SOMA Orthopedics

When does a patient need a total hip replacement?
A total hip replacement, also known as a hip arthroplasty, is indicated for a variety of conditions including arthritis and fractures. When performed for the appropriate patient, a total hip replacement is an excellent surgical option with a time tested track record. Initially performed in the 1960’s, hip replacement surgery has been described as one of the most important surgical innovations of this century. Since it’s advent, technological advances and procedural improvements have greatly increased the effectiveness of this surgery. The success with hip replacement surgery has prompted the expansion of arthroplasty into other joints including the knee, shoulder and elbow.

The decision for a patient to have a hip replacement should be a cooperative one between the patient, the patient’s family, the primary care physician and the orthopedic surgeon. While historically the indications for hip replacement have been in patients 65 years or greater with severe, end stage arthritis, current options have expanded the appropriate indications to better serve those patients who are experiencing a significant amount of pain and dysfunction secondary to their diseased hip. Many patients younger and older than 65 years with night pain, pain at rest, difficulty performing ADLs or the inability to enjoy their customary hobbies or sporting activities may be excellent candidates for hip replacement.

What is involved in a total hip replacement?
Total hip arthroplasty is a surgical procedure designed to remove the diseased portions of the femoral head and acetabulum. The procedure is also a powerful method to correct any alignment abnormalities or leg length discrepancies giving patients a more symmetrical, normal gait. Prior to the surgery, the orthopaedic surgeon will carefully evaluate the patient and his/her radiographs for conditions that should be addressed during the procedure. Whereas conventional incisions for this procedure have been around 15cm in length, minimally invasive techniques help reduce the surgical dissection required thus leaving incisions around 10cm for the appropriate patient. These techniques are not only important for aesthetics, but also for better post-operative pain control and immediate post-operative rehabilitation. During the procedure, the orthopaedic surgeon removes a majority of the femoral neck and the entire femoral head. The acetabulum is “reamed” in a manner to shave off diseased cartilage and bone. A metal stem is placed into the femoral canal and a metal ball is placed on the stem. In the native acetabulum, a metal shell is securely fixed to the bone and a plastic liner is secured to the shell. The new “joint” is the articulation of the metal ball with the plastic liner.

New technology in hip replacements has incorporated the use of modified plastics and metals such as ceramics for better wear characteristics and longer survival of implants.

What to expect after Total Hip Replacement surgery.
An important factor for patients in deciding whether to have a hip replacement is understanding what the procedure can and can’t do. For most types of hip replacements, the patient is highly encouraged to walk the day after surgery. Hospitalization is approximately 3-6 days and is tailored to the individual capabilities and needs of each patient. Extensive participation with physical therapy is required for an optimal result. As far out as 10 years, greater than 95% of patients will experience a dramatic reduction of hip pain and a significant improvement in their ability to perform common activities of daily living. Patients will be asked to refrain from high impact activities but will be able to perform many other types of sporting activist such as brisk walking, golfing, doubles tennis and even skiing on appropriate terrain.