Hip replacement surgery, things to consider.

image of total hip arthroplasty
Total Hip Arthroplasty – Copyright: eraxion / 123RF Stock Photo

Many of the patients I see post-op after a hip replacement could care less what approach or procedure was used, (it just hurts less, or more), others ask more probing questions.

As a  result of those questions asked by post-op THA patients, I determined to compile a general overview for those contemplating the procedure. We boomers are more likely than previous generations to research such procedures and, even more likely depending on the particular search to come away with a less than complete overview of the various procedures. My intent is to provide enough information whereby you may continue with a more specifically targeted search.

Never has ‘ask your doctor’ taken on more relevance; sadly, few take the time, simply following whatever is suggested.

Hip replacement or total hip arthroplasty (THA), is currently performed at a rate of <311,000 annually.  It is not my intent in this article to present possible causation of the increases, but rather to bring resources into one place for those researching procedures/outcomes/variations among the various orthopedic facilities and hospitals.. While healthy lifestyle choices of diet and exercise are a focus of thephysicalboomer.com, it it also my intent to publish relevant information with regard to healthcare as it pertains to us boomers.

“Approach” What it means, and where it comes from.

The way a surgeon gains access to the hip during hip replacement surgery is referred to as an “approach.” There are various types of “approaches” named according to the direction that the surgery is performed.

Current (2016) procedures owe a great deal to two surgeons,  Sir John Charnley, England in the 1950s was a pioneer in the development of prosthetics and his influence can be seen today most prevalent in the US.

  The other,   Robert Judet who in 1947 at Garches Hospital in Paris performed what is now referred to as the “new” minimally invasive anterior approach THA , the  predominate procedure in Europe brought to this country in the 80s by Joel M. Matta, M.D.

Why this is important to you as a prospective patient?

Compare/contrast of various ‘approaches’

It was due to a required in-service some years ago that I became aware of the various procedures used, with time donated to my learning from an orthopedic surgeon explaining the differences even to the point of being allowed to observe in the operating room, that today cause me to be more inquisitive into my patients outcomes and remarks during rehab.

One epiphany that came from interaction with the surgeon was noticing his insistence upon suturing each of the incisions with the three procedures observed. An extra 30mins in the OR he remarked…but lowered incidence of infections, much less visible scaring, and greater patient comfort. Staples are faster!

To say that I’m a fan of the true ‘minimally invasive anterior approach’ is no stretch based on the responses of my limited patient experiences. I say ‘true’ because as with most things (including medical procedures) today, marketing is huge and there are examples in existence that use the terminology but that do not follow Dr Matta’s protocols. The requirement of a special table (HANA) or the like (a substantial investment by the facility) not to mention a steeper learning curve is the primary obstacle from this procedure being more widespread. The above referenced surgeon remarked that he didn’t really get ‘good’ at it till he had done 50-100 of them.

Incision size, location, the lack of dislocation precautions due to not having the major gluteus maximus/ hip extensor musculature disrupted are what sways my opinion, also the lowered incidence of reported “leg length discrepancies” resulting from the posterior-lateral approaches.  There are some that have reported femoral nerve problems with this procedure, so as with any online article it pays to do your own research.

It it toward that end this article was written. To learn more from actual recipients of this procedure and their results there is a forum on topix.   http://www.topix.com/forum/health/hipreplacement/TR9AI1NUGJPEEOCUQ  Begun in Nov 2007 there are currently 1934 comments.

Live well my friends,

Dennis    thephysicalboomer.com

1 http://www.webmd.com/arthritis/news/20150212/number-of-hip-replacements-has-skyrocketed-us-report-shows#1

2 https://en.wikipedia.org/wiki/John_Charnley

3 http://www.newhipnews.com/medical-professionals/about-anterior-approach/anterior-approach-history/

good images of various approaches

4 http://www.orthobullets.com/recon/12116/tha-approaches

Overview article

http://www.aahks.org/care-for-hips-and-knees/do-i-need-a-joint-replacement/total-hip-replacement/

Dated review:2013 but will give you ideas for more current searches/reviews

http://khn.org/news/medicare-best-and-worst-hospitals-for-hip-and-knee-surgery/

Review from 2016 USNews

http://health.usnews.com/health-care/best-hospitals/articles/2016-08-02/high-performing-hospitals-in-9-procedures-and-conditions

POSTERIOR VS. ANTERIOR TOTAL HIP REPLACEMENT

http://jaykrusemd.com/hip-surgery/posterior-anterior-total-hip-replacement.php

Author: Dennis C Barber

PTA, gym rat, insatiable appetite for learning, healthy eating habits, lover of good cigars...