Great Outcomes: The Success of Total Hip Replacement (THA) Surgery

Dr. Rory Wright, Blount Orthopaedic Associates

Total Hip Arthroplasty (Total Hip “Replacement” or simply THA) surgery is typically performed for end-stage degenerative joint disease of the hip. Joint degeneration occurs as a result of previous trauma, congenital abnormalities of the hip, inflammatory arthritis, and, most commonly, osteoarthritis. THA surgery is one of the top surgeries we perform at the Orthopaedic Hospital of Wisconsin.

The American Academy of Orthopedic Surgeons states that as of 2010, there were over 300,000 THA surgeries performed annually in the United States! Several projections from orthopedic journals indicate this number is expected to increase nearly twofold by 2030, as the Baby Boomer population moves into their senior years.

Fortunately, THA surgery is one of the most successful orthopedic surgeries. Many patients report a fast recovery and a clear improvement in pain and mobility, just weeks after they undergo the procedure. If you’re facing THA surgery, rest assured you’re in good hands.

COMMON SYMPTOMS OF HIP DISEASE

Patients with hip disease often visit their doctor with a primary complaint of pain. The pain can be dull and constant or intermittent and very “knife-like.” The most common pain location is around the hip itself, but it often masquerades as a hernia with pain in the groin or as a back disorder with back pain near the beltline. Although less common, sometimes the presenting symptom of hip disease is chronic aching in the area of the thigh and knee. It’s important to visit your doctor if you’re experiencing any of these issues.

As the pain from hip disease increases, functions such as walking, exercising, sitting in the car, or even putting on shoes and socks become more difficult. A patient’s range of motion and flexibility in an end-stage arthritic hip is often quite limited. This hip pain and stiffness often cause patients to change how they move, sleep, and dress themselves. 

It’s not uncommon for hip disease symptoms to come on slowly. Friends and family may recognize that a family member is limping or facing mobility issues before the patient acknowledges the problem himself or herself. 

The good news about hip disease is that even if non-surgical interventions (such as activity modification, low impact exercise, use of a cane, medication, and physical therapy) are unsuccessful, surgery to replace the hip (THA surgery) is highly successful.

Orthopaedic Hospital of Wisconsin’s Dr. Rory Wright says, “In my practice patients undergoing hip replacement often volunteer that the pain they were experiencing prior to their surgery is improved even before they leave the hospital.”

 HOW IS THA SURGERY PERFORMED?

THA surgery has been performed for decades. For nearly 60 years, hip replacement has relied upon a surgeon’s ability to remove the worn away bone and replace it with a combination of metal and a special plastic.

There have been several iterations of hip replacement technology, including metal on metal hips, ceramic on ceramic hips, and both metal and ceramic combined. None of these have surpassed the function and longevity of the gold standard–a plastic bearing surface with either a metal or ceramic ball. This hip replacement material combination, along with a press-fit titanium acetabular shell and femoral component, provides many years of improvement. In the majority of THA surgical cases, successful hip replacement lasts a couple of decades.

THA surgery has recently received substantial media attention with headlines implying improvement or that there is something “new” (implying better). There have certainly been improvements in THA surgery over the last decade, but regardless of the approach, the outcomes are typically quite successful. Whether a hip is placed through an anterolateral incision, anterior incision, posterior incision, or some of the newer “minimally invasive” THA surgical techniques, they can all perform well.

Dr. Wright says, “I always remind my patients to be cautious about what is simply ‘new’ and ask discerning questions about whether ‘new’ is actually equal to or better than the ‘gold standard.'” Keep in mind that the Ford Pinto was once “new” (and is now considered one of the worst cars of all time).

THA surgery, like any surgery, poses risks, but in most cases, these are easily managed. Surgical teams minimize the risks associated with THA surgery such as bleeding, infection, dislocation, and fracture, by optimizing patients’ health before surgery and applying state-of-the-art surgical and anesthetic principles.

Years ago, patients stayed in the hospital for several days, often up to a week following THA surgery. It’s now common for patients to return home after only one or two nights in the hospital. By using a minimally invasive approach and improved pain management techniques, and by providing preoperative patient education, the length of time a patient remains in the hospital for THA surgery continues to decline.

Dr. Wright says, “I currently favor a minimally-invasive muscle-sparing approach but instruct all patients to choose their doctor and then have them perform the procedure in a manner that they feel is the best for the patient. There are many ways to achieve an extremely satisfying result.”

HOW LONG IS RECOVERY AFTER THA SURGERY?

Surgeons now commonly perform THA surgery in 60-90 minutes, and patients are asked to ambulate (use therapeutic movements) on the same day as the procedure. In many cases, patients can move with full weight-bearing on the day of their THA surgery.

During recovery, patients often use ambulatory assistance devices such as walkers, crutches, and canes for the first several weeks to ensure their safety while the hip is healing. By six weeks post-surgery, most patients are back to a near-normal lifestyle and beginning to exercise regularly.

Depending upon a patient’s level of fitness before THA surgery, some recovery stories are even more remarkable. Dr. Wright had a patient several years ago who was an avid motorcycle rider. He had a Harley Davidson delivered to his garage that he was unable to ride in the weeks leading up to his THA surgery due to his severe hip pain. After the hip replacement (in this case, a resurfacing), he chose to ride his new Harley to his two-week post-op appointment!

Dr. Wright says, “While this is NOT something I would advise for patients, it demonstrates how the combination of patient motivation and the newest surgical techniques can combine to generate near unbelievable results.”

Dr. Wright says, “My overwhelming opinion is that THA surgery is one of the most successful surgeries we perform… 25 years of caring for patients and listening to their numerous accomplishments post-hip replacement is the basis for this opinion. It is a very rare patient that doesn’t profusely shower their surgeon with THANK YOU’S following hip replacement.

If you have increasing hip pain, and it does not respond to rest and activity modification, we encourage you to visit an orthopedic surgeon and learn whether a hip replacement is right for you. Request an appointment online or call 414-961-6800 to set up a consultation.