Does your hip pain prevent you from completing everyday tasks or participating in the activities you enjoy? Is it hard to bend or lift your leg because you are so stiff? Have you been unable to find relief with nonsurgical treatments?
If you answered yes, you may be a good candidate for a hip replacement. More than 2.5 million Americans have had a total hip replacement—a procedure that removes the diseased joint and head of the femur and replaces it with an artificial implant typically made of metal and plastic. The artificial hip makes it easier and less painful to walk, bend, and exercise.
“Hip replacements give people their function back,” says Jordan Werner, MD, an orthopedic surgeon at Summit Health, who specializes in a cutting-edge technique known as anterior total hip replacement. “Over time, the joint surfaces move on each other and start to break down. This is usually caused by an arthritic process. When the joint no longer has any cushion, it becomes painful—people start to limp, have difficulty walking, and just generally slow down.”
Over the last two decades, hip replacements have grown in popularity throughout the U.S. As the population ages, there has been a significant increase in demand. Major advancements in hip replacement surgery have also led to more elective procedures.
Twenty years ago, individuals who had a hip replacement faced significant hurdles. After surgery, they stayed in the hospital for several days, needed blood transfusions, and then required several weeks of inpatient rehabilitation. Today, these same patients are leaving the hospital later the same day, recovering at home in half the time, and less than one percent require a blood transfusion. As a result, many patients who would have waited are having surgery earlier.
The key to faster recovery, explains Dr. Werner, is anterior total hip replacement. In the traditional posterior approach, an incision is made in the back of the thigh and the tendons and muscles are cut to access the hip socket. With this newer technique, an incision is made in the front of the thigh and the muscles are simply moved out of the way to reach the joint. This decreases blood loss, reduces scarring, and accelerates healing.
“Total anterior hip replacement is a much more precise approach. By eliminating the need to cut the tendons, we can get people moving and working with a physical therapist right from the recovery room,” says Dr. Werner. “Any period of inactivity is not good for the body. People can become weak and deconditioned very fast when they have major surgery.”
The anterior hip replacement procedure is performed on a special radiolucent table called a HANA bed. Since X-ray beams can pass through the material, the images that are taken during the operation are significantly clearer. This helps the surgeon match up the length of the hips with precision. The procedure, which now lasts about 45 minutes, can also be done under spinal anesthesia, as opposed to general anesthesia. This allows the patient to almost immediately begin physical therapy, even in the recovery room.
The success rate for total anterior hip replacement is between 90 and 95 percent, according to Dr. Werner. “Patients generally tolerate the surgery well,” he says. “I give them exercises and goals they can achieve on their own at home. Rarely do patients require a rehab stay, and many patients can use the exercise guides in lieu of traditional physical therapy. Most of my patients can complete their physical therapy at home, doing a series of simple stretches and exercises. In a few weeks they are climbing upstairs, walking around their block, driving, and are back to work. With the anterior approach, they do not have any restrictions after a week and are able to do anything they want as long as the pain is manageable.”
Hip replacements also last longer today. Durable materials including medical grade polyethylene and ceramic hold up extremely well over time. “Surgeons used to tell patients in their 50s and 60s to hold out as long as they could for hip replacement, because they would end up needing multiple surgeries,” he recalls. “Today, you can perform surgery on a relatively young healthy person, and the implants will likely last them their entire life.”
Patients who are considering surgery often ask Dr. Werner if they should stop running or playing recreational sports. “Inactivity is detrimental to the entire body,” he explains. “When your bones and joints are healthy, and you can move around with ease, it benefits your heart, lungs, and other systems. Even if it leads to a little more wear and tear, the best thing you can do for your overall health is continue to exercise and move around.”
There are no set criteria for surgery. Dr. Werner sees patients of all ages and activity levels. His job is to help them achieve their goals. Individuals in their 50s and 60s often want to get back to recreational activities, such as playing tennis or golf. People ages 80 and up — who often become deconditioned from hip pain — want to be able to take care of themselves and live independently.
Electing to have a hip replacement is a decision made in partnership between a patient and doctor. “While conservative management is always my first discussion with a patient, anyone who has pain that affects their daily life and prevents them from doing the things they want to do qualifies for surgery in my eyes,” he says.
While there is no age cutoff for surgery, individuals with medical conditions like diabetes or hypertension are at a higher risk of complications. As part of a multidisciplinary health network, Dr. Werner works closely with other specialists in cardiology, rheumatology, and endocrinology at Summit Health to make sure the patient is in optimal health before surgery.
When Dr. Werner consults with a new patient, they are often surprised to hear what activities they will be able to enjoy with a new hip, how the recovery has changed, and why implants can last so long. Whether it is running a 5K or simply being able to get in and out of the car pain-free, hip replacement can help individuals in every phase of life achieve their goals.