An innovative type of surgery is making recovery from a hip placement faster and easier.
If you’ve got a pain in your hip, you’re not alone. Today, a person’s lifetime risk of developing osteoarthritis in the hip is 25 percent, according to a long-term study funded by the Centers for Disease Control and Prevention and the National Institutes of Health.
In large part, that’s because people are living longer and staying active longer, making osteoarthritis—a degeneration of joint cartilage and bone—more common.
For many, the hip replacement surgery of choice is a newer type known as anterior approach hip replacement. While it may not be the answer for every patient, those who are able to have the anterior approach rather than more traditional forms of the surgery will experience less pain, a shorter recovery time and other advantages. Most orthopedic surgeons are not trained to do the procedure, but it is available at Jersey City Medical Center (JCMC). Richard Yoon, MD, Director of Orthopedic Research at JCMC and a member of RWJBarnabas Health Medical Group, explains.
What makes a person choose hip replacement surgery?
Patients who are candidates tend to have moderate to severe arthritis in their hip, whether from osteoarthritis, rheumatoid arthritis or post-traumatic arthritis. We start with nonoperative, conservative treatments such as anti-inflammatory drugs, physical therapy, cortisone injections and use of a cane.
But if pain continues to interfere with daily living activities—like walking, going up and down stairs, getting in and out of chairs and sleeping—even after these nonsurgical remedies, patients may elect to proceed with surgical intervention.
What is different about the anterior approach compared with more traditional forms of hip replacement surgery?
The most common approach to the hip joint during surgery is what’s known as the posterior approach. It’s done from the back of the hip and involves cutting through the muscle in the buttocks.
The anterior approach, as the name indicates, means that we make an incision down the front of the leg. It is a shorter incision—about three to five inches, compared to eight to 12 inches—and we don’t need to cut tendons or muscle. We can go in between muscles at a natural opening to get to the joint and replace it.
Because we don’t need to cut muscle with the anterior approach, patients have less pain, shorter hospital stays and a much quicker recovery time. And because the muscles are intact, they help hold the new joint in place, reducing the risk of hip dislocation.
In what cases would a patient not be eligible for the anterior approach hip replacement?
In some cases, a patient’s skeletal structure or body type may make this approach difficult. For select patients, I do the traditional posterior approach, as well as an approach from the side called the anterolateral approach.
Does the anterior approach require any special equipment?
At JCMC, I use a specific table, known as a Hana table, to best position the patient for the anterior approach. The Hana table also makes it easier to use fluoroscopy, an interoperative X-ray, to make sure all the components of the joint replacement are positioned in the best way possible to match the patient’s anatomy.
The surgery is a bit more technically challenging to do and requires specialized training in instrumentation. If a patient is interested in anterior approach hip replacement, I would advise him or her to find a surgeon who is well experienced in this type of surgery.
What is recovery like?
One of the reasons I love this procedure is because of the rapid recovery.
At one year, the outcomes for anterior and posterior hip replacement are essentially the same. But with posterior hip replacement, a patient has to wait for wounds and tendons to heal before therapy can begin. At about two weeks, they’re still using a walker, then they progress to a cane, and then after about three months they don’t need a walking aid.
With the anterior approach, the majority of patients don’t need a lot of formal physical therapy. They come for their first postoperative visit—about two weeks after the surgery—using just a cane, and more often than not the cane is just a precaution. By six weeks, they’re not using any walking aid. They have fewer hip precautions— movements to avoid—during recovery as well.
Some patients’ hips have been bad for so long that they’ve been less active and their muscles will need quite a bit of strengthening. In the second part of their recovery, they find that their improvement isn’t as exponential as it was after the first six weeks.
After three months, however, they can get back to their favorite activities, It’s so rewarding to see patients who are raring to go be able to get back to doing what they like to do.
Learn more about Jersey City Medical Center's orthopedic services, located at 355 Grand Street and also at our Newport location, 100 Town Square Place, Jersey City.