Hip Replacement

Arthritis is a common diagnosis in the hip joint that involves destruction of the cartilage, or the smooth surface that covers joints. The most common type of arthritis experienced by patients in the hip is osteoarthritis, or “wear and tear” arthritis.  There are other types of arthritis that can degrade cartilage including inflammatory conditions such as rheumatoid arthritis or post-injury joint damage such as fractures. Degeneration of the joint surface often leads to pain, stiffness, loss of function and significantly impaired quality of life. Pain from hip arthritis is usually experienced in the groin, buttock or radiating down the leg. It is often worse with movement and can impact sleep.    

Diagnosis of hip arthritis can be made through consultation with a physician and regular X-rays. More sophisticated imaging such as MRI scans are not often required. Furthermore, arthritis that can only been seen on MRI is often not severe enough to warrant joint replacement surgery.

The treatment of hip arthritis begins with optimization of non-operative treatment measures including alteration of activities, exercise-based physical therapy, walking aids such as a cane or walking poles, non-opiate pain medications, or injections. If non-operative treatment measures are unsuccessful, surgery including total hip replacement can be considered. Although arthritis often results in stiffness and loss of mobility, the main reason for requiring a hip replacement is pain that interferes with the quality of life of the patient.

Total hip replacement surgery is when the diseased articular cartilage from the acetabulum (or hip socket) and femur (or thigh bone) is removed and replaced with artificial components. Hip replacement components including the stem and socket are typically made of metal (titanium) and are covered with a rough surface that encourages your bone to grow into them. This type of component is known as an uncemented hip replacement and is the most common type performed at the VHKRI. The femoral head is made of ceramic which articulates with a special plastic liner (cross linked polyethylene) that locks into the metal shell. This combination of ceramic and surgical plastic allows most hip replacements to last 25 years and beyond.

A traditional hip replacement is made of metal components and hard plastic including a metal or ceramic femoral head. The stem and socket components can either be uncemented (covered with a rough surface that encourages your bone to grow onto them) or cemented where the components are fixed into place with surgical cement. Most hip joint replacements in North America are of the uncemented variety although some patients with osteoporosis or other bone abnormalities may require cemented components. At the VHKRI we typically perform uncemented primary hip replacements; however, we have all the necessary equipment for cemented hip replacements available if required. We typically utilize ceramic femoral heads and long-wearing surgical plastic liners for most uncomplicated hip replacements, instead of the traditional metal heads to avoid any complications related to the release of metal ions into the body.

In addition to the modern posterior approach used to perform most of our hip replacements, we also offer the minimally invasive direct anterior approach to perform primary hip replacements in select patients (not every patient is an ideal candidate). Dr. Neufeld received subspecialty training in the direct anterior approach and performs both approaches. The muscle sparing anterior approach is performed using an incision on the front of the hip joint with the patient lying on their back and uses intraoperative x-rays during the surgery. It is important to understand that the posterior approach is the tried-and-true way of performing hip replacements at our institution, the most common approach used in the world, and that both approaches offer excellent recovery and functional outcomes.

Hip resurfacing was initially marketed for younger active patients in whom traditional hip replacements might wear out too quickly. Over time, we have learned that hip resurfacing can generate a metal reaction that can be associated with complications and the need for revision surgery. Also, the older problems with a traditional hip replacement have been fixed. Newer technologies of traditional hip replacement including ceramic heads and improved plastic liners that wear very slowly over time have dramatically improved their performance to 25 years and beyond. We do not currently perform hip resurfacing at the VHKRI.

Hip replacements are considered in patients with pain in their hip joint due to arthritis that has not responded to nonoperative options and causes disturbance to their quality of life. While a hip replacement can restore some elements of function, they are not designed to allow you to return to some sports such as running and jumping as those activities may cause pain. While there are no imposed restrictions, certain activities may not be possible. Athletic individuals should understand that hip replacement may not restore high intensity activities to their liking. We encourage you to discuss your goals for returning to sports, or demanding activities, at the time of your consultation so we can help you determine realistic expectations based on best-available evidence.

If it is determined that the pain you are having is coming from your hip and you are a candidate for hip replacement surgery, a hip replacement is performed for your hip pain. In some patients, if back pain is related to hip stiffness, the back pain may improve. However, do not count of a hip replacement to solve all of your back pain problems. If in doubt, please discuss this with your surgeon at your appointment.

Some people with previous hip replacements require another surgery due to complications such as infection, fracture, the joint has worn out or there is bone loss. Revisions, or redo surgery are much more complicated that the initial operation. They require specialized components and are considered on a patient-by-patient basis. At VHKRI, we specialize in revision surgery and we have all the equipment needed for even the most difficult revisions including 3D-printed custom reconstruction for select cases that cannot be treated in any other way.

Although 95% of patients are satisfied with their hip replacement, complications can occur on occasion. These may include, but are not limited to, medical complications such as heart attacks, strokes or blood clots or surgical complications such as infection, bleeding, nerve injury, dislocation, fracture, loosening and leg length inequality. Your surgeons will discuss these rare complications with you, but please feel free to ask questions about risks, benefits, and anything else on your mind at your appointment.