Hip replacement technology is considered by many to be one of the top medical marvels of the last century, with phenomenal patient satisfaction rates and continued technological improvements to this day. It involves taking a hip joint that is worn out from arthritis or other degenerative condition and resurfacing the socket and replacing the head creating a new joint. This predictably relieves the deep pain in the hip with very low complication rates in the vast majority of patients.
Anterior hip replacement has become popularized because of the ability to perform this surgery through a small incision in the front of the hip without detaching any muscles. The advantages of this specific approach include a faster recovery and the lowest rate of dislocation.
The parts used to replace the hip involve the use of a stem into the femur with a metal or ceramic ball and a plastic lined shell into the socket of the pelvis. The components and instruments used for anterior hip replacement are specifically designed to accommodate this approach. A specialized table is often used to perform the operation to aid the surgeon and allow for an X-ray to be performed during the operation to check that anatomy is precisely restored.
The materials used in hip replacements have evolved to have very low wear rates with the majority of them doing well even after 20 or more years. The plastic technology has improved over the past decade and given the even lower wear rates, we anticipate them to last longer than ever. There are five major manufacturers for these implants and dozens of smaller ones. Most implants currently used have very good long term success rates, but there may be subtle differences that may be desirable when considering patient specific needs. The surgeons at Florida Joint Care Institute have an extensive knowledge of the implants and materials available and can help patients to understand which one may be most appropriate.
All hip replacement surgeries require careful planning. This begins from the moment a patient is seen in consultation. There are many health factors that are taken into consideration before surgery in order to minimize the chance of complications and improve outcomes. There are often medical conditions that require further treatment by an internist or specialist prior to surgery. To consider anterior hip replacement, a patient must not be morbidly obese. There are specific technical considerations to performing the operation in the front of the hip and abdominal obesity may interfere or even increase the risks associated with this procedure. We believe that a comprehensive approach to patient care is the best way to achieve a healthy and functional recovery.
The surgeons at Florida Joint Care Institute use cutting edge digital X-rays calibrated to each patient as well as specialized computer software to plan the surgery. This ensures appropriate component selection to match each patient’s anatomy and that the leg lengths are calculated to restore normal alignment and length which may have been altered from the degenerative joint disease. During the surgery there is additional instrumentation that measures anatomy directly to ensure sizing is exact. There is no more precise way to measure size and restore anatomy than planning the surgery appropriately and verifying using this direct technology during the operation.
Rehabilitation after anterior hip replacement is accelerated compared to traditional approaches. The majority of patients will start physical therapy to stand and walk the same day of surgery. This improves early functional recovery and lowers the risks of blood clots from forming. All patients recover in a private room and work with the orthopaedic and nursing teams within the joint care program. Many patients are discharged home the second day after surgery and feel comfortable and confident with their progress. Patients are discharged home with a home visiting nurse and therapist to perform visits for the first few weeks after surgery. If additional needs are required, a patient may elect to go to a rehabilitation facility to work aggressively with physical therapy until enough independence is reached to be discharged home.
Recovery occurs as a stepwise process. Many patients are completely independent of a cane or a walker two weeks after surgery. As therapy continues, endurance and strength improve and most activities including many low impact sports are resumed within six weeks of surgery.
Although anterior hip replacement has proven to be a great technology and outcomes better than ever, there are unique risks inherent to the operation. With careful planning these risks are minimized but it is important to have this discussion with your surgeon prior to the operation to be appropriately informed. By understanding these risks and expectations of benefits, our patients are able to achieve the best outcomes possible.