Walking or exercising on an injured or arthritic hip can be extremely painful. And as the joint continues to deteriorate over time, it can eventually lead to the need for hip replacement surgery.
Because the hip joint is one of the largest joints in the body, replacing it is considered a major surgery.
Fortunately, when hip replacement is necessary, new technology and advances in rehabilitation techniques can ensure that patients with an artificial hip feel “almost as good as new,” said Dr. Ronald Quam, Orthopedic Surgeon at WWMG’s Orthopedic, Sports, Spine & Hand Center.
Causes of Hip Joint Deterioration
The most common cause of hip pain that leads to joint replacement is arthritis. Frequently, many patients experience arthritis in both hips that requires replacement surgery on both sides.
Although arthritis is the most common culprit, in a small number of cases, hip replacement may be necessary as a result of other causes.
“Some patients have osteonecrosis, which is when the femoral head is damaged or the blood supply to it is compromised,” said Quam. Several things can cause this to happen, including injury, alcoholism, and chemotherapy. Sometimes a severe injury can cause the head of the femur to break off in ways that make total hip replacement simpler than repair.
Treatment Interventions Before Surgery
Because total joint replacement is a major surgery, health care providers work hard to delay it as long as possible.
“Typically, we won’t recommend jumping right to surgery from the first visit unless they absolutely can’t walk or they’ve been dealing with this for a prolonged period of time with failed management,” said Quam.
When a patient has hip pain, several treatment interventions are recommended before surgery:
- a primary care provider will prescribe anti-inflammatory medication
- a physical therapist will assign exercises to help build muscle support for the hip joint
- steroid injections may be used to manage more severe pain.
When is Hip Replacement Surgery Necessary?
When the patient’s pain becomes debilitating, hip replacement surgery is ultimately recommended.
How Hip Replacement Surgery is Done
“Hip replacement consists of replacing the arthritic hip’s femoral head and acetabulum [socket] with a prosthetic implant to take the place of the old one, decreasing pain and increasing mobility and function,” said Quam.
In the past, hip replacement patients expected to spend two or three days in the hospital and then go to rehab. Now about half of hip replacements can be performed at an outpatient surgery center, with patients returning home the same day.
“The surgery itself hasn’t changed that much. The implants have improved, the pain medication has improved, the anesthesia has improved. The techniques have been refined where you lose less blood and make a smaller incision that’s more minimally invasive, which helps things. But really, it’s the education, expectations, and aftercare that have improved most significantly,” said Quam, who performs both outpatient and hospital-based hip replacement surgeries.
Anterior vs. Posterior Hip Replacement
“A lot of patients are under the impression that the recovery with anterior [front] approach hip replacement is faster than a posterior [back] approach. I do both approaches but I’m very selective about patients that meet the criteria for anterior approach,” said Quam.
Those criteria relate to the patient’s anatomy. The shape of the pelvis can increase the risk of fracture and wound complications from anterior approach, and belly fat placement can interfere with access to the hip. When it is an option, the anterior approach is more muscle-sparing, in that fewer muscles and tendons must be released from the bone, and the dislocation rates are lower.
“But in my experience the results are the same” with either approach, said Quam.
Risks of Hip Replacement Surgery
“With any surgery there is always the risk of infection, nerve damage, and blood loss,” said Quam. “But the infection rate, blood clot rate and complication rates are really low, under one percent.”
One risk that is specific to hip replacement surgery is leg length discrepancy. In rare cases, the surgery can result in one leg being slightly shorter or longer than the other.
When a patient has arthritis in both hips, leg length discrepancy can be resolved with the second hip replacement surgery. Without a second surgery, the difference can usually be accommodated with shoe inserts.
Who Needs Joint Surgery at the Hospital
Whether a patient is eligible for outpatient hip surgery depends on several risk factors.
“Age is somewhat of a limiting factor for outpatient surgery,” said Quam. For patients over 80 years old, in most cases, the hospital is the preferred setting for hip surgery.
In addition, patients with BMI over 40 are ineligible for hip replacement surgery at an outpatient facility because obesity is correlated with high complication rates. Patients whose BMI approaches the cutoff will be referred to the hospital for their surgery.
Some patients who have heart conditions may be cleared by their specialists for outpatient hip replacement surgery. But co-occurring conditions like heart and respiratory issues that can increase the patient’s risk from anesthesia are more likely to be referred to the hospital.
Physicians whose patients have surgery in the hospital also have access to robotic assistance, although this adds time and cost to the surgery. “For precision of implants for a complex total hip, [robotic assistance] does help. But for a primary, straightforward hip, my [outpatient surgery] process is pretty dialed in and I’m confident not to use it,” said Quam.
Joint Replacement Surgery at An Outpatient Facility
For eligible patients, total joint replacement at Gateway Surgery Center has major advantages over surgery at a hospital.
“The biggest benefit is cost,” said Quam. Avoiding an overnight hospital stay can save patients thousands of dollars. Unlike the itemized bills at hospitals, outpatient surgery centers bundle costs, resulting in much lower copays.
“Our infection, fracture, and complication rates at Gateway are lower than at most hospitals,” said Quam. That’s partly a result of the fact that only low-risk patients are eligible for outpatient surgery.
But having to get up and move around to go home just a few hours after the surgery does improve a patient’s recovery as compared to remaining bedridden. In addition, the education and follow-up care that is provided by Gateway’s total joint replacement team makes a positive difference in patient outcomes.
“We really cater to the patient, really educate them and follow them much more closely than they are followed at the hospital,” said Quam. “It’s also just nice to be able to go home, be comfortable, and sleep in your own bed.”
Recovery and Rehab Expectations
Before hip surgery, it is standard for patients to have a pre-op consultation with a physical therapist, then at least one PT session within a few days after surgery.
Post-surgery, all hip replacement patients have follow-up visits with their surgeon after 2 weeks, 1 month, and 3 months to monitor their recovery.
Physical therapy is part of the program at Gateway Surgery Center, which contributes to better patient outcomes. Six to eight weeks of 2x weekly physical therapy is recommended for patient rehabilitation.
“That seems to speed up the recovery. It really helps with patient safety and education as well, because it reinforces the messages about precautions and exercises, what to do and what not to do,” said Quam.
Hospital patients must arrange their own physical therapist and may end up not receiving any physical therapy following their surgery.
How Long Does Rehabilitation Take?
After outpatient hip replacement surgery, patients will be at home recovering for at least 2 weeks before resuming a normal level of activity. In addition, those with more physical jobs may have to wait up to 8 weeks before returning to work.
Most patients will fully recover in about 90 days, and their new artificial hip can be expected to last 20-30 years. “Typically, after six months patients almost forget they had the implant,” said Quam.
In Summary
Hip replacement is an effective and reliable way to overcome the pain of arthritis and regain lost mobility. And with modern advances in technology and rehabilitation techniques, patients who follow through with their rehab exercises can resume their lifestyle after surgery in just a few short weeks.
Hip Replacement Surgery in Everett
If you’re suffering from hip pain, request an appointment with WWMG’s Orthopedic, Sports, Spine & Hand Center. Our experienced Orthopedic Surgeons can evaluate your hip pain and recommend treatment options, including if surgery is needed. If it is, ask about outpatient surgery at WWMG’s Gateway Surgery Center in Everett.
We look forward to supporting you in good health, so you can stay active and have a positive quality of life.