The posterior approach to total hip replacement is a minimally invasive surgical technique where the replacement of the damaged hip joint is made through the side of the hip, along the outer buttock area, and is the most commonly used approach. The normal incision is about five inches but may vary according to a patient’s body size. Though small incisions are often considered desirable by patients, it should be kept in mind that the degree and type of tissue disturbance beneath the skin is a more important factor. The hip joint is exposed by splitting the gluteus maximus muscle in line with its fibers. The piriformis and superior gemeli muscles, which are two of the four external rotators of the hip, are detached and later reattached to allow implantation. . The benefits of minimally invasive hip replacement include less damage to soft tissues, leading to a quicker, less painful recovery and more rapid return to normal activities. While the surgical process in a minimally invasive hip replacement is similar to the traditional approach, there is significantly less damage to the tissue surrounding the hip joint as the splitting of the muscles is greatly reduced and repaired after implantation of the prosthetics to prevent dislocation of the hip. Rehabilitation is accelerated and hospital time decreased because of the smaller incisions as well as less interference with the soft tissues. The rapid hip pathway employed by O+F surgeons allows for healthy patients to be done on an outpatient basis regardless of surgical approach. Larger femoral heads and smaller incision surgery has brought the dislocation rate to between .5-1%. The posterior approach can be extended for revision surgery with little difficulty. Possible complications of minimally invasive hip replacement include infection, injury to nerves or blood vessels, fractures, hip dislocation and the need for revision surgery.

When an individual has arthritis of the hip, the underlying bone develops spurs and irregularities which can cause severe pain and loss of motion. A total hip replacement (also referred to as total hip arthroplasty) has the ability to relieve pain and restore normal function in patients whose hip joint has been significantly damaged by overuse or trauma. In this type of surgery, the damaged hip ball-and-socket of the femur is replaced by man-made, prosthetic implants. Total hip replacement surgery has been done routinely for the past 50+ years with the main objective being to restore the natural, pain-free movement of the hip joint and allowing patients to return to their desired level of activity. Of all the joints currently replaced in the human body, total hip replacement has had the most success, is the most durable (lasting upwards of 30 years), and has the quickest recovery period.

A total hip replacement entails the removal of the damaged bone and cartilage of the hip ball-and-socket and replacement with man-made prosthetic components. A total hip replacement procedure takes anywhere between one to two hours to complete and occurs in the following order:

• Entering the Joint – An incision is made near the side of the hip and the muscles, tendons, and other tissues are moved away from the joint to expose the femoral head (ball) and acetabulum (socket). The hip is then positioned to expose or open up the joint.
• Removal of Femoral Head – During this step, the head and neck of the femoral head is removed and the acetabulum is cleaned out in preparation for the replacement components.
• Femoral Canal Preparation – Once the acetabulum is cleaned out, an acetabular metal shell component is fit into the space along with a plastic liner to surround the prosthetic femoral head to allow or a smooth gliding surface. The femur is then hollowed out in preparation for the femoral stem insertion.
• Femoral Placement– The femoral stem may be secured with the use of cement or be “press-fit” into the hollow center of the femur. A carefully fitted metal or ceramic ball is then secured to the top of the femoral stem.
• Rejoining the Hip Joint – The hip joint is then rejoined and all the surrounding muscle and tissues are repaired back to position and the procedure is completed.

Recovery after a total hip replacement will depend heavily on how well the individual follows home care and precautions after the surgery. After a total hip replacement surgery, there will be some pain, but the medical team will provide the proper medication to make the patient as comfortable as possible. Walking and hip movement will being soon after the surgery where a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Major part of the recovery process will occur at home where proper care must be taken in terms of wound care, diet, and activity as prescribed by the physician and physical therapist. Patients who have undergone total hip replacement surgery generally resume normal activities three to six weeks post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.

TOTAL HIP REPLACEMENT VIDEO

When an individual has arthritis of the hip, the underlying bone develops spurs and irregularities which can cause severe pain and loss of motion. Depending on the severity of the damage in the hip joint, the physician my recommend a partial hip replacement (also referred to as hip hemiarthroplasty), which has the ability to relieve pain and restore normal function in patients whose hip joint has been significantly damaged by overuse or trauma. In this type of surgery, the femoral head of the damaged hip joint is replaced by man-made, prosthetic implants. Partial hip replacement surgery is done primarily to treat injuries rather than degenerative arthritis (which often lead to a total hip replacement surgery). Partial hip replacements are ideal for “broken hips” – occasions where a fracture that is difficult to mend develops in the femoral neck, but the socket is still strong. Partial hip replacements are only seldom recommended for elderly patients who are not very active.

A partial hip replacement entails replacement the ball of the femur with man-made prosthetic components. A partial hip replacement procedure takes anywhere between one hour to 90 minutes to complete and occurs in the following order:

• Entering the Joint – Depending on the approach and the physician, an incision is made near the front, side, or back of the hip and the muscles, tendons, and other tissues are moved away from the joint to expose the femoral head (ball) and acetabulum (socket). The hip is then positioned to expose or open up the joint.
• Removal of Femoral Head – During this step, the head and neck of the femoral head is removed.
• Femoral Channel Preparation – The channel inside the femur is then hollowed out in preparation for the femoral stem insertion.
• Femoral Placement– The femoral stem may be secured with the use of cement or is “press-fit” into the hollow center of the femur. A carefully fitted metal or ceramic ball is then secured to the top of the femoral stem.
• Rejoining the Hip Joint – The hip joint is then rejoined and the surrounding muscle and tissues are repaired back to position and the procedure is completed.

Recovery after a partial hip replacement or total hip replacement for hip fractures will depend heavily on how well the individual follows home care and precautions after the surgery. After a partial hip replacement surgery, there will be some pain, but the medical team will provide the proper medication to make the patient as comfortable as possible. Walking and hip movement will being soon after the surgery where a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Major part of the recovery process will occur at home where proper care must be taken in terms of wound care, diet, and activity as prescribed by the physician and physical therapist. Patients who have undergone partial hip replacement surgery generally resume normal activities three to six weeks post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.

PARTIAL HIP REPLACEMENT VIDEO

Femoroacetabular impingement (FAI), also known as hip impingement, is a mechanical condition or structural disorder where the bones of the hip are abnormally shaped. Since they do not fit together perfectly, over time, the hip bones repetitively “bump” or rub against each other and cause damage to the joint, cartilage or the labrum. Femoroacetabular impingement occurs when the femoral head (ball) does not have its full range of motion within the acetabulum (socket). Femoroacetabular impingement can occur in people of all ages, including adolescents and young adults.

There are three main types of femoroacetabular impingements:

Cam Impingement – In cam impingement, the femoral head is not perfectly round, therefore it cannot rotate smoothly within the acetabulum. This is due to excess bone that has formed around the femoral head (bone spur). The bone spur grinds the cartilage inside the acetabulum.

Pincer Impingement – In pincer impingement, extra bone extends out over the normal rim of the acetabulum, crushing the labrum. When the hip is flexed, the neck of the femur bumps against the rim of the socket, resulting in damage to the cartilage and the labrum.

Combined Impingement – In combined impingement, both cam and pincer impingement occur together.

If symptoms persist after all non-operative treatments are exhausted, an arthroscopic surgery may be deemed necessary. During the procedure, an arthroscope, which is a small, flexible tube with a camera attached, is inserted into the hip joint. Two or three small incisions, called portals, are made to allow the scope and other surgical instruments to enter through a narrow space between the femoral head (ball) and the acetabulum (socket). Once inside, the physicians will examine the femoral head and acetabulum for any bone overgrowth and either trim or shave the spurs. The physician will also examine the labrum and the articular cartilage surrounding the hip joint to identify any inflammation, loose bodies, etc. and make any necessary repairs removing loose fragments of cartilage or trimming torn portions of the labrum. Once all the repairs are made, the incisions are closed with sutures, steri-strips, or small bandages and the procedure will be completed. In very few cases, people with femoroacetabular impingement may require a total hip replacement depending on the extent of damage and arthritis affecting the hip joint.

Hip arthroscopy often results in a quick recovery process as symptoms often improve immediately following the procedure. Swelling generally subsides within a week and the sutures will either dissolve or be removed in seven to ten days. The time of recovery will depend on the severity of the labral tear. Regardless, a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.

The acetabular labrum is a ring consisting of fibrous cartilage and dense connective tissues surround the femoral head. The acetabular labrum acts like a gasket or seal to help hold the femoral ball at the top of the thighbone securely with the acetabulum socket. The exact function of the labrum is a topic for discussion, however, it is thought to aid in the stability of the hip as well as decrease the stress placed on the hip joint as well as the acetabular cartilage. The labrum is susceptible to damage, tearing, or injury as a result of a traumatic event. Athletes participating in sports such as soccer, football, golf, or ice hockey or individuals with abnormal structure of the hips are at a higher risk of developing a hip labral tear.

If symptoms persist for more than eight to eight weeks of non-operative treatment, an arthroscopic surgery may be deemed necessary. During the procedure, an arthroscope, which is a small, flexible tube with a camera attached, is inserted into the hip joint. Two or three small incisions, called portals, are made to allow the scope and other surgical instruments to enter through a narrow space between the femoral head (ball) and the acetabulum (socket). Once inside, the physicians will examine the labrum and either repair or trim portions of the torn labrum. The physician will also examine the articular cartilage and other soft tissues that surround the hip ball-and-socket joint to identify any inflammation, loose bodies, bone spurs, etc. and make any necessary repairs removing loose fragments of cartilage or lining or removing painful bone spurs. Once all the repairs are made, the incisions are closed with sutures, steri-strips, or small bandages and the procedure will be completed.

Recovery with more-conservative treatment will vary based on the extent of the damage and the severity of the individual’s symptoms. Hip arthroscopy often results in a quick recovery process as symptoms often improve immediately following the procedure. Swelling generally subsides within a week and the sutures will either dissolve or be removed in seven to ten days. The time of recovery will depend on the severity of the labral tear. Regardless, a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.