Know Your Procedure Options - Hip Replacement

Total hip replacement is an extremely successful surgery with generally high patient satisfaction scores. However, that does not mean that all hip replacements are the same. There are many options when it comes to hip replacements.

Let’s start by looking at what all hip replacements have in common. When you undergo a total hip replacement, the damaged ball and socket portions of your joint are replaced with implants that are made out of metal, ceramic, plastic, or some combination of these materials. Beyond that, there are many different options.

One thing that I always tell my patients is that, in the long run, the most important thing you can do is find a surgeon you feel comfortable with, and learn as much as you can to prepare and set realistic expectations for your specific condition. For many patients, joint replacement can reduce pain and restore motion. But, recovery takes time and effort. It’s important to understand the risks of hip replacement surgery so you know the importance of following your post-operative instructions, and can recognize signs of potential complications.

Traditionally, hip replacements have been performed in a hospital setting. Patients used to spend many days, and even weeks, in the hospital recovering from their surgery. However, today a healthy patient will typically only spend a couple of days there.

In the orthopedic space, there has been an emphasis on recovery protocols. All this means is that we’re trying to get patients back to the comfort of their own homes faster. These protocols tend to involve a coordinated effort between your surgeon, anesthesiologist, and other members of your care team including therapists and nurses. The protocols vary, but globally involve minimizing the use of narcotics by maximizing other pain control options, encouraging movement quickly after surgery, and focusing on the goal of getting home.

Given the success of more aggressive recovery protocols, some surgeons and centers have started performing total hip replacements on an outpatient basis (meaning that you would be able to go home the same day).¹  This has also been shown to be an effective way to perform hip replacements if you meet your center’s qualifications.^1-2 Not all hip replacement patients are appropriate for outpatient surgery. Talk to your surgeon to see if that is an option for you.

Over the years, a lot has changed in the way that hip replacements are performed. As our understanding of what is necessary to put implants in and how they function has improved, we have been able to develop less invasive methods.

There are multiple approaches to hip replacement. The approach tells you where your surgeon will make your incision(s) and how they will get your implants in. These include posterior (backside), lateral (side), anterolateral (front side), direct anterior (front), and even superior (top) locations on your hip.

Try not to become overwhelmed with this medical terminology. Just know that there are options available and that your surgeon will choose the approach based on your specific case, his/her past experience and his/her training. Many of the approaches have become less invasive over the years as we’re able to make smaller incisions, be more friendly to tissue and muscle, and repair important structures to an anatomically correct position.

As mentioned above, one of the most important things about your hip replacement is that the implants are put in properly. There are many ways that your surgeon may evaluate this for you. They may get an X-ray in the operating room using trial implants, which can reveal changes that can be made to improve the location of the final implants. Others may use a machine called a fluoroscope to get real time information about where the implants are placed. There are also computer programs meant to use information from either X-rays or fluoroscopy to help determine if your hip implants are in the right spot. Another emerging technology is the use of a robotic assistant to help surgeons optimize the position of the implants.³

Also, other differences like the type of implant that you receive, the materials it’s made out of, and many other factors exist, but can get very technical. It’s important to understand that there are not superior and inferior ways to have a hip replacement. If any of these were shown to be far superior, then all surgeons would be switching to that particular technique. As I tell my patients, it’s important to understand what’s happening with your surgery and to do your research, but in the end you need to find someone that you trust to perform your surgery and then allow them to do their best work for you.

1. Stambough, J., et al. (2015). Rapid recovery protocols for primary total hip arthroplasty can safely reduce length of stay without increasing readmissions. J Arthroplasty. 30(4): 521–526. doi:10.1016/j.arth.2015.01.023
2. Goyal, N., et al. (2017). Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty. Clin Orthop Relat Res. 475(2): 364–372. doi:10.1007/s11999-016-4915-z
3. Kamara, E., et al. (2017, Jan). Adoption of Robotic vs Fluoroscopic Guidance in Total Hip Arthroplasty: Is Acetabular Positioning Improved in the Learning Curve? J Arthroplasty. 32(1): 125-130. doi: 10.1016/j.arth.2016.06.039