Hip Replacements

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. The hip joint is one of the body's largest weight-bearing joints, located between the thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint.

Several diseases and conditions can cause damage to the articular cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.

Disease Overview

Arthritis is inflammation of the joints resulting in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability. The three most common types of arthritis that affect the hip are:

• Osteoarthritis: It is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage wears down, the bone ends rub against each other and cause pain in the hip.
• Rheumatoid arthritis: This is an autoimmune disease in which the tissue lining the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). This leads to loss of cartilage causing pain and stiffness.
• Traumatic arthritis: This is a type of arthritis resulting from a hip injury or fracture. Such injuries can damage the cartilage and cause hip pain and stiffness over a period.

Symptoms

The most common symptom of hip arthritis is joint pain and stiffness resulting in limited range of motion. Vigorous activity can increase the pain and stiffness which may cause limping while walking. 

Diagnosis

Diagnosis is made by evaluating medical history, physical examination and X-rays.

Surgical Procedure

Surgery may be recommended, if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms.

The surgery is performed under general anesthesia. During the procedure, a surgical cut is made over the hip to expose the hip joint and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone is removed using a reamer. The acetabular component is inserted into the socket using screws or occasionally bone cement. A liner made of plastic, ceramic or metal is placed inside the acetabular component. The femur or thigh bone is then prepared by removing the arthritic bone using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place using special cement.  The muscles and tendons around the new joint are repaired and the incision is closed.

Risks

As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement include:

• Infection
• Dislocation
• Fracture of the femur or pelvis
• Injury to nerves or blood vessels
• Formation of blood clots in the leg veins
• Leg length inequality
• Hip prosthesis may wear out
• Failure to relieve pain
• Scar formation
• Pressure sores

Total hip replacement is one of the most successful orthopedic procedures performed for patients with hip arthritis. This procedure can relieve pain, restore function, improve your movements at work and play, and provide you with a better quality of life.

Total joint replacement surgery is one of the most advanced successful procedures in patients dealing with severe hip and knee pain. The goal of the surgery is to relieve pain and restore the normal functioning of the joint and help patient resume normal activities.

Over the past few years, there have been great advances in the treatment options, implants, and minimally invasive techniques. The latest technique in joint replacement such as anterior hip replacement has resulted in a dramatic improvement in outcome.

What is direct anterior approach hip replacement surgery?

Direct Anterior Hip Replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles or tendons.  Traditional hip replacement involves cutting major muscles to access the hip joint. Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions to allow the cut muscles to heal.

However, for Anterior Hip Replacement patients, hip precautions are not necessary as no muscles are cut.

Anterior Hip Replacement surgery can be done on an "outpatient basis".

Advantages of both anterior hip replacements include:

• Less postoperative pain
• Minimal soft-tissue trauma
• Smaller incision
• Less scarring
• Minimal blood loss
• Shorter operative time
• Quicker recovery
• Early mobilization
• Less postoperative restrictions
• Quicker return to normal activities
• Short hospital stay

Indications:

Revision hip replacement is advised in patients with the following conditions:

• Increasing pain in the affected hip
• Worn out plastic or polyethylene prosthesis
• Dislocation of previous implants
• Loosening of the femoral or acetabular component of the artificial hip joint
• Infection around the hip prosthesis causing pain and fever
• Weakening of bone around the hip replacement (Osteolysis)

Risks:

As with any major surgical procedure, there are certain potential risks and complications involved with revision hip replacement surgery. The possible complications after revision hip replacement include:

• Infection
• Dislocation
• Fracture of the femur or pelvis
• Injury to nerves or blood vessels
• Formation of blood clots in the leg veins
• Leg length inequality
• Hip prosthesis may wear out

Failure to relieve pain

Traditionally, total hip replacement will be performed through a 10–12-inch-long incision made on the side of the hip. A minimally invasive approach has been developed in recent years where surgery is performed through one or two smaller incisions rather than the single long incision as in the traditional approach. Advantages of the newer approach are lesser muscle dissection, minimal pain, quicker recovery, and faster rehabilitation.

Anterior approach total hip is considered a minimally invasive approach

Anterior approach muscle sparing technique allows for this surgery to be performed in an ambulatory or outpatient basis. Also improved strategies regarding pain control and physical therapy improve the success of outpatient total hip replacement.

Procedure

Outpatient hip surgery is designed to allow surgeons to replace the damaged hip bones through a relatively small incisions. The single incision measures around 3 to 6 inches compared to 10 to 12 inches for traditional surgery and is usually placed on the anterolateral aspect of the thigh. The muscles and tendons are separated to expose the hip socket and femoral head, like traditional surgery, but to a lesser extent. The head of the damaged femur is removed and the hip socket is cleaned. The stem and ball prosthetics are then fitted into the end of the femur and cement may be used to secure them. The hip is then rejoined and the surrounding tissues are brought back to the normal position. As the incision is very small, fewer muscles and tendons are traumatized.

Advantages

The benefits of outpatient hip surgery are:

• Smaller incisions
• Less scarring
• Less blood loss
• Shorter hospitalization
• Early return to work
• Shorter rehabilitation
• Less tissue trauma

Robotic-assisted surgery is a minimally invasive procedure where your surgeon is assisted by a robotic system to perform the surgery.

The robotic system consists of a surgeon’s console, robotic arms, a high-performance vision system and special surgical instruments. A computed tomography (CT) scan is taken before the surgery to create a 3D model of the affected hip or knee joint. This is interpreted by the system, which accurately guides your surgeon. Unlike a traditional surgery, this procedure is performed through small incisions. The 3D camera provides your surgeon with a magnified view of the operating area. Your surgeon sits at a console and controls the movement of the robotic arms holding the special surgical instruments. The movements of your surgeon’s hands are translated by the robotic system into precise movements of the miniaturized instruments that are held by the robotic arms.

The enhanced vision and superior control of the micro-instruments improves the precision of the surgery. This accuracy helps repair the damaged joint and optimally position any prosthetic implant for a more natural feeling joint after surgery, while ensuring minimal injury to neighboring tissues. Being a minimally invasive procedure, benefits include less post-operative pain, shorter hospital stay, rapid recovery and faster return to daily activities when compared to traditional joint surgeries.

Candidates for robotic-assisted surgery include:

• Osteoarthritis of the knee
• Degenerative hip disease
• No relief from pain and disability with non-surgical treatment and medication
• Partial knee resurfacing
• Total hip replacement

Makoplasty Total Hip Replacement

Degenerative joint disease (DJD), a common cause of hip pain, is a chronic condition hampering the quality of life of affected individuals. There are different types of DJD and the most common ones include osteoarthritis (OA), post-traumatic arthritis, rheumatoid arthritis (RA), avascular necrosis (AVN), and hip dysplasia.

MAKOplasty® Total Hip Replacement is a novel surgical alternative for patients with degenerative joint disease (DJD).  In this procedure a Robotic Arm Interactive Orthopedic System (RIO®) assists the surgeon in aligning and positioning implants more precisely.  

MAKOplasty can be considered in patients with pain while bearing weight on the affected joint, pain or stiffness in the hip while walking or performing other activities, and also in patients not responding to a conservative line of management.

Makoplasty procedure

Accurate placement and alignment of the hip implant is crucial in hip replacement surgery. MAKOplasty® Total Hip Replacement utilizes a CT scan of the patient’s hip to generate a 3-D model of their pelvis and femur. This aids the surgeon in planning your surgery.

During surgery, the RIO® software provides dynamic information to enhance accuracy of the procedure. Such real-time information assists the surgeon in precise placement of the implant, which can be difficult to achieve with traditional surgical techniques.

The benefits of MAKOplasty® Total Hip Replacement include:

• Precise placement of the hip implant using the surgeon-controlled robotic arm system with a decline in the possible risk of hip dislocation
• Uniformity in leg length, reducing the requirement of a shoe lift
• Increased longevity of the implant due to a reduction in abnormal rubbing between implant and bone

Robotic Arm Interactive Orthopedic System (RIO®)

The RIO® Robotic Arm Interactive Orthopedic System has three-dimensional pre-surgical planning. During surgery, the RIO® provides the surgeon with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning. Such optimal placement can result in a more natural hip motion following surgery.

RIO^® Features:

• Accurately plan implant size, orientation and alignment utilizing CT-derived 3-D modeling
• Enabling the pre-resection capture of patient-specific kinematic tracking through full flexion and extension
• Real-time intra-operative adjustments for correct hip kinematics and soft-tissue balance

Minimally invasive and bone sparing, with minimal tissue trauma for faster recovery