A hip new way of fixing things

Replacement may be needed if you’re feeling out of joint

WHO’S AT RISK

Every year, over 300,000 Americans get a hip replacement, most of them as the result of hip trauma or wear and tear that accumulates over time.

“Hip-replacement surgery uses metal, plastic or ceramic parts to take the place of a diseased or damaged hip,” says Dr. Michael Bronson. “Just about everybody is at risk of needing a hip replacement one day because so many common things lead to hip arthritis, which causes the cartilage protecting the hip socket to wear away.”

A healthy hip is a simple ball-and-socket joint, in which both ball and socket are covered with a layer of cartilage that prevents friction.

“Some cartilage wear and tear is inevitable, but if it deteriorates enough that friction builds up, then the hip joint grows stiff,” says Bronson. “That’s when everyday activities like simple walking or putting on shoes can be difficult.”

The many underlying causes of hip arthritis range from hip trauma to genetics to inflammatory diseases like rheumatoid arthritis and Lyme disease.

Hip replacement is often associated with aging, since the deterioration of the hip joint’s cartilage accumulates over time.

“The most common age for hipreplacement surgery is the 60s and 70s, but I’ve had patients in their late teens and in their 90s,” says Bronson. “Because there are so many causes, this is a problem that transcends any one age group.”

SIGNS AND SYMPTOMS

The No. 1 indication that you might be a candidate for hip surgery is pain accompanied by a decreased range of movement. “The pain associated with hip arthritis can occur in a variety of different areas including the groin, buttock or even radiating down the thigh to the knee,” says Bronson.

“As the ball of the hip joint becomes misshapen, patients notice a lack of movement in their leg: Often they can’t bend over, or the joint is profoundly stiff when you get up,” he says.

Because even walking can become painful, many patients become sedentary, which leads to the additional problem of cardiovascular deconditioning.

Every patient has a different threshold for the symptoms they can live with and when intervention is needed.

“Some people are very active and don’t want to tolerate a little loss of movement or stiffness, while other patients prefer the stoic approach of putting up with more pain before surgery,” says Bronson. “However, if you delay surgery until you’ve lost a lot of movement, the surgery will not likely have the same results it would have had earlier.”

TRADITIONAL TREATMENT

All patients with hip arthritis are first treated nonsurgically.

“The first step is usually physical therapy exercises to maintain range of motion and flexibility, accompanied if necessary by antiinflammatories, including overthe-counter drugs like naproxen and ibuprofen,” says Bronson. “When the meds are no longer working, that’s the proper time to intervene surgically.”

Some patients’ arthritis worsens to the point of needing surgery over a few years, and some can successfully manage their arthritis without surgery for the rest of their lives.

“All hip-replacement surgery involves removing the arthritic ball and socket and replacing them with synthetic materials like plastic, ceramic or titanium,” says Bronson.

“The traditional surgery involved an incision in the buttock area and two hours of operating while the patient was under regional anesthesia.”

Most patients spend four to five days in the hospital, and then progress from a walker or crutches to a cane over six weeks.

The Anterior Supine Intermuscular (ASI) total hip replacement goes through the groin while patients are supine — lying flat on their backs. “It’s intermuscular because we’re able to go between the muscles, rather than cutting through them,” says Bronson. “This decreases blood loss, pain and recovery time — the morning after surgery, most patients only complain of soreness, not pain.”

Most ASI patients are walking perfectly in two weeks.

“The ASI operation is much less stressful, which is especially important for patients who are elderly or have other health problems.” says Bronson. “This surgery can take patients who are minimally ambulatory and living in discomfort and transform them into patients who can be as active as they want.”

RESEARCH BREAKTHROUGHS

In the past, the ASI approach to hip surgery wasn’t possible because it required special instruments to get access to the hip.

“It’s just over the last five years that we’ve had the necessary breakthroughs in surgical instruments designed to allow for small incisions and that can image the hip internally,” says Bronson. “ASI is still in the process of becoming routine — in New York, there are only a handful of people doing hip replacements with ASI.”

QUESTIONS FOR YOUR DOCTOR

Every patient getting a hip replacement should ask the surgeon, “How frequently do you perform this surgery?” Surgeons who perform more hip surgeries have better patient outcomes. Another good question is, “What kind of replacement is being inserted?”

“Some of the metal-on-metal replacements that surgeons were using over the past 10 years have had high failure rates,” says Bronson. “You want to get an uncemented hip, with titanium stem and either plastic or ceramic components.”

The question everyone asks

is “How much time will I need off from work?” “With the new ASI techniques, patients can be back in the office in 10-14 days,” says Bronson. “In the past, it used to be months.”

Finally, everyone asks, “How long will my new hip last?” “With modern technology, 2030 years is readily achievable,” says Bronson.