Hip Replacement
Arthritis of the hip is a common and debilitating problem. It is typically found in elderly people, but younger active people can get arthritis as well, especially those people that had heavy laboring occupations or were in the military. Hip arthritis can cause leg-length discrepancy, loss of motion, and severe pain. Unfortunately, there are only a few things that can be done for hip arthritis. Initially the orthopedic surgeon may recommend anti-inflammatory medication or a hip joint steroid injection. But if that fails the most curative and predictable way of treating hip arthritis is with a total hip replacement. The new hips usually last 15 to 20 years.
Hip arthritis typically causes pain in the groin but can
also refer pain to the buttock area. Also, it can refer pain down the leg to the front part of the thigh. In general ‘start up’ pain is common; this is when you first get up in the morning or get up after a long dinner at a restaurant. Patients tend to say that the first few steps are the most difficult, but the more they move the better it gets. One of the goals of treating hip arthritis is to maintain motion. This is why the orthopedist will recommend physical therapy, especially in patients who have difficulty walking.
Another major concern with hip arthritis is the loss of hip motion. Patients may find that they lose rotation of their hip, making it difficult for females to cross their legs. The loss of rotation can also cause golfers to lose their swing as they are unable to rotate around the ball. Another motion affected by hip arthritis is abduction, or the ability to lift the leg out away from the other leg. For women this becomes an embarrassing and painful problem with a ‘female’ exam at the gynecologist office. And for all patients this loss of motion is problematic with dressing, showering and general normal ambulation.
“I go through exhaustive preoperative steps to minimize complication” – Dr. J Salinsky
Hip arthritis can also be mistaken for back problems. Even worse, hip arthritis can actually worsen or cause back problems especially if there is a leg-length discrepancy (the leg with the arthritic hip is shorter than the other). Ambulating on an arthritic hip can cause people to limp or use a cane which can immediately cause the back to have to compensate. This can worsen back problems and cause the back muscles to spasm. It can even lead to disc herniations and ‘sciatica’. A good orthopedic exam should be able to distinguish between back problems and hip arthritis. But if a patient has both back and hip problems there are diagnostic tests that can be done to discern which is most severe.
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If medication, injections, and physical therapy have failed a patient may be left to get a total hip replacement. In this procedure the arthritic ball and socket are removed and replaced with a polished metal and plastic socket. This is very scary and complications can occur; but, this is why I go through exhaustive preoperative steps to minimize complication and medically optimize patients’ medical conditions. 
Our team spends a tremendous amount of time with education on the surgery and what to expect. We even have a preoperative hospital ‘walk through’ so the patient can see where they will be before, during, and after the surgery. While in the hospital all patients are given medication and mechanical devices to prevent infection, blood clots and respiratory problems. Finally, most patients will spend between 5 and 15 days in a rehabilitation setting to regain strength, motion and confidence.
There has been a lot of recent rumors about the anterior approach to hip replacement. But to this day there are no current studies showing it is better. And there are complications that can occur that can be devastating, like a broken femur. This is why I use a traditional posterior approach. The pain is predictable and minimal, while the scar will be hidden by your undergarments. There is NO ‘cutting of the muscle’ that people tend to hear about. There is in fact some detachment of vestigial small muscles, but they are repaired at the end of the surgery and virtually never cause problems. There is no need for a special table and therefore time under anesthesia is minimized. In fact this surgery usually takes me about an hour! I only use companies and implants that are not under recall and I would be happy to share and discuss the company I use prior to your operation.
