Total Hip Replacement: Techniques & Technology

Over the last two decades, the number of total hip replacements being performed each year has steadily increased in the United States according to the American Association of Hip and Knee surgeons. Many of the existing techniques and technology that were developed by Rothman specialists, can help improve the condition that you’re dealing with and many see complete success.

In order to understand the various methods of surgery, it’s helpful to learn about the anatomy of the hip and what a replacement consists of:

• The femoral stem inserts into the femur or thigh bone. This vast majority of replacements are made from titanium although cobalt-chromium is also possible.
• The femoral head, or ball, fits onto the end of the stem and is usually made of ceramic or cobalt-chromium.
• The acetabulum cup structure inserts into your pelvis and is also made from various metals such as titanium or tantalum. These cups hold the liner in place which is made of polyethylene plastic and provides the slippery surface for the ball at the top of the femur.

Now that you have a better understanding of what the hip is made up of, learn about the procedures that can have you feeling more like yourself. Understanding the technology available and learning about new procedures can help you become more familiar as you prepare for surgery and recovery.

Robotics

The robotic-assisted technology uses computer-assisted navigation to guide an instrument that machines or cuts the bone into the correct shape to receive the implant. This is used to gather data which is uploaded to a computer to generate a three-dimensional model specific to the patient. This allows the surgeon to determine the amount of bone that needs to be removed in order to best fit the implants.

Lastly, combining the necessary bone resection with appropriate ligament tension, the robotic tool is used to carefully prepare the bone and execute the surgical plan under the surgeon’s control. You may require a CT scan or additional imaging the surgery which can be uploaded during the procedure to help guide the surgeon.

Studies show that robotic surgery is very accurate, and the hope is that future studies will show that it leads to better results for our patients.   Rothman Orthopaedics physicians are constantly researching which newer techniques like robotics will make joints work better and last longer. Discuss with your doctor to find out what’s best for your condition.

As always, it’s most important that you find a top-notch surgeon who you can trust to provide the best outcome since the robot only assists with the procedure. As pioneers in robotics, our physicians have seen and done it all, and will tailor their approach to your specific case for the best quality outcome.

Computer Assisted Navigation

Computer assisted navigation uses a computer to help guide the surgeon to very accurately place the joint implants. This technology allows the surgeon to calculate each replacement operation down to the degree and millimeter.

During surgery, the surgeon collects data points to help the computer generate a virtual model of your hip. You may require a CT scan or an MRI before the surgery which can be uploaded during the procedure to help guide the surgeon. The accuracy of computer guidance for joint replacement surgery is very similar to robotics, but rather than using a robotic tool to cut the bone, the computer guides the surgeon to use conventional orthopaedic tools to cut the bone in the ideal place.

Minimally Invasive Hip Surgery

The philosophy of minimally invasive surgery is to reduce the amount of damage to tissue around the hip to the greatest extent possible.  The traditional surgical approach to total hip replacement uses a single, long incision to view and access the hip joint, while a minimally invasive procedure uses one shorter incision.

Minimally invasive surgery may not be the answer for every patient or condition. Recent advances in joint surgery including rapid rehabilitation programs and sophisticated pain control techniques have been shown to have fantastic results.

Hip Replacement Approaches

Hip replacement approaches refer to the location on the thigh or buttocks the incision is made for the surgery. This can be anterior (front), lateral (side), or posterior (back). Once the hip joint is uncovered, the internal work that is done on the joint is the same regardless of where the incision is made.

• Benefits of advanced hip replacement approaches can include:
• Reduced muscle trauma
• Reduced pain
• Earlier and easier recovery
• Shorter hospital stay
• Decreased chance of hip dislocations

Posterior Hip Replacement

A posterior hip replacement means that the incision is made in the buttock area.  The incision can be small or large. This method of performing hip replacements has been done for over 50 years and has been very reliable with excellent outcomes. In addition to regular replacements, posterior incisions are often used for major reconstructions. This is the most common method used for hip replacements.

Anterior Hip Replacement

A direct anterior hip replacement is when the surgeon makes an incision in the front of the hip rather than in the side or back. Anterior hip replacement surgery has become very popular in recent years and has received a lot of attention. Some surgeons use a special table for this procedure although it can be performed safely with or without the table. Our surgeons have extensive experience with this technique and were some of the earliest to perform this procedure in the US.

Direct Lateral Hip Replacement

The direct lateral approach is when the incision is made on the side of the hip. This technique has been used for several decades in the US with excellent results.

How to decide which type of hip replacement you should have:

Our experienced orthopaedic surgeons routinely perform all of these types of hip replacements and regularly teach them to other surgeons across the country. It’s very important that you see a qualified surgeon to discuss the advantages and disadvantages of each for your specific situation. As one of the most advanced orthopaedic organizations in the US, Rothman Orthopaedics we can provide you with orthopaedic joint replacement specialists who can help you decide what would be best for your particular situation.

Rapid Recovery Programs

Another popular type of joint surgery is what is known as Rapid Recovery Protocol (RPP). By assessing a patient's particular situation including their general health, fitness, and medical history surgeons will determine the best plan for the patient’s recovery program. This usually includes a combination of advanced medications to prevent pain, anesthesia that can reduce anxiety and complications and modern rehabilitation methods to provide the highest level of mobility and function.

The decision to move forward with a total hip replacement is not always easy and involves careful consideration from yourself, your loved ones and your surgeon. Understanding the facts can help you go into these conversations with your doctor informed.

About Hip Replacement Surgery at Rothman Orthopaedics

Rothman Orthopaedic Institute performs hip replacement surgery utilizing both traditional methods and advanced technology based on the patient’s specific case. Visit our website for more information and to find out if hip replacement surgery is right for you.