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The Latest Developments in Hip Replacement Surgery

Typically, the most common reasons for hip replacement surgery include constant pain due to arthritis or serious injury to the joint. When medication and lifestyle changes aren’t enough to manage the pain, surgery is often the best option.

A total hip implant is made of three parts: the stem, the ball and the cup. These three parts duplicate the natural hip joint, which is a ball and socket at the end of the long thighbone. The stems of most replacement joints are made of titanium or chromium-based alloys. The ball is made of cobalt/chromium alloys or ceramic materials, which are polished to ensure smooth movement within the socket. The socket is typically made of metal, polyethylene or a combination of the two.

There are many types, sizes and manufacturers of hip implants. The type your doctor chooses depends on your age, weight, bone quality, health status, activity level and your doctor’s preference. 

In the last 40 years, hip replacement technique has seen a great deal of refinement and success. Today, patients can expect an 80 percent chance of a hip replacement lasting for 20 years. People who weigh less than 165 pounds are most likely to have replacements that last the longest.

Over time, the implants can suffer from wear and tear just as the original joint did. When that happens, a second replacement surgery is often the best option.

The traditional replacement
In traditional hip replacement, the surgeon makes an 8- to10-inch incision through leg muscles and tissue to gain access to the hip joint. Patients usually spend 3 to 5 days in the hospital and 6 to 8 weeks on crutches.

These operations have improved the quality of life for many patients, and are still sometimes the best option. But today, many orthopedic surgeons are offering newer, less invasive hip replacement. These are called “minimally invasive” procedures.

Minimally invasive hip replacement
Minimally invasive hip replacement surgery involves smaller incisions, less muscle and tissue, shorter hospital stays, quicker recovery and less pain. There are currently two types, the mini-hip surgery, which has become popular in the last few years, and two-incision surgery, which is still being studied and is gradually being offered in more hospitals throughout the country.

Mini-hip surgery: One 3- to 4-inch incision is made. Surgeons cut through less muscle and tissue, so recovery time is faster and pain is decreased. Patients generally stay in the hospital for 2 to 3 days.

Two-incision surgery: Surgeons make two incisions, typically a 1½-inch one in the buttock and a 2-inch one in the groin. Muscle does not have to be cut. These procedures are currently only being performed on patients who are under 60 years old, have active lifestyles and are motivated to get better quickly. These patients usually go home the day of the surgery or the day after, and they can often walk with a cane in about six days. 

There are some drawbacks to the minimally invasive procedures. For one thing, they’re harder to perform. Surgeons need additional training before they’re qualified to perform them. And not enough time has gone by to determine whether there are long-term complications, especially for the two-incision procedure.

But there’s no question that if your hip is giving you a lot of pain, now is a better time than ever to talk with your doctor about whether you’re a candidate for hip replacement surgery.

Source:
American Academy of Orthopedic Surgery; The New York Times, “Weighing Pain, Gain and Risk in Replacing a Hip,” 7 October 2003.


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