The hip joint is one of the largest joints in your body. Unfortunately, it is also one of
the most easily injured—and not all at once. Osteoarthritis (known as ‘wear-and-tear arthritis’) can set in gradually and can cause not only stiffness but also pain.
What causes the hip to deteriorate to the point where it needs replacement? Sometimes osteoarthritis is the culprit, and it may be that genetics play a role. In other cases, the ball of the hip joint (called the femoral head) loses its blood and simply dies, leading to degeneration.
At first, the discomfort might be noticed only when bending or when putting pressure on the extremity. This commonly occurs, for example, when walking up and down stairs. Eventually, the pain can become nearly constant. In time, the pain may affect the individuals ability to enjoy a full and active life. A measure of
relief may come through medication and walking aids, but sometimes these remedies are short-lived. For long-term treatment, the solution might be total hip
replacement. “Hip replacement surgery is becoming more and more common as the population of the world begins to age,” notes the article A Patient’s Guide to Total Hip Replacement Surgery, on the web site healthpages.org.
The hip joint is composed of two parts: The ball and the socket. During surgery, the two parts are removed and replaced with artificial surfaces. The ball is usually made of metal or ceramic, while the socket is composed of a titanium shell with a plastic liner. The option of hip replacement is completely up to the patient. As a doctor, my recommendationsto patients are based on many factors including the patient’s medical history, weight, health status, and radiography. After considering non-operative options, some decide that the benefits of total hip replacement far outweigh the risks and complications.
True, the very idea of hip surgery may seem daunting, But new developments—mainly over the past few decades—are changing the face of hip replacement for the better. For example, a procedure known as musclesparing total hip replacement now allows surgery to be performed less invasively. It uses the same implants that are employed in traditional surgery. But one major difference is in the incision. Whereas traditional surgery requires a 12-inch cut, the incision made with the musclesparing
technique is much smaller. Not only does this result in a smaller scar, but also it means less trauma to the muscles surrounding the hip area. All around, the patient can gain mobility--and thus begin exercising the legs—much sooner. Overall, the musclesparing technique eliminates some of the complications of traditional surgery. It also speeds up recovery and helps the patient return sooner to normal activities. This is the muscle sparring anterior approach, which I perform with the Stryker Mako Robot.
Our patients commonly ask: "What are the risks of a total hip replacment and how does an artificial hip hold up over time?" The major long-term problems are loosening or wear. Loosening occurs either because the cement crumbles (as old mortar in [a] brick building) or because the bone melts away (resorbs) from the cement. Some factors that can affect loosening include your weight and level of activity. Of course, there can always be a second surgery. But the results of a second operation are not as good as the first, and the risks of complications are higher.
When total hip replacement is recommended, the outcome can be positive. “A total hip replacement will provide complete or nearly complete pain relief in 90 to 95 percent of patients,” says the Virtual Hospital web site. “It will allow patients to carry out many normal activities of daily living. The artificial hip may allow you to return to active sports or heavy labor under your doctor’s instructions. Most patients with stiff hips before surgery will regain near-normal motion, and nearly all have improved motion.”
