State-of-the-Art Hip Surgeries for Active Adults:
About the Procedures

Total Hip Replacement
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).

Expert orthopedic surgeons can successfully perform this operation in 35 to 45 minutes on average. Skilled hip-implant teams can also conduct the operation using smaller incisions 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.

Most patients gauge their post-operative pain as mild to moderate. They may use various pain-control techniques during the days after surgery. In addition, physicians can now more effectively treat post-op side affects such as nausea and hypotension (low blood pressure) with medication and fluids.

The usual hospital stay for this procedure is two days. For the first month after surgery, while the muscles and tissue around the hip are healing, hip-replacement patients may have to 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.

Hip Resurfacing
This type of hip replacement surgery was introduced in the United States in 2006. Today, the results are extremely positive.

“While traditional hip replacements are very effective, the hip resurfacing procedure is an attractive alternative for patients who are relatively young and are extremely active,” says William Hozack, MD, Professor of Orthopedic Surgery at Jefferson Medical College (JMC) of Thomas Jefferson University and Director of Joint Replacement at Jefferson Hospital. “It restores full hip functioning while preserving as much of the bone area as possible. Plus, orthopedic surgeons are able to maintain a more anatomic ball and socket joint with resurfacing.” 

In hip resurfacing, the surgeon shapes the patient’s arthritic or damaged joint and then covers or “surfaces” both sides of the joint with metal prosthetic implants. “One side – the end of the leg (femur) bone – is capped, somewhat like a tooth,” Dr. Hozack explains. “The other side, which is the hip socket, is cupped with an implant. This process preserves bone stock should a revision ever be needed.”

Patients generally undergo physical therapy for one month after surgery, which for many is just a different approach to daily exercise workouts.

Anterior Femoroacetabular Osteoplasty
This groundbreaking, minimally invasive procedure preserves the hip by eliminating pain caused by femoroacetabular impingement. It was co-developed by Javad Parvizi, MD, FRCS, Professor of Orthopedic Surgery at Jefferson Medical College of Thomas Jefferson University and Vice Chair of Clinical Research at the Rothman Institute.

Impingement is caused by a lack of room between the neck of the femur and the rim of the acetabulum, causing the neck and rim to jam together as the hip is flexed (as in sitting or running). This jamming leads to pain manifested in the hip or groin region and may lead to early degenerative arthritis of the hip.

“When you look very carefully at X-rays of these patients, you’ll see a bump at the femoral head, or a deep socket, as opposed to a shallow socket that you see in dysplasia,” Dr. Parvizi says. “Some people have a non-spherical femoral head, and each time it rolls, the bump makes contact with the rim and eventually tears the labrum, much like the meniscus in the knee, causing severe pain, especially in the hip or groin area.”

Anterior femoroacetabular osteoplasty focuses on smoothing the surface in the space between the neck and the head of the femur. “Basically, through a small incision in front of the hip, we are able to visualize the bump, take it down, repair the labrum and do whatever else we have to in order to get rid of the impingement,” explains Dr. Parvizi.

The surgery takes about an hour and requires an overnight hospital stay. Recovery takes about six weeks because the labrum has to heal.