© 2019 by Orthopaedic Research Clinic Alaska

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The American Board of Orthopaedic Surgery

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Hip

Hip Procedures

Your hip is a pivotable joint to our body, working together with tendons, bones, and muscles collectively to move the body and propel us through life, which is why mobility is crucial. The most common mobility deficiency resides in the hips, possibly because of the “ball and socket” anatomy giving you ability to rotate and move forward, and the stability to be able to hold your bodyweight, or because of overuse and wear-and- tear of constantly being in motion.
 

Hip replacement surgery is a common procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief. We here at ORCA advocate nonoperative care whenever possible but understand that operation may be the only solution. If it is determined that surgery is necessary,

 
Total Hip Replacement/Arthroplasty

The purpose of total hip arthroplasty or replacement is to provide pain relief for most types of hip arthritis and improve the patient’s overall quality of life. Most patient are asked to try non-operative treatments before undergoing THR. Some non-operative treatments include activity modifications, using a cane, and medications to manage pain and inflammation. While these non-operative treatments cannot reverse hip arthritis, these treatments can delay the need for total hip arthroplasty.

Arthritis refers to joint inflammation. More than 100 different conditions can cause inflammation of the joints and lead to the permanent destruction of the cartilage of the hip. Cartilage is the hip’s weight-bearing surface. The surface of healthy cartilage in humans is more slippery to help the joints in the hips move comfortably and without pain.

In total hip arthroplasty, the surgeon will remove damaged cartilage and bone and insert prosthetic components as a replacement. The surgeon removes the damaged femoral head and inserts a metal stem in the femur’s hollow center. The femoral stem can be “press fit” or cemented into the femur. A ceramic or metal ball is inserted to take place of the damaged femoral head. A metal socket will replace the socket’s damaged cartilage surface. Cement or screws may be needed to keep the socket in position. A metal, plastic, or ceramic spacer provides a smooth gliding surface between the new socket and ball.

Minimally Invasive Anterior Hip Replacement

The anterior approach for total hip arthroplasty is an alternative to traditional hip replacement surgery. Minimally invasive anterior hip replacement allows for faster recovery, less pain, and improved mobility because the healthy muscle tissues are spared during the operative procedure. The anterior approach allows the physician to work between the tissues and muscles without detaching the muscles and tissues from the thigh bones or hip. This technique spares tissue from the trauma. The surgeon tries to keep muscles intact in order to avoid dislocations. The surgeon uses the anterior approach to insert on incision on the anterior of the hip rather than the back or side.


The incision is located in the front, so the patient doesn’t have to deal with the pain of sitting on or applying pressure to the incision site. Anterior hip replacement also allows for fewer restrictions during the process of recovery. Different patients will respond differently to the anterior hip replacement procedure. However, most patients are able to bear their full weight and bend their hip freely soon after the surgery.


Since anterior hip replacement involves only one small incision, the potential for scarring is reduced. Anterior hip replacement often allows for the stability of the implant after the surgical procedure. The implant becomes stable more quickly because the key tissues and muscles are not disturbed during the surgery.

 
Total Hip Revision

For most patients, total hip replacement proves to be a reliable and effective procedure. During this traditional procedure, the surgeon will insert a mechanical system with ball and socket parts. These parts are assembled prior to the procedure. This prosthetic ball and socket restores movement to the hip during the prosthesis’ lifespan. However, mechanical devices used for total hip replacements can suffer from biological or mechanical failure. If the mechanical device fails, the patient may need to undergo re-operation for the hip replacement to deal with the failure of the mechanical device. Total hip revision refers to a re-operation of the total hip replacement.


Most elderly patients who undergo a hip placement procedure will be able to retain the prosthesis for up to decades. Some elderly patients are able to keep their prosthesis for life. However, other patients end up requiring one or multiple revisions of the hip placement. This is especially true if the patient undergoes the original hip replacement surgery at a young age and leads a very active physical lifestyle.


The preoperative investigations for patients who need to undergo revision surgery are usually more thorough and extensive than the investigations required for patients undergoing a primary surgery. In many cases, a patient will need to undergo special x-ray projections, MRIs, and CT scans of the hip to identify the position and fixation of the mechanical parts. The results of these imaging tests will help determine the severity of the bone loss surrounding the failed implant. A preoperative fluid sample and blood work may be required if the surgeon believes the failed hip is infected.


In the United States, revision hip replacement is a fairly uncommon procedure. For every 100 hip replacement procedures performed, there are about 18 revision hip replacement procedures performed. The main reasons for revision hip replacement are mechanical failure, repetitive dislocation of the hip replacement, and infection.

 
 
Hip Core Decompression

Osteonecrosis refers to a disease that can ultimately lead to joint destruction if left untreated. While osteonecrosis can impact any joint in the body, this condition most frequently afflicts the hip. Doctors are uncertain about the main cause of osteonecrosis. However, physicians have managed to identify a number of factors that appear to contribute to the disease. The treatment options depend on the severity of the disease. In the advanced stages, a patient will need to undergo a total hip replacement. However, other alternatives are available if the disease is diagnosed early enough. Core decompression is one of these alternatives. A surgeon can perform core decompression by drilling a small hole in the diseased hip bone.


According to many studies, a diseased bone experiences an increase in pressure within. This rise in pressure is the cause of pain in most patients. In some cases, the pain associated with the rise of pressure becomes intolerable. The purpose of core decompression is to reduce the pressure within the bone, which is a very rigid structure. Over time, the drill hole becomes filled with tissue. Sometimes, new bone develops in the area of the drill hole. This procedure may boost blood and help new blood vessels form in the diseased area of the bone. The core decompression procedure seems to slow the progression of the disease and even stop the progression in some cases.


In the right circumstances, the core decompression procedure will prove to be an effective treatment option for osteonecrosis. The results of this procedure are usually optimal in the earlier stages of osteonecrosis. If the joint has already collapsed, the core decompression procedure tends be far less effective, but pain relief often still occurs. If the x-rays turn out normal but the hip is painful, core decompression is an optimal treatment. The results are usually better if the procedure is performed by an experienced surgeon. The rate of complications tends to be higher with surgeons with lack of experience with the core decompression procedure.


One of the main features of a core decompression procedure is that it does not hinder the potential for future surgical treatment if the disease progresses. This procedure is simple and the recovery process is fairly painless and quick. Usually, pain relief occurs immediately or rapidly after the procedure.