NOT your grandma’s hip replacement

Zachary D. Post, M.D. September 28th, 2012

When you hear the words, “hip replacement” you probably picture a very old person who uses a walker and spends most of their day watching games shows and soaps. In the past, that may have been true, but things have changed. There have been several important advancements in the past 10 years that have completely changed the type of implants that are used and how they are put in.

New plastics have almost eliminated the possibility of hip replacements wearing out. Not that long ago I would tell patients to plan on their hip lasting 10 to 20 years. Now, I routinely tell patients to expect their hip replacement to last the rest of their lives. Patients in their early 50′s were routinely told to wait until they were older before having a hip replacement. Now, age is only a minor consideration. Not having to worry about your hip “wearing out” is a significant improvement over the old days.

In addition to new materials, we have new ways of doing hip replacement. Traditionally a hip replacement was done from the back, meaning it was put in from the back side of the hip. In fact, still today, the vast majority of hip replacements are put in this way. However, your hip needs stability in the back more than any other place. Activities such as bending over, putting on your shoes, even turning over in bed put stress on the back portion of your hip. When a hip replacement is put in through the back it weakens the ligaments that stabilize the hip during those activities. Subsequently, many people who have a hip replacement from the back are given restrictions to prevent their hip from “coming out”. These can be as simple as not bending more than 90 degrees (try putting your shoes on without doing that) to as complex as having to sleep with a pillow between their legs. Patients who have had a hip come out of the socket live in fear of it ever happening again. That was the old way.

This new way of putting a hip replacement in is called the anterior approach. You’re likely to hear it called the anterior hip. Less chance of the hip coming out is only the beginning. This anterior hip is so much more stable that patients are no longer given restrictions after hip replacement. That’s right, no restrictions. After an anterior hip replacement you can do anything you want to. Anything. I have patients who hike, bike and hunt. I even have one lady who water skis. In the past some of those activities were unthinkable after hip replacement.

Another big difference between the anterior hip and the old way of doing things is the recovery. Traditionally, patients who had a hip replacement would spend 5 to 7 days in the hospital. Often they were allowed to put only 50% of their weight on their new hip for up to 6 weeks. This could mean using a walker for months. With the new anterior hip, a patient who has a hip replacement on Monday morning will walk, putting their full weight on the new hip, on Monday afternoon! In most cases we are able to send patients home from the hospital the next day. I feel that this faster recovery leads to less pain and fewer complications. In addition, it means getting back to work sooner and more importantly, getting back to your life sooner.

One final advantage of the anterior hip is one that is difficult to measure. In my patients’ experience, it feels more natural much sooner after surgery. Unlike the traditional methods of doing hip replacement, we don’t cut any muscle with the anterior hip. That means the muscle recovers more quickly and it feels more like your own hip sooner. In fact my patients will often say that within a few months after their anterior hip replacement they forget which hip they had replaced. It’s almost like the arthritis never happened. In my mind, that is the measure of a successful operation.

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