I offer my patients with severe hip arthritis a safe and reliable hip replacement operation.
A hip replacement is the correct treatment when the following conditions are fulfilled:
The hip replacement operation is performed using power tools, chisels, and hammers. The operation looks very violent to the untrained eye.
I use the the Corail/Pinnacle prosthesis, with a metal on UHMW polyethylene bearing. This is a device with an excellent track record. I have used this prosthesis since 2009, and I can say from first hand experience that it is a very good hip prosthesis.
Here's a picture: on the left are the separate components, which are assembled on the right.
As a patient, you need to know that there are several different manufacturers who sell hip prostheses in the USA. Each manufacturer offers different prosthetic options. Even within a single prosthetic line, each manufacturer offers different bearing types, from polyethylene, to metal, and ceramic.
The manufacturer of the hip prosthesis that I use is DePuy, a J&J company. Like the other orthopedic manufacturers, DePuy markets several different lines of prostheses, some of which have had problems. As I explained above, the Corail hip system remains an excellent choice, and has had an excellent track record for close to 30 years.
Hip replacement is routine operation, but it is not risk free. As a patient you must understand these risks. If these risks are not acceptable to you, you should not have this operation.
The risk of death from a heart attack increases with age. Therefore, patients who seek joint replacements have an inherently increased risk of heart attacks.
For conventional hip replacement surgery, with the patient positioned on the side, state of the art is such that up to half an inch of leg length difference can be expected after a hip replacement. This sounds almost unfair, but keep in mind that up to half of an inch leg length difference can be found in the normal population, in regular healthy people who have no pain and no problems at all in their hips.
Please keep in mind that power tools and hammers are used routinely during the operation. Fractures do happen occasionally, most are not mechanically significant and weight bearing without restriction is often allowed.
Deep vein thrombosis is a well known complication and a leading cause of death after major surgery in the US. DVT may lead to PE, and a big enough PE may cause sudden death. However, most patients who suffer from thromboembolic disease do not die from it.
Unfortunately, the medical profession does not have a full understanding of this important issue. There is an important element of "bad luck," but do inform me and other health care professionals involved of any history of embolism that you may have.
The current state of affairs is such that most physicians recommend using anticoagulant medications ("blood thinners") after the operation, in order to decrease the chance of getting DVT or PE. It could be aspirin (the mildest,) Coumadin (a very fussy medicine,) or Lovenox (which requires daily injections). By their very nature these medicines can cause additional bleeding. Duration of such preventive treatment is controversial.
Infection affects approximately one in 100 patients with a hip replacement. Cure usually requires removal of prosthesis (a second surgery), IV antibiotics for 6 weeks, and delayed reimplantation of the hip prosthesis (a third surgery). In other words, an infection makes for a very unpleasant half year or so. During that time it may be difficult to get around without a wheelchair.
Dislocation occurs when the artificial ball of the prosthesis disengages from the artificial cup.
Together with infection, dislocation is one of the two main orthopedic complications after a hip replacement operation. In other words, when a hip replacement operation has to be redone, it is usually either due to an infection or due to dislocation.
Statistically, the posterior approach surgery has a higher risk of dislocation. In addition, certain diseases, such as Parkinson's, are associated with a much higher risk of dislocation after a hip replacement.
The direct anterior approach diminishes the risk of dislocation. The anterior approach is described in a separate file, but the main point is this: it decreases the risk of dislocation associated with the posterior approach, it avoids the limping of the anterolateral approach, at the cost of being a bit more demanding for the surgeon.
The risk of having a foot drop after hip replacement is approximately 0.5%, that is to say, out of 1000 patients with hip replacements, 5 have some degree of visible foot drop. The reason for developing foot drop is unclear most times. Most patients with foot drop after hip replacement have preexisting spinal stenosis and a certain predisposition for developing this problem.
Foot drop complicates rehabilitation after hip replacement, but prompt fitting with an AFO can mitigate the problem. Roughly half of patients improve and become able to dorsiflex the ankle, but it can take a year or more.
The xrays are from a 40 year old patient who had sustained a posterior acetabular wall fracture. His initial injury had been treated surgically at a major university. Unfortunately, the nature of such injuries is such that most of them develop arthritis despite prompt appropriate care. Two years after his acetabular fracture surgery, his left hip joint is as arthritic as can be. The xray to the right shows the implanted DePuy Corail/Sector hip prosthesis. This solved his pain problem and restored normal gait.