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.”
Next: Go for "pre-hab." »
3. Go for "pre-hab"
Rita Redding, a 58-year-old nurse who had hip replacement surgery last year after developing avascular necrosis — a malady of insufficient blood supply to a joint — regrets that she didn’t do more to prepare for her surgery. If she could do it over, she says, she would have started seeing a physical therapist several weeks before the procedure for advice on exercises to strengthen the muscles in her hips and legs.
Another good reason for “pre-hab”: A physical therapist who understands your functional ability before surgery is better able to help you recuperate after surgery, says James Dunleavy, administrative director of rehabilitation services at Trinitas Regional Medical Center in Elizabeth, N.J.
4. Lose weight (if you're heavy)
A hip prosthesis is designed to handle normal body weight, says Mark Petty, M.D., of the Orthopedic Institute in Gainesville, Fla. Small wonder that he worries when someone overweight walks into his office. A Body Mass Index (BMI) of 25 or less is ideal. (For a woman who is 5 feet 4, that’s 145 pounds or less.) If it gets high into the 30s, many orthopedists will make weight loss a condition for the replacement.
And a BMI over 40? “No way,” says Petty, adding that if a patient is too heavy he’ll encourage them to lose weight before surgery.
5. Commit to physical therapy
Total hip replacement is usually followed by two to three days in the hospital, two to three weeks in a sub-acute rehabilitation center (which is usually covered by insurance) and two to three months of outpatient care.
Dunleavy puts his patients into one of two categories during the outpatient phase: hearty and passive. The hearty ones need only two, maybe three, visits to the physical therapist each week because at home they religiously follow the prescribed exercise regimen, which typically consists of 15- to 20-minute sessions, three times a day. The so-called passive do little or nothing at home, so they need to see the physical therapist nearly every day.
Some studies have found that patients continue to benefit from physical therapy that focused on improving walking skills after the initial three months of therapy. It’s a time to be fully engaged, says Dunleavy.
Redding was back to work three months after her operation. She says she now walks without a limp, and is almost pain free. “My function has been completely restored,” she says.
Washington was back on the putting green at two months and playing 18 holes four months after his surgery. “I did everything I was told to do and then some, including losing weight before and after the operation,” 30 pounds total, he says. “I wanted a shot at what I used to be before the pain, and I got it.”
Also of interest: Getting back in the game after surgery.