SOMA Orthopedics
Medical Group Inc.
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.