What is arthritis?

Arthritis it the process inside a joint when cartilage is worn down. This may be due to a slow mechanical process (osteoarthritis), chronic inflammation (inflammatory osteoarthritis), or in response to prior traumatic injuries to the joint (post-traumatic). In all these situations, the protective covering of the joint is broken down. This leads the joint to lose the normally smooth, low-friction movement and causes the joint to become stiff and painful.

What is a hip replacement?

A hip replacement is a surgery that is used to relieve pain and improve function in an arthritic hip joint. When arthritis causes the hip joint to lose the protective cartilage, it can become painful and stiff. This can make it difficult to walk, bend, or twist, and severely limit your quality of life. The hip joint is a ball in socket joint. A hip replacement cuts off the arthritic, damaged head of the thigh (femur) bone, the ball, and then uses a titanium (or other metal) stem that fits into your femur to restore this damaged bone. For the socket, we shave off the arthritic bone and place a titanium cup into the molded bony space in your pelvis (acetabulum). Between the two implants, there is a thin piece of plastic (high-molecular-weight polyethylene) that is specially designed to prevent wear down, and this acts as your new cartilage, allowing smooth, easy motion. During the surgery we use anatomic landmarks, intra-operative x-rays, or some form of navigation or robotics to help restore your hip to how it was before arthritis caused it to breakdown.

“Anterior” versus “Posterior” hip replacement?

There are many ways for the surgeon to get down to the hip joint and perform the necessary surgery to replace the hip joint. These different approaches to the hip have different benefits.

An anterior approach allows the surgeon to perform the surgery with the patient lying down flat. This approach is more stable than the posterior or lateral approaches, and allows you to get to the hip without cutting or splitting any muscles. After surgery, patients get up and get moving a little bit faster and don’t have strict precautions after surgery. This approach may not be ideal for patients who are larger with a larger belly, because the belly can hang over a portion of the incision, making it harder for the wound to heal, and raising concerns for possible drainage or even infection. Given the quicker recovery and less restrictions after surgery, Dr. Bradley prefers to use this approach for the average patient.

A posterior approach requires the surgeon to have the patient lying on their side during the surgery. The approach allows easier extension, which is particularly helpful when performing a revision surgery, or in more complex cases, when a minimally-invasive approach is not appropriate or safe. For larger and more complex patients, this may be a better approach. The downside to this approach is that there is slightly higher risk for instability (hip dislocation), so patients are often restricted from certain movements during the initial healing process, although there is some evidence these restrictions may be unnecessary.

Dr. Bradley will discuss the preferred approach for your specific situation, taking into account everything about your unique situation!

What about outpatient hip replacement surgery, can I go home afterwards?

As joint replacement surgery has gotten safer and our technology and protocols surrounding surgery have improved, the need to keep patients in the hospital after surgery to monitor them after surgery has become less common. In order to determine if you are healthy enough to recover from surgery at home, Dr. Bradley will talk with you about your current medical issues and what support you will have at home. For those patients that are healthy enough to have outpatient surgery, studies have shown that it is safe, without higher risks of medical or surgical complications, and an overall higher level of satisfaction with the surgical experience.

How is the implant secured to the bone, cement versus cementless?

There are two main ways that we secure the implants to the bone to make sure everything is stable after surgery. For most hip replacements, we use “cementless” implants that have special coatings or designs to allow the bone to actually grow directly into the implant. Recent technologic developments in the materials and implant design we use have improved these to allow them to be more stable and last longer. Sometimes for the socket (cup or acetabulum), we will use a screw or a few screws to help further stabilize the implant and protect it while the bone initially grows into the implant. We will especially use this in people with softer bone.

For the stem (femur or thigh implant), we will again often use these “cementless” implants that are inserted directly into the thigh bone. In order to place these implants, we slowly dilate the bone using tools, and identify the specific size of your thigh bone. We then place an implant that fits your specific bone size. If your bone is thinner, or you are older, sometimes we will help support the stem by using a medical-grade cement (polymethyl methacrylate) to help “stick” the femoral stem implant into the bone, and this will lower the risk of the bone breaking for patients at risk.

Dr. Bradley will help decide on the best implant for you specifically, but he is happy to discuss the options and the reason for his decisions, just ask!

How long do these implants last for?

While there is no expiration date on these implants, over time, there is a risk that the plastic insert used to allow smooth motion inside the hip joint can slowly wear down. There’s also a small risk that the implants can loosen from the bone. These implants are expected to last 20-30 years, or even longer.

Can I get more information?

Please read through my specialized patient guide to knee replacements, that provides information about both full and partial knee replacements. This document provides information from the time before surgery up through your recovery.