Hip Replacement

Half a century ago, even as recently as the 1960s, patients with arthritis were crippled, as good options did not exist for the treatment of their pain. As arthritis progresses and gets more severe, the conservative treatments, such as a change in lifestyle and medications, may no longer suffice for pain relief. This is when you may be a candidate for hip replacement.

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The first modern total hip replacements were performed in the 1960s. Although plagued with problems, these early operations helped thousands of people conquer the pain from arthritis when their options had run out. Numerous advances have occurred the last 20 years. These recent advances include improved wear and loosening rates and better medical care after surgery. Great strides have also been made in pain management, physical therapy, and recovery of function. Today, hundreds of thousands of hip replacements are performed annually.

Hip replacement, technically speaking, is a close as we come to a “cure” for arthritis of the hip. It removes the arthritis and replaces the joint with prosthetic surfaces that have smooth and painless motion. A common misconception is that the entire hip is removed. This is not the case. Only the ball is removed, so that a new prosthetic stem can be placed within the upper thigh-bone with a ball on top of it. The socket is only shaped to fit the prosthetic socket snugly. Newer hip replacements, called “resurfacings”, conserve even more bone and can be extremely successful for the appropriate patient.

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Procedure

The patients arrive at the hospital on the morning of surgery. Routine hip replacement patients should expect to stay 2-3 days.

The procedure involves an incision along the side of the hip, measuring anywhere from 3-8 inches. The size of the incision very often depends upon the patient’s body shape and size. The prosthesis is then placed on the shaped bones and all muscles are re-attached. Ask Dr. Mathews to see a model, so that you can see an example in the office.

Hip Replacement Pre Op

 

Hip Replacement Post Op

 

THA Model

Mini-incision hip replacement, which is a recent development, can and will be performed on you by Dr. Mathews, if your body shape and size allow it.

Resurfacing hip replacement, which is a very recent development in the news, can and will be performed on you by Dr. Mathews, if your body shape and size allow it.

Types of hip replacement

  1. Non-Cemented / Press-Fit – The patient’s bone to “grows into” the metal. This is the now the most common type of hip replacement.
  2. Cemented – This more classic approach was the way hip replacements were originally done. This is still the option in patients with very poor bone quality. Cement bonds the metal and plastic parts to the bone.
  3. Hybrid – Also commonly used, this is use of a cemented stem and non-cemented socket, which has shown excellent results for all bone types.
  4. Resurfacing – This more recently popular treatment has garnered much attention. Read more about Hip Resurfacing

The decision for which type of prosthesis to use ultimately will be made by taking several factors into account, including patient age and activity level, patient medical problems, and the patient’s bone quality.

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Virtual Hip Replacement – Take on the role of the Surgeon throughout a hip replacement surgery.

The Bearing Surface

Much research effort and money has been spent in order to find the “perfect” ball-and-socket bearing surface. Ideally, this surface would be one with no wear and no other risks. Highly specialized metals, plastics, and ceramics have shown excellent results.

Dr. Mathews will use one of these low-wear surfaces in your hip replacement, so that it has a chance of lasting as long as possible.

Hip Replacement and Age
A common misconception is that a patient feels that they are too young or too old for a hip replacement. Hip replacements are performed in people of a wide range of ages – from their 40s well into their 90s. A young age is becoming less of an issue, as the ability to implant longer-lasting joint replacements increases. Old age is also not a contraindication, as medical management and surgical techniques are far better now than they were years ago. Most people lean toward replacement when they would rather not live their lives out in pain, and would rather enjoy life while they are healthy.
Timing of Hip Replacement

This is an individual decision, based upon general health, the amount of pain and limitation, as well as expectations.

The question of tolerability is very important. What is tolerable to one person may not be tolerable to another. For some people, driving around in an electric wheelchair is far preferable to having a hip replacement. Others simply are frustrated that they can no longer get through their 18 holes of golf and would rather have the painful joint replaced.

Once again, however, this is an individual decision. Dr. Mathews can inform you and help guide you, but the final decision is truly yours.

  • Factors which play a role
    • Pain level
    • Inability to do things you used to do
    • Affected activities of daily living
    • Patient health and the ability to withstand an operation. This decision factor will ultimately involve the input of your medical doctor, and possibly other specialists, in order to assess your medical risk

Hip Replacement Benefits
Scientific studies have time and again demonstrated the exciting benefits derived from hip replacement. These include pain relief and return to previous function, as well as patient satisfaction. Total hip replacements usually last for the rest of a person’s life. Results better than 90-95% are the norm.

Hip Replacement Risks
All surgeries (even the most minor ones) have risks, although rare, and total hip replacement is no different. Your doctor can review these risks of the surgery with you at any time.

The Cost of a Hip Replacement
This will usually depend upon the insurance coverage of a patient. Our office can help you with this, as can the hospital personnel.

Anesthesia for Hip Replacement

  • Anesthesia is generally done one of two ways:
    • General anesthesia
    • Epidural / spinal
  • Both methods are low-risk and effective. This is a decision that will be made with your anesthesiologist.

Medical Clearance
The ultimate clearance for surgery will come from your medical physician or, if you do not have one, one that you will be referred to. Prior to surgery, he/she will look you over from head-to-toe and decided if any further tests (other than the routine ones) or consultations by other specialists need to be done. Once the clearance is completed and any medical issues are attended to or stabilized, then surgery can be performed more safely.