Healthy hip function
The femoral head and acetabular “socket” are supposed to be very smooth, with both articulating surfaces covered in a thin layer of articular cartilage. This layer is about an 1/8th of an inch thick and prevents bone-on-bone contact. There is also a protective layer of cartilage around the rim of the acetabulum, called the labrum. If the cartilage is damaged or missing, the resulting bone-on-bone contact can cause pain and/or limit motion.
A large group of muscles surround the hip joint, and appropriate muscle tension is needed to keep the hip stable. These muscles allow the four basic movements: flexion (to bend), extension (to straighten), abduction (move the leg away from the body), and adduction (bring the leg back towards the body). They are divided up into three basic groups, based on location: anterior (front), posterior (back), and medial (middle). The stability of the hip is also dependent on the strong ligaments that encircle the hip. These ligaments completely envelop the hip joint and form the joint capsule. The iliofemoral ligament, which connects the femur to the acetabulum anteriorly, is the strongest ligament in the body.
Total hip replacement
Total hip replacement implants are designed to replace affected areas with components that re-create healthy hip joint mechanics. The main components of an artificial hip consist of the acetabular component (socket), the femoral component (thigh bone), and the femoral head (ball). The acetabular component is a two-piece component with a metal shell that fixes into the pelvis, and a polyethylene (plastic) liner that becomes the articular surface for the metal or ceramic femoral head. The femoral component is made of a combination of medical-grade metal, typically titanium. With each of these components working together, you should be able to regain your hip movement without pain. After examining your hip damage, your physician will determine what procedure is necessary to get you back to a normal, active life.
Surgical approaches for total hip replacement
There are several surgical methodologies (approaches) for total hip replacements: from the front (anterior), from the back (posterior), and the side (lateral). No matter the approach, hip replacement surgery includes the replacement of the joint’s damaged cartilage and bone with implants.
The decision as to which surgery will be best for you will be determined through physical examinations, diagnostic imaging (X-rays, CT-scans, etc.) and discussions with your surgeon.
Of course, you will discuss these options with your surgeon to determine which is best for your specific health status, condition and anatomy.
Direct anterior approach
In the anterior approach, the surgeon accesses the hip joint by entering through the front of the body and going between the hip muscles that help hold the hip joint in place. Smaller incisions (using minimally invasive surgical techniques) are often possible with this procedure versus traditional hip surgery.
The anterior approach to total hip replacement is becoming more popular because it is less invasive, hospital stays are shorter, and recovery and rehabilitation are quicker for patients.
Back or posterior approach
In the posterior approach, the “traditional” hip replacement surgery, an incision of eight-ten inches is made beside or behind the hip joint. The surgeon must go through muscle and detach the muscles from the “ball and socket” of the hip joint.
This approach gives the surgeon excellent access to the joint, preserves the hip abductor muscles and minimizes the risk of abductor dysfunction post-operatively.
Minimally invasive surgery
Hip replacement surgery can be performed using minimally invasive techniques. This approach enables the surgeon enters the hip joint through one to two small cuts which results in less blood loss, less pain, shorter hospital stays, less scarring. It can also speed the healing process. Surgeons often use minimally invasive techniques through the anterior approach.
Computer assisted systesms use navigated instrumentation to help the surgeon to plan and execute a surgical procedure that is truly specific to your condition and anatomy, with the intent on improving overall joint function.
Q: Is there a maximum age limit for hip replacement surgery?
A: Consult your physician about your general health and your ability to withstand surgery. In general, age is not a factor for hip replacement surgery if you are in reasonably good health and you have the desire to continue pursuing an active and productive life.
Q: Will my recovery from surgery be painful?
A: As with most surgeries you should expect considerable amounts of tenderness on the repaired area. Pain medication will be given to you during the hospital stay and the pain should decrease over several weeks.
Q: How much pain relief or increased mobility should I expect?
A: You should experience significant reduction in pain and improved mobility after hip replacement surgery within the first few weeks. Many factors, including physical condition, weight, activity level, personal anatomy and willingness to comply with your surgeon’s instructions prior to and after surgery will play an important role in your recovery.
Q: When will I be “me” again?
A:You should be able to stand and walk with assistance soon after surgery. Physical therapy will begin as soon as you feel ready, generally one to two days after surgery. You should expect six weeks or more of physical therapy before you can completely resume your normal activities. In general, however, you should be able to partake in certain low-impact activities within a few weeks. This will depend on multiple factors, including your health, the type of surgery and your recovery. Typically surgeons discourage patients from any high impact activities such as running and other strenuous sports. Complete recovery usually takes several months.
Q: How long does the procedure take?
A:Most hip replacement surgeries take approximately two and a half hours. Some of this time is taken by the operating room staff to prepare for surgery. Your doctor will discuss with you all of the details regarding your surgery including how long the procedure is expected to take.
Q: How do I know if I need a hip replacement?
A: If you have chronic and persistent hip pain that restricts regular activities, it is likely that you are a good candidate for a total hip replacement. As always, it is best to discuss possible treatments with your physician.
Q: How long will I be in the hospital?
A: In most cases, patients are discharged from two to five days. If you need more time for rehabilitation, other options might be available.