificial socket — the main complication of hip replacement and a common reason that patients sometimes require a second or even third operation.
Now: Dislocations are rare. At one time, about 3% of patients who had hip replacement would eventually suffer a dislocation. Now, only about 1% do. Here’s why…
Bigger ball joints. The size of the ball joint has increased from about an inch to an inch and a half in diameter. The larger surface area creates a bigger jump distance — how far the hip can move without the risk that the ball will “jump” from the socket.
New procedure: With anterior hip replacement, the surgeon makes an incision on the front of the hip rather than on the side (lateral) or back (posterior). Studies show that patients who have this type of surgery are only about half as likely to suffer a dislocation as those who don’t.
However, the anterior procedure can have a higher risk for other complications, such as nerve injuries or bone fractures. It’s possible that surgeons haven’t yet developed the expertise that they have with older procedures. More research must be done before we will know whether the anterior approach is better than other techniques.
Movement. In the past, people undergoing hip replacement were told to avoid putting pressure on the joint for up to six weeks after surgery.
Now: Patients are encouraged to stand up and bear as much of their weight as they would by walking within just a few hours of leaving the recovery room.
Resuming activity soon after surgery reduces the risk for potentially deadly blood clots, one of the most dangerous complications. A Swedish study showed that double the number of patients on a fast-track rehabilitation protocol felt well at three months after surgery.
Better pain relief. A decade ago, patients who had undergone hip replacement were given oral and intramuscular narcotics for pain.
Now: More potent combinations of drugs, including slow-release oxycodone (OxyContin) to control pain… and injections or pills of advanced anti-inflammatory drugs — such as ketorolac (Toradol) or celecoxib (Celebrex) — to reduce inflammation, are typically used.
Quicker physical therapy. With hip replacement, physical therapy has traditionally begun the day after surgery. Patients weren’t discharged from the hospital until they could perform certain movements, such as a straight-leg raise or getting in and out of bed without help.
Now: The same type of physical therapy is used, but it’s often started within four hours of leaving the recovery room. A study reported in the Journal of Arthroplasty found that joint-replacement patients who received modified anesthesia and painkillers and quickly started physical therapy were able to complete straight-leg raises in eight hours, compared with 73 hours for those following older protocols.
Quick Facts: Hip Replacement
Most people who undergo a hip replacement are over age 60. That’s when the main reasons for the procedure, including hip pain caused by osteoarthritis or a broken hip due to a fall, are most likely to occur.
During a hip replacement, the surgeon removes damaged bone, then presses or cements an artificial hip socket into place. A metal stem with a ball on top is inserted into the top of the thigh bone. The ball is then fitted snugly into the socket. Most artificial hip joints last 20 or more years.