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Hip replacements have come a long way from the very first attempt at one back in 1891, and modern hip replacements, which began in the 1960s, had a high success rate from the start. In the past 10 years, doctors have made even more improvements in the procedure and, today it is one of the most successful operations in all medicine. More than 300,000 total hip replacements are performed each year in the United States. Here are some of the most significant advances in hip replacement surgery that continue to improve the procedure, helping many people regain mobility and experience less pain.
Improved Materials and Techniques for Hip Replacement
Surgeons used to replace the ball and socket joint of the hip with a stainless steel stem and plastic socket, which they cemented in place. Today most hip replacements don’t use cement; instead, doctors use parts that allow bone to grow into the implants, anchoring them more securely.
There is a wide array of artificial hip components to choose from these days. Out of hundreds of options, your doctor will recommend one based on his or her experience and your particular circumstance. The replacement joint can be a combination of metal, plastic or ceramic. For instance, you may have a metal ball and a plastic socket, which is the most common, or a ceramic ball and a plastic socket. Ceramic on ceramic joint replacement is less popular because it causes a squeaking noise in 1 to 2% of patients.
A newer plastic for artificial joints, called “highly cross-linked polyethylene” was introduced in 2006. It extends the life of the implants and reduces the risk of having a weakened or fractured bone for up to 10 years. Each material—metal, plastic and ceramic—has its pros and cons, so it’s important to review all options with your doctor so you can make an informed decision about what kind of replacement joint you will receive.
Another major advance in hip replacement has been in the area of revision surgery, when your artificial joint needs to be repaired or replaced. Revision surgery is more difficult than first-time joint replacement because bone loss, which is common in hip replacement patients, makes it harder to attach the new implant. New, very porous metals help solve this challenge by allowing more bone to grow into them.
Less Invasive Hip Replacement Surgery Options
Traditionally, surgeons would make a long incision so they could reach your hip joint, but today, some patients can have a less invasive procedure, in which your doctor makes either one or two shorter incisions. The operation means fewer muscles are cut as well, but it can make it harder for the surgeon to reach the hip joint and the surgery may take longer, which can also slow recovery.
If you are a candidate for this newer procedure, you may be able to bend your hip and start to put weight on it sooner after surgery than with the traditional approach, in which you have to limit the use of your hip motion carefully for several weeks. If you are considering this kind of hip replacement technique, make sure to find a surgeon who has significant experience with it to reduce your risk of complications. Most candidate patients opt for the less invasive approach are younger, at a healthy weight, and highly motivated for rehabilitation.
Hip Resurfacing Versus Hip Replacement
Some surgeons perform an operation known as hip resurfacing, which is a different type of hip replacement approved by the FDA in 2006. In a hip resurfacing, the damaged ball of the leg bone isn’t removed but, instead, surgeons trim it and cover it with a smooth piece of metal that is attached with a pin and cemented in place. They repair the socket with a metal lining, similar to conventional hip replacement.
Doctors disagree about the benefits and risks of this approach. It preserves more of your own bone, and increases the chance that you will be able to participate in activities like high-impact sports, which is less likely with a traditional implant. However, it is a more difficult operation and there is evidence it may increase the risk of fracture. Not everyone is a candidate for hip resurfacing, which is performed on patients who have less bone damage, but if it’s an option for you, talk with your doctor to understand the pros and cons.
With the high rate of success and wide variety of options available for hip replacement surgery, many people with hip problems recover much of their mobility and have far less pain for many years; the implants can last for 15 to 20 years or more. If your doctor has suggested you have hip replacement surgery, take time to learn about the range of choices available to you, and know what you will need to do to have the best possible recovery and make the most of your hip replacement.
