|
Hip Replacement and Resurfacing
Total Hip Replacement (THR) surgery has been a successful treatment for hip arthritis for over 30 years. Many improvements have been developed in both the surgical techniques and the implants over the years. Today THR is considered one of the safest and most beneficial surgeries in the world.
Hip Replacement surgery is a treatment for severe hip arthritis when medicines or Physical Therapy fail to alleviate the pain and restore function to the affected hip. The typical signs of hip arthritis include hip stiffness, difficulty putting shoes and socks on, pain in the hip area and limping.
When a hip is replaced, all the arthritis is removed from the hip. The removed bone is replaced with the implants of the replacement; the ball, stem, cup and bearing. Recovery usually involves a couple days in the hospital followed by several weeks of PT.
Risks associated with THR include infection, blood clots and blood loss. Antibiotics and blood thinners are routinely used to prevent these and are rarely seen today.
Recently a technique called ‘Minimally Invasive’ surgery has become popular. The principles of minimally invasive surgery include a smaller incision than the standard 10 inch incision and not cutting muscle. This usually leads to a quicker recovery than the standard THR approach. Minimally invasive THR can carry a higher risk of complications including bone and nerve damage.
Computer assisted THR is also a newer technique that is available. With this state-of-the-art technology, the hip anatomy is registered into the computer. Next the computer will help plan the next steps and also show what was done within a couple millimeters accuracy. This can provide a more accurate THR.
The implants used in THR are usually made of titanium or cobalt-chrome alloy. The ball and bearing are made of cobalt-chrome, ceramic or plastic. Each pair has advantages and disadvantages. The metal-plastic combination has been used extensively for decades with minimal risks. It does carry a higher risk of wearing out than other combinations. The metal-metal combination has been used for decades, but had little success before the late 1990s. Currently the metal-metal combination has a very low wear rate that could allow it to last a lifetime. Special risks associated with this include metal ions released into the blood. This has a theoretical risk of causing cancer or damage to the kidneys, but the association is still theoretical. The ceramic-ceramic combination also produces very low wear and does not produce metal ions. The downsides include a ‘squeaky hip’ and a risk of the ceramic shattering. Newer combinations are being developed that may add benefits and reduce risks.
Activity after a THR is usually limited during recovery. Permanent restrictions, if any, are usually determined by the surgeon. High impact activity like running is believed to wear the implant more quickly, though newer studies are being conducted to evaluate the durability of the newer designs of implants.
Hip Resurfacing is a newer option for the younger person in need of hip arthritis surgery. Resurfacing has been performed for decades, with mixed results before the 1990s. More recent versions have had great success. Resurfacing is generally reserved for the patient with hip arthritis who is a male age 65 or less, or females age 55 or less. These age limits are based on bone density and may change, depending on the bone density of each patient. Resurfacing is similar to THR in that surgery removes the arthritis and places implants in the hip joint. The advantage is the preservation of the femoral neck, more bone, so that it more perfectly re-creates the patients original anatomy. This is believed to allow for a better and higher functioning replacement, which the younger more active patient desires. The recovery is similar to THR for the first week or 2, but then becomes much quicker, getting patients back to work or play faster than a THR. All hip resurfacings are a metal-metal combination, and carry the above named benefits and risks of that combination. Resurfacing can also be performed with computer assistance to increase the accuracy of the surgery. After hip resurfacing, restrictions are rarely placed on activity, though running is generally not encouraged.
Today, when hip arthritis limits activity, there is a safe and successful surgical option to restore hip function.
About the Author:
Dr. Tigges is a board certified Orthopedic Surgeon with Orthopedic Associates of Dutchess County and is the chairman of the Department of Surgery at Northern Dutchess Hospital in Rhinebeck. |