Hip Disorders

Treatment Options

Total Hip Arthroplasty
Total hip arthroplasty is one of the most successful medical procedures ever invented. This procedure can treat a wide variety of disorders that ultimately lead to severe arthritis of the hip. Arthritis is characterized by destruction of the articular cartilage and direct contact of the bony surfaces of the hip socket and femoral head. This can lead to pain, stiffness, inability to walk, difficulty sitting, and other disabilities. The main goal of total hip replacement is to relieve pain. However, many patients have the ability to walk farther after the procedure and often no longer require walking aids after the surgery.



You may need a total hip replacement if :

• Other treatments such as medicine, steroid injections and physical therapy, no longer stop your pain or help movement of the joint.
• The pain or poor movement in your hip prevents you from doing your normal activities

FAQ - Hip Arthroscopy

• What are current hip replacements made of?
• Most contemporary metal hip replacements are made of titanium alloys or cobalt-chromium alloys. The best way to understand the implants used in current replacements is to divide them into two parts. First is the metallic components that are directly fixed to the bone. These can be either through the use of cement (mostly on the femur or thigh-bone) or through a cementless or ingrowth process where the bone actually grows onto the metal. The second part of the hip replacement is made of the parts that actually move relative to one another (the bearing). These can be made of either metal on polyethylene plastic (most common) or other bearings such as ceramic-on-ceramic or metal-on-metal.
  
  
• How long will I be in the hospital?
• In most cases, patients remain in the hospital at our facility for a minimum of 2 days and usually 3-4 days.
  
  
• Can I put my full weight on the leg after a hip replacement?
• In most cases of ingrowth prostheses, we restrict the amound of weightbearing on the leg for 4 to 6 weeks. This has been shown to lead to decreased risk of the stem collapsing into the femur
  
  
• When do you use bone cement?
• Bone cement has had a long history of use in total hip replacement. Over the past 15 years, its use has declined due to the risk associated with loosening of cemented joint replacements. In our efforts to improve on the results of the cemented joint replacements, a number of cementless implants have been developed. Cementless implants depend on the ingrowth or ongrowth of bone onto their surface. The various surfaces can be made of a roughened surface, a surface with small beads, or a fibrous metal mesh. The cementless implants on the socket side have performed exceedingly well. A number of earlier cementless implants on the femoral side did not perform as well as cemented femoral components. However, we have learned important lessons about factors that are associated with success in cementless femoral components. Currently, a number of published reports have shown that some cementless femoral and acetabular designs have a 98 to 100% success rate at 10 years. These are equal or better to many cemented designs at the same time intervals. We currently use predominantly cementless designs unless we are concerned about the fixation of such implants. In such cases, cemented implants offer immediate fixation to bone and permit immediate weightbearing for the patient.
  
  
• Do hips wear out?
• Total hip replacements can wear out. This has been associated with higher activity, with polyethylenes with poor mechanical properties, and with larger diameter femoral heads. Currently, with bearing surfaces such as highly cross-linked polyethylenes, metal-on-metal, and ceramic-on-ceramic, the rates of wear in hip replacements may finally be controlled.
  
  
• Can I jog after my hip replacement?
• No published study has documented the clinical outcome of hip replacements in patients who are runners. However, the association of higher failure rates with younger, more active patients suggest that such activities may lead to an earlier need for revision surgery.
  
  
• Do I have to follow any other precautions after my surgery?
• Depending on the approach, there will be certain precautions/positions to avoid after hip replacement. For most posterior approaches, the patient is asked to avoid bending their hip greater than 90 degrees, to avoid turning their knee in (internal rotation) during activities like picking up an object from the floor, and to avoid deep, cushioned couches. Anterior or lateral hip approaches often require anterior hip precautions (no turning out of the foot while standing or lying flat).
  
  
• Will my leg lengths be equal after the surgery?
• Your surgeon will make efforts to achieve equal leg lengths after the surgery. The most important factor in success after total hip replacement is the achievement of a stable hip (a hip that does not dislocate). The stability of the hip depends on the positioning of the implants, the tightness of the soft-tissues, and the bony anatomy. In some cases, the leg needs to lengthened slightly in order to achieve adequate soft-tissue tension.
  
  
• What would happen if my hip dislocates?
• A dislocated hip can occur during activities in which the precautions are not followed or as a result of soft-tissue laxity or impingement. Impingement is a situation where the component or bony structures contact each other in such a way that they push the hip out of socket.
  
  
• What if I have a car accident with a hip replacement? Can the bone break around the replacement?
• Yes, trauma of any kind after a hip replacement can lead to very severe fractures which are even harder to treat that a fracture without a hip replacement. The treatment of these injuries often requires either the use of plates and rods or the revision of the hip replacement entirely with placement of a new, long femoral component to span the fracture.
  
  
• What is resurfacing total hip replacement?
• Resurfacing total hip replacement is a type of hip replacement that places the femoral component on the neck of the femur rather than passing a stem down the shaft. The cup component in the hip socket is usually a one piece all metal component.