Hip replacements become even more common
Valley View Hospital
Total hip replacement, also known as hip arthroplasty, is a common orthopedic procedure and, as the population ages, it is expected to become even more so. While hip replacements are not as common as knee surgeries, approximately 332,000 total hip replacements are performed in the United States each year, according to the Centers for Disease Control and Prevention.
During this surgical procedure, the diseased parts of the hip joint are removed and replaced with new, artificial parts known as the prosthesis. The goals and benefits of hip replacement surgery include increasing mobility, improving the function of the hip joint and relieving pain so that patients are able to resume normal, everyday activities.
The traditional surgical approach to total hip replacement used a large incision on the side of the hip, cutting through muscles and tendons that would have to be repaired at the end of the procedure. Dr. Robert Adams, who recently joined Valley View to launch the Glenwood Orthopaedic Center, since March 2012 has been doing a new approach using a much shorter anterior (frontal) incision that goes between muscle planes. This anterior approach spares the need to repair muscles or tendons at the end of the procedure. The benefit of this approach is that it dramatically reduces post-operative pain, and also enhances the speed and ease of recovery.
According to Adams, this direct anterior approach has three main benefits:
1. Much faster recovery. Most patients are only using assistance in walking for the first week.
2. X-ray guidance is utilized to ensure perfect size and placement of the new prosthesis.
3. Lower chance of post-operative dislocation as the muscles are left intact.
Two new adjuncts that Adams uses are the medications tranexamic acid and Exparel. Tranexamic acid decreases blood loss after surgery. In the past, the patient would donate blood prior to surgery. This is no longer necessary now that the need for a blood transfusion after hip replacement is less than 3 percent. Exparel is a long-acting local anesthetic pain reliever injected into the muscles around the hip joint that helps control pain for up to three days after surgery.
People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis, a chronic inflammatory disease that causes joint pain, stiffness and swelling; osteonecrosis or avascular necrosis, which is the death of bone caused by insufficient blood supply; injury, fracture and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
“Ninety-five to 98 percent of the cases are patients with hip joints that are just simply worn out, and most of that is genetic,” says Adams. “I like to use a tire analogy. Some people are born with cartilage (tread) that has a 15,000-mile warranty while others have cartilage with a 60,000-mile warranty. If you have poor-quality cartilage, your hip joint may wear out earlier in life.”
In the past, doctors reserved hip replacement surgery primarily for people older than 60. Historically, the thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well.
The new technology has improved the artificial parts, allowing them to withstand more stress and strain. Longer-lasting materials have been developed, such as ceramic femoral heads, as well as much more durable plastic liners. This may allow new hip joints to last 25 years or more. Today, a person’s overall health and activity level are more important than age in predicting the success of a hip replacement. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes.
For the majority of people who have hip replacement surgery, the procedure results in:
• Decreased pain
• Increased mobility
• Improved daily living activities
• Improved quality of life
Before considering a total hip replacement, Adams says your doctor may try other methods of treatment, such as exercise, walking aids and medication. An exercise program can strengthen the muscles around the hip joint. Walking aids, such as canes and walkers, may alleviate some of the stress from painful, damaged hips and help you to avoid or delay surgery.
For more information, contact Dr. Adams or his staff at Glenwood Orthopaedic Center at Valley View Hospital. 970-384-7140.
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