Today, hip replacement surgery is one of the most common elective surgeries in the United States, with more than 400,000 replacements performed annually. While the contemporary replacement surgery was popularized in the 1960s, we’ve seen a revolution in techniques over the past few decades, which minimize recovery times and pain after surgery. One of these increasingly popular newer techniques is the direct anterior hip replacement approach.
Hip replacement surgery is most often used to treat hip osteoarthritis. However, not everyone with this common variety of hip pain will require surgical intervention. So how do you know if you need a hip replacement? If you or a loved one are suffering from severe hip pain that limits mobility, it’s important to understand your full range of treatment options. Let’s take a look at the nonsurgical strategies as well as anterior hip replacement surgery — a minimally invasive hip replacement procedure.
The hip, also known as the acetabulofemoral joint, is a ball-and-socket joint. The head of the femur forms the “ball” portion of the joint, which fits into the acetabulum “socket” of the pelvis. Cartilage along these surfaces allows the joint to operate smoothly. Unfortunately, over the course of our lives, injuries and general wear and tear can interfere with the natural movement of the hip joint.
Today, osteoarthritis affects more than 30 million adults in the US alone, with an estimated one in four people developing the painful condition at some point in their lives. While osteoarthritis may affect any joint in the body, it is most likely to develop in weight-bearing joints such as the knee and hip. Several factors affect your likelihood of developing osteoarthritis, including a family history of arthritis, age, and obesity.
Hip arthritis symptoms may develop as the protective cartilage in the joint wears away over time. In the early stages of hip osteoarthritis, the most common symptoms include pain, swelling, and sensitivity around the joint. These symptoms may be more pronounced following activity, however, hip pain after prolonged sitting and standing is also associated with hip arthritis. Some individuals report thigh and groin pain that extends down the leg and into the knee. Hip joint stiffness and limited range of motion are also hallmark hip osteoarthritis symptoms.
A severe injury to the hip can also substantially increase the risk of developing arthritis in the hip joint later in life. Per a recent study, such post-traumatic arthritis (as it is known) accounts for roughly “12 percent of all osteoarthritis cases.” Whether it is the result of a car accident, sports collision, or other traumatic incident, a hip injury may structurally damage the bones and tissues, affecting the overall mechanics and mobility of the joint. This can cause the cartilage in the joint to wear away faster than it normally would, leading to pain, hip inflammation, and ultimately hip osteoarthritis.
Some individuals with more severe osteoarthritis also report bone on bone hip pain symptoms. Loose or adrift pieces of cartilage or bone may impede the proper movement of the joint, causing the joint to catch or stick, which the patient experiences as hip locking or hip popping. Currently, there is no known cure for hip osteoarthritis. However, there are many treatment options to help you manage your hip arthritis symptoms on your own terms.
When discussing options, many patients inquire specifically about how to avoid hip replacement all together. Fortunately, not all hip injuries require hip surgery. At Sports Medicine Oregon, we offer a range of non-surgical hip treatment options (many of which can be performed at our state-of-the-art outpatient physical therapy center). These initial conservative treatments focus on lifestyle adjustments and other nonsurgical techniques, including physical therapy exercises for hip pain.
For some individuals, a weight loss regimen can help reduce the overall impact and burden on the hip joint. Similarly, switching to a low-impact fitness routine may help manage hip pain during exercise and hip pain after exercise. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used to help manage basic hip pain and swelling, as part of these initial lifestyle adjustments. During physical therapy, we use aerobic exercises, strength exercises, and flexibility training to strengthen the surrounding muscles, relieve chronic hip pain, and increase the hip joint range of motion.
Other noninvasive treatments include injections for hip pain, which are designed to minimize pain and swelling in and around the hip joint. These injections may provide lasting pain relief (up to 12 weeks), however, it’s important to remember that a cortisone shot for hip pain is not a cure, and this symptom relief will fade over time. To experience long-lasting relief, patients may need to return for multiple injections throughout the year.
If these conservative treatment options fail to adequately alleviate your hip pain symptoms, or if your hip pain is holding you back from your activity goals, your doctor may recommend hip replacement surgery. As a last resort, hip surgery is a valuable treatment option for hip joints severely damaged by injury or arthritis.
As mentioned previously, total hip replacement surgery is a common procedure. It has been estimated that more than two percent of adults in the U.S are currently going about their active lives with an artificial hip. During a total hip replacement surgery, the head and neck of the femur are removed, along with any damaged cartilage. An artificial stem and ball, made from plastic, metal, and ceramic components, are then inserted into the femur. The damaged acetabulum is also replaced with an artificial socket, allowing the hip to function smoothly and optimally.
It’s important to note that not all patients will require a total hip replacement. In some cases, a partial hip replacement is sufficient to replace the damaged or diseased portions of the hip joint. Nonetheless, most hip surgeries are based on the same principles and objectives. However, there are several different approaches to consider. Some of these hip replacement approaches cause more damage to the soft tissue and require longer recovery times than others. So what are your hip replacement options? Let’s take a look...
Today, direct anterior hip replacement surgery has changed the entire hip arthroplasty paradigm, and for good reason. This minimally invasive hip surgery offers many advantages over other hip replacement techniques. In fact, a study published in the World Journal of Orthopedics found that the anterior approach to hip replacement resulted in shorter hospital stays, when compared with the posterior approach.
It’s important to remember that not all orthopedic surgeons are experienced in this type of hip replacement. Fortunately, at Sports Medicine Oregon, we specialize in this minimally invasive hip replacement technique. So what are the key differences between the posterior approach and the direct anterior approach to hip surgery?
During a traditional hip replacement, the surgeon makes the incision on the back side of the hip. This specific technique is known as the posterior approach and is the most commonly used method today. Due to the anatomical positioning of the tissues around the hip, the posterior approach to hip replacement requires the surgeon to cut muscles and other connective tissues to gain access to the joint. Unfortunately, the clipping of these tissues greatly increases the overall recovery time and the complexity of both the healing process and the postoperative physical therapy. It may take months for these muscles to fully repair themselves, and this interim instability may increase the risk of dislocation and reinjury.
Conversely, a direct anterior approach hip replacement allows access to the hip via the front side of the joint. This entry point enables the surgeon to perform the entire surgery without clipping muscles and connective tissues. During a typical direct anterior hip replacement, the surgeon can work between muscles and tendons to ensure access and visibility. By sparing the muscles and other connective tissues during surgery, the direct anterior approach to hip arthroplasty minimizes recovery time, reduces swelling, and allows patients to get back to their active lives faster.
Unlike more invasive hip replacements, patients are allowed to return to weight bearing activities soon after an anterior hip replacement and can resume many less strenuous activities within a few days, due to the lower risk of dislocation. Nonetheless, posterior hip replacement surgery is currently the most common approach to hip arthroplasty. The reasons for this are complicated, however, many surgeons simply lack the training and experience to perform a direct anterior hip replacement. If you or a loved one are looking for an experienced direct anterior hip replacement surgeon, look no further than Sports Medicine Oregon.
Nearly a quarter-million total hip arthroplasties are conducted annually. While it is difficult to estimate exactly how long the results of hip arthroplasty will last, the latest generation of hip replacements are certainly capable of withstanding the rigors of even the most active lifestyles for many years to come. The involved technologies and techniques have progressed substantially since the 1980s and 1990s, when surgeons would routinely estimate that about 90 percent of hip replacements would last for around 15 years.
In a recent study, more than 80 percent of artificial hip joints lasted for over 20 years without requiring additional surgery. Rather than perpetually enduring the ups and downs of short-term treatment strategies, total hip replacement offers long-term relief and stability, allowing you to live the active life of your dreams.
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