Hip ops have taken major strides
As tennis star Andy Murray faces more hip surgery, an orthopaedic surgeon tells LISA SALMON how techniques and technologies have improved
AT THE age of just 31, Andy Murray is considering more surgery on the painful hip that looks set to end his tennis career.
As a top-level athlete, who will have pushed his body to the limit and has racked up years of demanding training, Andy’s case is obviously a little different to most – but he could be joining thousands of people who undergo hip surgery in the UK and Ireland each year.
Hip surgery is carried out for a number of reasons, including injuries and fractures, and problems arising from wear and tear or arthritis. Andy has been struggling with his hip for a number of years now and underwent surgery last January – only to announce, in a very emotional statement earlier this month, that he’s in a “lot of pain” and plans to retire soon.
One suggestion is that he may have hip impingement – a common problem in high-impact sports involving the ball and socket joint.
“Hip impingement is common in young athletes with highintensity use, such as Andy Murray. There is usually extra bone growth along the hip joint as a result of high-level use. This extra bone growth results in distortion of the shape of the hip joint, leading to impingement. This can cause severe symptoms and significant effects on performance – sometimes career-ending,” says consultant orthopaedic surgeon Mr Panos Gikas, who works at HCA Healthcare’s Lister Hospital.
This may be treated with hip resurfacing surgery, where the ball is smoothed and covered with a metal cap, and a layer of metal is also placed within the pelvic socket. A replacement may be the last resort. Most hip replacements are carried out on people aged 60-80, although adults of any age can potentially have the surgery.
Traditionally, the procedure has been associated with invasive and painful techniques and long recovery times but Mr Gikas says advances in surgical techniques and technologies have revolutionised hip replacement surgery.
Here, he outlines seven of the key advances...
1. MORE CHOICE
IN the past, total hip replacement surgery required a long incision at the side of the hip and the surrounding muscles to be cut and detached.
“Today, surgeons use novel techniques and surgical approaches that allow better functional outcomes, as well as improved longevity of the hip replacement and faster return to normal activities postoperatively,” says Mr Gikas.
“Patients can today carefully research and identify which surgeon and technique is going to be best for them.”
2. LESS PAIN
ONE of the most effective techniques for minimal pain is anterior muscle sparing hip surgery. This involves accessing the hip joint from the front of the hip, avoiding the need to cut through the muscles around the hip. Postoperative pain is less, as there’s no injury to the soft tissues.
3. CUSTOM-MADE IMPLANTS
IMPLANTS may be custom templated before surgery, to ensure the optimum fit with minimal bone loss, leading to improved range of movement afterwards.
4. CEMENT ALTERNATIVES
DURING hip replacement surgery, the head of the femur (thigh bone), also called the ball, which forms half of the hip joint, is removed from its socket, and a new artificial ball and socket are fixed in place. Mr Gikas says traditionally, acrylic cement was used to fix these components in place but now there’s another option. “It’s becoming more common, especially in younger and more active patients, for the hip components to be inserted without any cement. Bone is a living substance and will continue to grow and bond itself over time if it’s strong and healthy. So, instead of cement, surgeons are simply roughening the surface of the implants to allow the bone to grow onto the prosthetic surface naturally. It helps to ensure better results and longer lifetime of the hip replacement.”
5. STRONGER IMPLANT MATERIALS
TRADITIONALLY, a metal alloy or plastic prosthesis would have been used in hip replacements, but one of the biggest advances in the surgery is the implant materials used. New materials have been developed, such as ceramic and special plastics, allowing high durability and prolonging the lifespan of the prosthesis.
6. ROBOTICS
ACCURATE positioning of the ball implant is key to a successful hip replacement and for this reason, orthopaedic surgeons are now using techniques such as robotics or instruments designed for the unique anatomy of each patient.
“This helps ensure implants are aligned to the patient’s unique anatomy with as much precision as possible, allowing better function and lower risk of complications.”
7. FASTER RECOVERY TIMES
GENERALLY speaking, the length of hospital stay for hip replacement surgery varies depending on the technique used, and Mr Gikas says that with traditional posterior operations, patients may need to stay in for three to seven days. Full recovery can take six to 12 weeks, due to precautions that need to be observed, such as not crossing the legs, or sleeping on your side.
But with the modern anterior muscle sparing approach, hospital time is significantly decreased, with the average length of stay between 48-72 hours. In some cases, patients have gone home as quickly as day one after surgery, and will usually be back to normal within two to four weeks.