Osteoarthritis is a wear and tear condition that destroys joint cartilage, the cushioning tissue of joints.  Arthritis of this type develops over years of constant stress and pressure. As the cartilage wears away, the joint becomes increasingly painful and difficult to move. Unfortunately, cartilage does not have the ability to repair itself like other tissues in the body. Osteoarthritis affects 21 million people in the United States, and can affect most joints in the body, including the hip. 

There are other conditions of the hip which can cause problems--such as traumatic arthritis (injury), rheumatoid arthritis, avascular necrosis (loss of blood supply to the ball), and other inflammatory arthritic conditions.  These often result in loss of movement of the hip, progressive pain, and difficulty performing every day activities.

Once the problem is identified, doctors try to treat it in a conservative fashion-- including exercises, weight loss, anti-inflammatory medications, and pain medications. Remember that once cartilage is damaged or destroyed, it’s gone for good, and non-surgical treatment may not relieve the pain or improve your ability to function comfortably. It is at this point that an Orthopaedic surgeon may recommend total hip replacement.

Hip replacement surgery is generally a very successful procedure. The first total hip replacement was performed over 50 years ago; since then, millions of people have had their quality of life improved by undergoing the operation. Nearly 400,000 are performed every year in the United States.  The success rate is usually 98% effective for pain control, and most people return to a nearly-normal lifestyle. 

Traditionally, hip replacements have been done through an 8 to 12-inch incision.  This approach allows the surgeon to fully visualize the diseased joint.  Implants are used to resurface and replace the bones, re-creating the smooth gliding surfaces that were once intact. Total hip implants are typically made from a metal alloy such as titanium or cobalt chromium and medical-grade polyethylene, a durable plastic.  These high-tech materials provide a long-lasting solution to hip arthritis.

However, there is a downside to the large incision that is used—it results in a lot of post-operative pain, long healing times, blood loss that often requires transfusion, and slow rehabilitation in therapy.  Orthopaedic surgeons are always working to develop new techniques to help make surgery less painful and allow patients recover more quickly.

One of the most significant advancements in total hip replacement is the recognition that the procedure can be done with less invasive techniques.  Mini-incision hip replacement is performed utilizing specialized instruments designed with the patient in mind.  They allow the surgeon to implant a new hip with much less surgical trauma.  The vast majority of patients can now have a hip replacement with an incision that is 4 inches or less in length.

An operation done with a small incision has a number of benefits for the patient.  First and most obvious, the scar is much smaller.  This has more than cosmetic value, as there is less to heal.  Thus, the second major advantage is faster recovery from surgery of “smaller” size.  This advantage has been recognized for years with arthroscopic surgery of the knee and even laproscopic gall bladder removal, appendectomy, and hernia repair.

When hip replacement surgery is done with smaller incisions, patients require fewer blood transfusions, have shorter hospital stays and return to work or recreation sooner.  Patients report that a joint replaced with these new techniques is much less painful than with the previous large incisions. 

We try to use this limited exposure on all patients.  However, it must be remembered that the first priority in performing the operation is to be able to see all that is necessary.  Thus, there are still situations that arise which require a larger incision.  As with all surgery, there are potential complications—including infection, blood clots, hip dislocation, and limb length inequality.  The majority of the time these risks are far outweighed by the benefits of excellent pain relief and regaining a more normal lifestyle.

My colleagues and I at Carolina Orthopaedic and Sports Medicine Center are pleased to offer this new approach to hip replacement, and would be happy to discuss it with you.  Appointments in our clinic can be made by calling 704-865-0077.