Total Hip Replacement
The hip is a “ball-and-socket” joint where the “ball” (the femoral head) at the top of the thigh bone (the femur) fits inside the “socket” in the pelvis (the acetabulum). A layer of articular or hyaline cartilage covers the femoral head and lines the acetabulum, to allow smooth and painless motion of a healthy hip. The joint is also lubricated by synovial fluid- a viscus fluid produced by all joints in the body.
When the bone and/or cartilage of the hip becomes diseased or damaged from arthritis, hip fractures, bone death or other causes, the joint can stiffen and be very painful. A total hip replacement may be recommended for patients who experience severe hip pain and whose daily lives are significantly affected by the pain. Total hip replacement involves replacing the diseased bone and cartilage with metal and plastic to relieve pain and restore movement and function to the joint. After this procedure, patients will be able to once again move without the stiff, debilitating pain of arthritis. During a total hip replacement, an incision is made in the joint to carefully remove the damaged bone and cartilage ends and replace them with the prosthetic joint. The prosthesis is usually a “cement-less” design, meaning that the prosthesis is designed to allow the body to form a permanent “bond” between the bone and the prosthesis. In patients with severe osteoporosis or soft bones, the prosthesis may be cemented in place. Dr. Davis will determine which technique is best for your individual condition during a pre-surgical consultation. The surgery is typically performed under a combined spinal and general anesthesia and lasts approximately one hour, followed by 60-90 minutes spent under observation in the recovery room (also known as the PACU). New technology has allowed for certain minimally invasive techniques to be employed during the hip replacement procedure. Patients can benefit from shorter recovery times and less scarring with minimally invasive total hip replacement.
Direct Anterior Total Hip Replacement
No one prosthesis or technique can truly be claimed to be clearly superior to another. However, there are trends in hip replacement surgery that are proving to lead to long-term success with a shortened recovery time for patients. One of these advances has been the use of the Direct Anterior (or DA) Total Hip Arthroplasty. This surgical approach has been gaining popularity with the regular use of specially designed operating room tables that facilitate the ease of the surgery procedure.
The potential benefit to the patient is an earlier and speedier recovery with (hopefully) less pain and disability. There are always individual patient circumstances that may influence the actual surgery and ultimate recovery time – this will be discussed with Dr. Davis prior to surgery. Please do not hesitate to ask questions or raise any concerns that you may have about the surgical care.
To achieve the desired result of a less-invasive hip replacement surgery, Dr Davis follows a specific protocol, that starts prior to surgery and continues both during and after surgery. This protocol includes:
- Pre-operative physical therapy, also known as “prehab”, for a thorough conditioning program prior to surgery to help reduce joint stiffness and improve muscle function and strength before surgery;
- Pre-operative patient education, with a dedicated “team-approach” to surgery to ensure that the patient will have appropriate education and resources dedicated to them prior to and after surgery to maximize the outcomes of surgery;
- A “multi-modality” pain management approach with pre-emptive medication regimen;
- Meticulous handling of the tissues in and around the hip during surgery to minimize tissue inflammation;
- Careful control of any bleeding during surgery to minimize hematoma formation after surgery;
- Precise placement of the hip prosthesis, with careful attention to implant size, alignment, position and soft tissue balancing of the hip joint;
- Routine injection of longer-acting local anesthetic medications within the hip joint to minimize pain and bleeding after surgery;
- Routine use of medications that help control bleeding during and after surgery – medications known as anti-fibrinolytic agents, known as Tranexamic Acid or Amicar;
- Regular and aggressive use of “cryo-therapy” (a fancy way of saying icing) of the hip and thigh after surgery;
- Early post-operative mobilization with physical therapy to minimize stiffness of the hip joint and the muscles around the hip.
Before & After Photos (examples)
Patient 1 – Pre-operative Right Hip (Front View)
Patient 1 – Post-operative Right Hip (Front View)
Pre-operative Medical Evaluation
Prior to any surgical procedure, a medical evaluation is recommended. This evaluation is usually performed by a patient’s primary care physician, arranged in conjunction with our office.
Occasionally, medical concerns are identified that need attention and treatment prior to surgery. Patients with diabetes are of particular concern. There is substantial research to suggest that diabetic patients are at increased risk for complications. This increased risk can be reduced if the patient is compliant with their blood sugar control.
Obesity is another medical challenge for some patients. Obesity is defined based on a patients’ “Body Mass Index” or BMI for short. A BMI over 40 increases the risk for infection after joint replacement surgery. If a patient is unsuccessful, through a combination of diet and exercise, at losing weight to get their BMI below 40, bariatic surgery may need to be considered.
Patients with underlying lung, heart, kidney or liver problems may need consultation with a specialist in one or more of these areas prior to surgery. Further testing may be needed depending on a patient’s individual circumstance.
Tobacco use is another cause of concern. Smoking have been shown to increase the risk of complications after many orthopaedic surgeries, including joint replacement and spinal surgery. The best advice is for the patient to stop smoking. Help from your primary care physician can be obtained to assist in this goal.
Our goal is to minimize the risks associated with surgery – this includes reducing the medical risks that our patients may be exposed to.