Arthritic Hip Surgery
When non-operative treatments for hip pain due to arthritis fail to work, surgery may be indicated.
Surgical options include hip arthroscopy, resurfacing and total hip replacement.
Hip arthroscopy is usually an outpatient procedure to repair torn cartilage (aka the labrum) and to remove extra bone that occurs in the very earliest stages of arthritis using small stab incisions around the hip to allow for insertion of the arthroscope (tiny camera). It is rarely indicated for patients over 50 years of age.
Total Hip Replacement
Total hip replacement is the gold standard for disabling hip pain. It can be indicated in all ages, sexes, and activity levels, although generally speaking it is best to do after the age of 60 because of the risk of reoperation after 15 to 20 years due to mechanical failure. It can be performed through various approaches (front, back, side) with various implant designs. Currently the most common designs are made out of titanium with metal heads against the newest plastics. Other materials may be used for the head/ball and liner (e.g., ceramics) in selected cases. It is extensive surgery that requires inpatient hospitalization for 1-3 days, and recovery usually takes 6-8 weeks.
Factors that include the size of the patient, the complexity of the surgery, and surgeon preference. Most studies have shown that smaller incisions offer no improvement in pain or recovery and may actually worsen the surgeons’ ability to adequately perform the procedure.
It is often quoted that total joint replacements last "15-20 years." This is not the ideal way to interpret the longevity of total joint replacements. The more accurate way to think about longevity is via the annual failure rates.
Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint today, you have a 90-95% chance that your joint will last 10 years, and 80-90% that it will last 20 years. With improvements in technology, these numbers may improve.
Different Approaches to Hip Surgery
When a hip is replaced, the way a surgeon gains access to the hip is referred to as an "approach." There are various types of approaches named according to the direction that the surgery is performed. The most common approach today is referred to as the “posterior approach” and this is done from the back of the hip. Some more recent improvements to this approach (small incision and less tissue trauma) have been called “mini posterior approach.”
Another currently popular approach is known as the “anterior approach,” because it is performed from the front of the hip. The lateral approach is less popular. There are pros and cons of each approach and little science to endorse one over the other. A conversation with your surgeon should help decide which approach is the best for each patient.
Minimally Invasive Hip Surgery
Minimally invasive surgery is a term that describes a combination of reducing incision length and lessening tissue disruption beneath the incision. This includes cutting less muscle and detaching less tendon from the bone. Combined with these techniques are advancements of anesthesia and pain management that take place around the surgery. All of this combines to allow patients to feel better, have less pain, and regain function faster than in the recent past.
The size of the incision is variable, and depends on several factors that include the size of the patient, the complexity of the surgery, and surgeon preference. Most studies have shown that smaller incisions offer no improvement in pain or recovery and may actually worsen the surgeons’ ability to adequately perform the procedure.