Tuesday, October 25, 2016
Total Hip Replacements
By: K. David Moore, M.D.
Andrews Sports Medicine & Orthopaedic Center
Making the decision to have a total joint replacement is a life-changing decision for all involved. In the past 40 years, millions of people have suffered from arthritic hip pain and experienced relief and restored mobility through total hip replacement. Most patients report that pain experienced after surgery pales in comparison to the pain they were living with on a daily basis.
What advice do you have for those considering a hip replacement?
At Andrews Sports Medicine & Orthopaedic Center, our philosophy is to partner with our patients to help them claim victory over their condition or injury. The first step when making the decision about a hip replacement is for the patient to schedule an appointment with us to see if they are a candidate for total hip arthroplasty (THA). During the initial visit, we take the patient’s medical history, perform a physical examination, and x-ray the hip.
Even if the pain is significant and the x-rays show advanced arthritis of the joint, the first line of treatment is nearly always non-operative. This may include weight loss if appropriate, modifying certain activities, medication, or injections. If the symptoms persist despite these measures, then I recommend that the patient consider a total hip replacement.
The decision to move forward with surgery is not always straight forward and usually involves a thoughtful conversation between me, the patient, and their loved ones. The final decision rests with the patient based on how limited they are by hip pain. I often tell patients that when they have tried non-operative measures, but continue to have to order their loves around what their hip pain will allow them to do, it is time to consider hip replacement.
After having a hip replacement, how many years can a patient expect it to last?
On average, a total joint replacement lasts approximately 15-20 years. However, a more accurate way to think about longevity is via the annual failure rates. Most current data suggests hip replacements have an annual failure rate between 0.5-1.0%. This means that if a patient has a total joint replaced today, they have at least a 90-95% chance that joint will last 10 years, and a better than 80-85% that it will last 20 years.
With continual improvements in technology, these numbers will likely improve. Despite such improvement, I communicate to all my total hip replacement replacements that it is important for them to maintain long-term follow-up with me to assure their replacement is functioning appropriately.
Have hip replacement trends changed in recent years?
I believe that it’s important that we first consider what has not changed about hip replacement. Hip replacement has been an excellent operation for decades. It is an operation that very reliably alleviates pain and restores function. When people have studied everything that we do as physicians in terms of quality of life restored per dollar spent, nothing surpasses hip replacement.
That said, we have continued to improve our techniques and the quality of the implants over the past several decades. The surgery in now done through much more muscle sparing approaches. The Direct Superior approach is the latest of these and may be more muscle sparing than the direct anterior approach that became popular again a few years ago. We have also refined our physical therapy protocols and the way we manage post-operative pain. All of these measures allow patients to get back on their feet and back to the activities that they enjoy more quickly.
Our patient population has changes as well over the past few decades. There has been a definite shift towards a younger patient population considering the procedure. In the past patients often put off hip replacement surgeries until they reached their 60’s & 70’s for a myriad of reasons – surgery, hospitalization, post-surgical pain, extensive recovery time.
As hip replacement technology and recovery times have improved, we have seen a trend of younger patients seeking our attention for hip related problems.
Today’s patients are generally more invested in their health and more motivated to maintain an active lifestyle. Total hip replacement is an excellent option to help them achieve those goals.
K. David Moore, M.D. is an orthopaedic surgeon, specializing in total hip and knee replacements. Prior to joining Andrews Sports Medicine & Orthopaedic Center in June of 2016, Dr. Moore was Director of the Center for Joint Replacement at the University of Alabama at Birmingham. He joined the faculty at UAB in 2001, after serving as Chief of Adult Reconstruction for the United States Air Force at Wilford Hall Medical Center in San Antonio, Texas.
For more information, contact Andrews Sports Medicine & Orthopaedic Center at (205) 939-3699 or visit www.AndrewsSportsMedicine.com