HIP REPLACEMENTS DR. GIRLING DISCUSSES TOTAL HIP REPLACEMENTS
“I THINK THE BIGGEST MISCONCEPTION IS THE STIGMA AROUND HAVING A REPLACEMENT”
The hip joint is a “ball and socket” joint. The socket area (acetabulum) is inside the pelvis. The ball part of this joint is the top of the thigh bone (femur). It joins with the acetabulum to form the hip joint.
In a total hip replacement, we remove the ball, clean out the socket, and put in metal and plastic to make up for bone and cartilage loss. Because the center of gravity of our body is focused between the two hips and its force is exerted onto the hips, we remove a little bit more bone than we would for a knee replacement. We spread those forces out into the thigh bone to make sure that the hips are going to stay stable and last a long time.
TOTAL HIP REPLACEMENTS ARE INTERESTING BECAUSE MOST PATIENTS WILL COME IN NOT EVEN REALIZING THAT THE SOURCE OF THEIR PAIN IS COMING FROM THE HIP JOINT.
Hip pain, mainly happens in the groin. For patients who come in with really bad groin pain, that's not responding to other treatment options, we consider a total hip replacement. Because there's a lot of different reasons for a total hip replacement we tend to a wide age-range of patients.
Depending on the disease process in the hip joint, total hip replacements are a great option. Before we commit to replacement surgery, we make sure we've explored other paths to confirm the pain is not going to get better without surgery. In some instances, smaller surgeries may not solve the problem thus leading to a total hip replacement.
Just as any other replacement or surgery, our biggest concern is going to be infection. Managing risk factors and making sure we reduce the risk of infection is going to be key. Fortunately for us, the risk of infections in our patients is much, much lower than the average, but still something I always worry about.
When we do a replacement, we try to get your leg length as close to even as possible. Sometimes we have to adjust the length to be longer or shorter based on the soft tissue and nerve to make sure you have good stability. That’s always a risk—that it's not going to be exactly the same as the other side.
Likewise, we worry about fractures around the implants. Especially, if you were to have a fall. That's a big one! To prevent those situations, we recommend using walking aids. Similarly, we worry about the nerves around the hip joint. However, we are proactive about taking measures to ensure we're protecting that nerve. Lastly, we worry about the effects of administering an anesthetic—as one would with any anesthesia procedure. We worry about blood clots, the heart, the lungs, and making sure we're safe and healthy for surgery.
Rest assured, all the details of the process are certainly going to be discussed before we ever enter the operating room.
For select patients, we actually do ‘outpatient,’ a medical treatment that does not require being admitted to a hospital. With ‘outpatient’ we can have you at home—you can be with your family, your loved ones, you can work rehab at home, and home health will typically come to you. Or, we can always do traditional surgery.
WHEN WE DO A HIP REPLACEMENT, YOU'RE GOING TO BE UP AND WALKING THE SAME DAY.
The goal is to get you out of bed and moving right away. Hip replacements, on average, tend to allow functional recovery a little bit faster than a knee replacement, so patients are back to moving a little bit quicker.
The slower portion is learning how to balance after a hip replacement. A lot of patients going into a hip replacement have really bad weakness in the muscles around the hip joint because the joint suffered problems for a while. In the process of easing the pain, the joint becomes compromised.
You're using the walking aids, for as little as one to two weeks. Some patients only need the walking aids for as long as four weeks. But, really, it's not because you're leaning on the walking aids. It's mainly to help get rid of the limp that you've had for a long time.
The patient will be getting a lot stronger and will be getting rid of that limp in about four to six weeks, on average. At three months is when we consider the replacement completely healed. In that time, you're going to be adding new activities, things you haven't been doing. Then, full recovery. We say you keep on getting better for a full year, but you're doing a lot before that.
TOTAL HIP REPLACEMENTS ARE ONE OF THE MOST SUCCESSFUL SURGERIES IN ALL OF MEDICINE.
Patients do extraordinarily well with these surgeries, on average.
The biggest thing, as with all of the surgeries that we do, we worry about falls and trauma, but in terms of activity level, you're doing so much more than you were before surgery. The recovery is relatively quick as long as you can put in the time and effort to work with the therapist to make sure we get you strong.
The downside is, if there ends up being a complication, it does end up being one that can really limit you. If you talk to patients and you find somebody who's having a problem, they're certainly going to be vocal about it as complications become limiting to the patient. And, it’s a valid point. Because there’s a chance, you've got to make sure you really know the details of the upcoming process.
That being said, it's such a great surgery and patients do overwhelmingly well. You’re moving again and you don't have many restrictions. I'd say, in general, you're going to see a lot of improvement right away.
So, it's a great surgery. I think the biggest misconception is the stigma around having a replacement. But, I really recommend it to people who are having pain and experiencing limitations but haven’t found treatment. Please consider it.
Because we are using new approaches to hip replacements—and, there's a lot of different approaches—don't fall for the advertising where somebody says, “Oh, my goodness. My way is the only way to do it.” All approaches still have risks and they all still have recovery windows. For those reasons, we recommend having a comfortable relationship with your surgeon to have a good expectation of the procedure.