Hip pain is a debilitating condition that can result in severe pain, limited ambulation, and significant loss of quality of life. Symptoms typically including limping and reduced range of motion in the hip. Patients may have trouble getting on socks and shoes, difficulty entering and exiting a vehicle, and challenges with many of activities of daily living. The most common cause of chronic hip pain is osteoarthritis which is a degenerative condition of the hip involving loss of cartilage with resultant inflammation, pain, and dysfunction. Other causes of hip pain include post-traumatic arthritis, rheumatoid arthritis, and avascular necrosis. All of these conditions lead to a common final outcome of chronic pain within the hip and groin associated with loss of mobility and decreased functional abilities.
For the vast majority of history there was no treatment for this chronic debilitating condition of hip arthritis. Patients either gave up normal activity or were restricted to use a cane to help with walking. Fortunately, in 1962 Sir John Charnley performed the first total hip replacement surgery for the treatment of severe arthritic pain. Since that time the technology and technique of hip replacement surgery have changed significantly. There have been major improvements in the actual prosthetic design which the development of materials that allow the replaced hip to function well with minimal wear for decades. The surgical technique has evolved such many patients who formerly would have been hospitalized for 1-2 weeks after total hip replacement now go home within a few hours after surgery. Surgeons remain committed to continuing this process of improvement in order to better serve all patients in the years to come.
So what exactly is meant by the term “total hip replacement”? Many outside observers assume that this surgery entails the removal of large structural parts of the leg and pelvis. However, the truth is that surgeons seek to preserve as much of the native bone and tissue as possible. During a hip replacement the surgeon will expose the hip through one of several basic approaches. The Posterior approach is the most traditional often involving a large incision over the buttocks regions and cutting of significant portions of the gluteal musculature. The Lateral approach is performed with an incision of the lateral aspect of the hip with the need to cut large sections of the lateral abductor tendons of the hip. The Anterior approach is the most minimally invasive of the potential surgical approaches and involves an incision on the front of the thigh with surgical dissection proceeding between muscle layers. This approach is typically performed by surgeons who are experts in hip replacement surgery due to the experience level necessary to perform Anterior hip replacement without complication. The Anterior approach is considered by most surgeons to be the most minimally invasive option for hip replacement leading to less postoperative pain and quicker recovery.
Once the hip is exposed the surgeon will then typically remove the diseased and arthritic femoral head (the “ball” portion of the ball-in-socket hip joint). The hip socket (acetabulum) is then prepared by removing small of amounts of arthritic bone to obtain healthy tissue followed by the placement of a titanium hemispherical prosthetic socket that is placed into the pelvis mimicking the position of the native joint. Typically a plastic polyethylene liner is placed into the titanium socket. At this point the surgeon will prepare the femoral bone for a prosthetic femoral head ( the “ball”) by broaching a pocket within the bone for placement of a titanium “femoral stem” which fits tightly into the canal of the femur. Once the femoral stem is stable a prosthetic ball is the attached to the stem and at this point the new “ball” is placed in the prosthetic “socket” thereby completing the hip replacement surgery. The goal of the surgery is to closely match the native anatomy of the hip as much as possible while simultaneously protecting muscle and soft tissue to reduce post-surgical pain and allow for rapid recovery.
“Total Hip Replacement Prosthesis”
“54 year old female attorney with severe right hip osteoarthritis and chronic pain. Patient has significant limping with ambulation and inability to participate in desired activities such as golf and pickleball.”
“Patient underwent minimally invasive anterior hip replacement as outpatient with same day discharge. Patient was walking unassisted within several days with minimal pain. She was able to return to both golf and pickleball within 6 weeks with no significant discomfort”
