Hip Surgery Flip! The Newest Replacement Approach

The numbers are sky-rocketing. There were more than 300,000 total hip replacements in 2010, that's up 135,000 compared to just 10 years earlier.

As more and more people need help to relieve the pain, there's an option that's becoming popular with patients and surgeons.

Jill Porter is 59 years-old and bench presses 185 pounds.

"It didn't look pretty but I was happy to have another world record," explains Powerlifter Jill Porter.

The whole time her hip was killing her. Four days later she was getting it replaced.

Doctor Stefan Kreuzer of Memorial Hermann Hospital recommended she try something new.

"It's a less invasive approach," explains Stefan Kreuzer, MD Associate Professor at Memorial Hermann Hospital.

He went through the front of her leg to get to her hip, instead of the more traditional technique of going through the back.

"Fewer muscles are cut during the surgery," says Dr. Kreuzer.

So many of the muscles we use to stand up, sit down, and walk are not detached. Direct anterior hip replacement can also mean a shorter hospital stay. Instead of three to ten days.

"The results are 98 percent of our patients stay for one to two days," says Dr. Kreuzer.

Recovery time can range from two to eight weeks, compared to twelve weeks with the posterior approach and the risk of dislocation drops too.

Jill's thrilled the surgery lifted her pain.

"I just can't even being to say the difference," explains Porter.

Now she's focused on training and adding to her 39 records.

The doctor says the normal post-operative restrictions on hip movements do not apply to patients who undergo direct anterior hip replacement.

He tells us it is great for most people in need of a hip replacement, including highly active patients. The doctor is currently training surgeons from around the world on the technique.


TOPIC: Hip Surgery Flip! The Newest Replacement Approach
REPORT: MB # 3583

BACKGROUND: Hip replacement, or arthroplasty, is a surgical procedure in which the disease parts of the hip joint are removed and replaced with artificial parts, called prosthesis. The goal of hip replacement surgery is to increase mobility, relieve pain, and improve the function of the hip joint. People who have hip joint damage that interferes with their daily activities and are not benefitting from treatment are candidates for hip replacement surgery. The most common cause of hip joint damage is Osteoarthritis, but other conditions like rheumatoid arthritis, osteonecrosis (the death of bone caused by insufficient blood supply), injuries, bone tumors, and fractures can also lead to the breakdown of the hip joint. Doctors used to reserve hip replacement surgery for people over 60 years old. They thought that older people are less active and put less stress on the artificial hip than younger people. In recent years, however, doctors have found that hip replacement surgery can be successful in younger people because technology has improved the artificial parts. Today a person's overall health and activity level is more important than age in predicting a hip replacement's success. (Source: www.niams.hih.gov)

SURGERY AND OTHER TREATMENT OPTIONS: Before a total hip replacement can be considered, the doctor may want to try other methods of treatment, like exercise, walking aids, and medication. Exercising can strengthen the muscles around the hip joint. Walking aids, such as canes and walkers, may hinder some of the stress from damaged hips. Doctors recommend the analgesic medication acetaminophen for hip pain without inflammation. If there is inflammation, treatment consists of non-steroidal anti-inflammatory drugs, or NSAIDS (aspirin or ibuprofen). Some cases require stronger medication, like tramadol or codeine. Topical analgesic products can also provide additional relief. Sometimes corticosteroids are injected into the hip joint to alleviate pain. If exercise and medicine do not alleviate pain, then doctors will recommend a less complex corrective surgery, osteotomy. This procedure involves cutting and realigning bones to shift weight from the damaged bone to a healthy one. (Source: www.niams.nih.gov)

NEW TECHNOLOGY: During a traditional hip replacement, which lasts one to two hours, the surgeon makes a six to eight inch incision over the side of the hip through the muscles and removes the diseased bone tissue and cartilage from the hip joint. The surgeon then replaces the head of the femur and acetabulum with new artificial parts. (Source: www.niams.nih.gov) However, new discoveries are allowing doctors to use anterior (front), posterior (back), and lateral (side) hip replacement techniques. The direct anterior hip replacement technique utilizes a muscle interval in front of the hip joint where muscles and tendons are not cut for joint exposure. It has some added benefits: total hip joint replacement and reconstruction, it allows the surgeon to make a smaller surgical incision (leading to less blood loss, scarring, and tissue damage), and muscles surrounding the hip joint are separated at intervals that naturally occur within the tissue (muscles are not cut so patients do not have to heal from surgical trauma as well). Patients who have had direct anterior hip replacement surgery report that the post-operative pain is remarkably less than traditional approaches. Also the recovery time is faster. Most patients get to leave the hospital after the second day and are walking with aids by the second week. (Source: www.stevenbarnettmd.com)


Linda Biehunko
Surgery Scheduler
Memorial Hermann Hospital
(713) 827-9316

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