Small Incision Total Hip Replacement Surgery
Fact Sheet:
Hip Replacement Surgery May Be Faster, Safer, Less Invasive
The hip joint endures a lot of wear and tear in the course of a lifetime. One
of the largest joints in the body, this structure can develop problems as a
result of disease, stresses, and injury.
In healthy hips, cartilage covers the end of the bones in this
ball-and-socket joint, helping the bones to move easily and painlessly against
one another. But arthritis can break down this cartilage. Arthritis can be of
two kinds, the inflammatory type (rheumatoid arthritis) or the type caused by
physical use and strains (osteoarthritis). Either way, the result for many
people is hip bones that rub together, cause pain, stiffness, and loss of
function.
Hundreds of thousands of individuals in the U.S. experience discomfort and
reduced ability to move because of worn-out hip joints. For many, the condition
can decrease their daily abilities and activities. Worn-out hip joints can take
away simple pleasures of life, such as physical exercise and independence. Some
people are disabled by hip disease that prevents them from climbing steps,
walking, or standing.
What is hip-replacement surgery?
Total hip replacement is one of
the most common major surgical procedures performed in the U.S. Thomas Jefferson
University Hospital performs a high volume of these operations. In the
procedure, the surgeon opens the hip joint area, removes the worn-out bone, and
implants an artificial hip joint (prosthesis). The high-tech, implantable joints
used for this purpose are made of titanium, cobalt chrome, or sophisticated
alloys. The joint consists of a cup implanted into the pelvic bone (acetabulum),
and a shaft with a ball-like end replacing the top of the thighbone (femur).
At their connections, these components have smooth surfaces that permit the
recipient of the new joint to move the hip smoothly and without pain. Hip
replacement systems come in two types, those cemented in place with bone cement
and those that have a rough surface that allows the recipient’s bone to grow
into them (biofixation). Each year, tens of thousands of people with severe hip
problems regain long-term mobility and activity in their lives, as a result of
hip replacements.
Has hip replacement improved in recent years?
Hip replacement was
traditionally a long operation, often taking hours. It was also a more invasive
procedure, requiring typically a foot-long incision over the hip area. In
surgical procedures in general, the larger an incision is – and the longer it is
open – the greater the blood loss and, more importantly, the greater the chance
of infection or other complication. In addition, larger surgical openings tend
to require more time to heal.
Twenty years ago, orthopedic surgeons did not have the benefit of the
high-tech materials and techniques available today in advanced hip-replacement
programs such as Jefferson’s. As a result, hip replacement as an operation
potentially carried more risk, and patients may have stood a greater chance of
requiring revision surgery for implants that develop mechanical problems such as
loosening, fracture, or wear.
What are the benefits of new capabilities in hip
replacement?
Today, orthopedists continue to discuss the best approach to
this operation. They are constantly refining their strategy, to make hip
replacement an even better procedure. For example, at leading programs such as
that at Jefferson University Hospital, improved experience, techniques, and
tools have allowed surgical teams to shorten the length of this procedure in the
operating room. Expert surgeons at top centers such as Jefferson’s can now
successfully perform this operation in 35 to 45 minutes on average.
Skilled hip-implant teams can also conduct the operation using smaller
incisions. They can access the joint area and achieve the shorter operating time
through an incision of only about four to six inches on average. They have also
developed techniques to minimize the trauma to the muscles and ligaments around
the hip joint.
In addition, at Jefferson and other centers dedicated to hip replacement,
surgeons perform the surgery in operating rooms designed specifically for the
procedure. They conduct hip replacement in ORs that use special air filtering
systems, super-sterile gowns for the surgical teams, and exceptionally germ-free
equipment.
All of this means that the patient is less likely to experience an infection
after the operation. Good programs can achieve infection rates of less than one
percent. Jefferson’s infection rate is less than one half of 1 percent
(<0.5%). The shorter operation and smaller incision also help patients
recover faster and experience briefer hospital stays. Altogether, these advances
may have made hip-replacement surgery less invasive, quicker, and safer.
While some centers have promoted hip replacement through even smaller
(approximately three-inch) incisions, this approach lengthens the time of
surgery, which may not be as good for surgical results.
Improved cements, better-made porous surfaces into which bone can grow,
computer-designed prosthesis elements, and extremely strong, long-lasting
materials for artificial joints have also made revision surgery less likely.
Today, hip surgery is easier and can assure most patients of pain-free mobility
for decades.
What else does hip replacement involve?
At comprehensive centers
such as Jefferson’s, the patient benefits from the expertise of a complete team
of health professionals. While each person’s experience is different, the usual
hospital stay for this operation is three to five days – a time when patients
receive multidisciplinary care.
The patient may use various pain control techniques during the days after
surgery. With special assistance, guidance, and care from nurses, therapists,
and other allied healthcare workers, hip recipients can normally walk with a
walker or crutches at the time they are released from the hospital. Some
patients are discharged directly to home, while some go to a rehabilitation
facility to complete the recovery period.
For the first six weeks after surgery, while the muscles and tissue around
the hip are healing, hip-replacement patients must restrict activities. Physical
and occupational therapy help them to restore mobility and command of
activities. Home exercises aid the patient in gaining and maintaining strength.
If you are a physician and would like to refer a patient to a Jefferson
orthopedic surgeon for this procedure, please call 215-955-0215.
If you are a patient and would like to make an appointment with
a Jefferson orthopedic surgeon or would like more information about
this procedure, please call 1-800-JEFF-NOW.
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