En español |Total hip replacements are on the rise. Now, more than 285,000 of the procedures are performed in the United States each year, up more than 25 percent in just five years, according to the American Academy of Orthopedic Surgeons.
“Total hip replacement surgery has some of the best results of all major surgeries,” says Paul King, M.D., director of the Joint Center at the Anne Arundel Medical Center in Annapolis, Md. Insurance, whether Medicare or commercial, usually covers the bill short of the co-pay. What’s more, the implants, whether ceramic-on-ceramic, or metal and highly crosslinked polyethylene, typically last 20 to 25 years.
See also: My brand-new hip: A personal tale.
Still, a hip replacement shouldn’t be taken lightly. It’s a big surgery and — as with all surgeries — there can be complications. To boost your chances of having a successful surgery, pay attention to these five things.
1. Choose an experienced surgeon who frequently performs hip replacements
William Washington, 73, of Washington, D.C., had a total hip replacement nine years ago after arthritis had so damaged cartilage in his hip that bolts of pain routinely shot through his back. He’s pain-free now and plays golf regularly, a happy outcome he attributes to his choice of an experienced surgeon. “He had done plenty of these and many people had recommended him,” Washington says. “He’s the mechanic. He knows the way to do it.”
Experience is the key, but how much? At least 30 replacements a year, says Brian Parsley, an orthopedic surgeon in Houston and one of the directors of the American Association of Hip and Knee Surgeons. And the surgeon should have done at least 100 procedures, says Justin Cashman, a Maryland orthopedic surgeon. How to find such a surgeon? “Your primary care physician can point you in the right direction,” says Cashman.
2. Don't sweat the techniques
In a total hip replacement the bones that form the ball and socket of the hip are replaced with an artificial joint, called a prosthesis. The two most common approaches involve incisions either close to the buttock (posterior approach) or in the thigh (anterior approach). In some cases, surgeons may also use minimally invasive techniques, which involve smaller incisions, and the two-incision technique, in which they make one incision in the front of the thigh to insert the synthetic socket, and another in the back of the thigh to insert the ball and stem.
Because less muscle is cut with the anterior approach, patients sometimes have fewer restrictions on movement after surgery. Some say the anterior approach results in a shorter hospital stay, less pain and a lower risk of hip dislocation after surgery.
Joshua Jacobs, chairman of orthopedic surgery at Rush University in Chicago and a vice president of the American Association of Orthopaedic Surgeons, cautions against making assumptions about benefits of any of the various approaches. He says he’s “heard all of those claims” but hasn’t yet seen the studies to support them. For his part, Paul King generally prefers the anterior approach but say his preference is based more on his own surgical experience than evidenced-based science.
According to Brian Parsley, the skills of the surgeon are more important than placement of the scalpel. “I’ve been in practice for 24 years and I’ve come in from all directions,” he says. “The differences from one procedure to another are more theoretical than practical. If you do it right, the patients are in the same place two or three months after surgery, no matter what procedure is used.”
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