By Mark J. Fletcher M.D.
Total hip arthroplasty (THA) continues to be one of the most successful and cost-effective procedures in medicine. THA can relieve pain, restore function, and improve quality of life for patients experiencing hip pain from a multitude of conditions. Over 400,000 total hip procedures are performed annually in the US! The amount of THA will continue to increase due to the amount of individuals wishing to remain active while they age as well as the increased number of obese individuals. Both THA and TKA (total knee arthroplasty) are commonly performed at Coastal Orthopaedics at Norwalk Hospital’s Center for Joint Care.
A THA surgery replaces the diseased hip joint surfaces with synthetic materials to alleviate pain and improve function. Surgery is usually considered as an option once all non-operative methods of pain control have been exhausted. A THA can be life changing with improvements in pain, function, and life quality for patients with severe hip disease. Conventional THA surgery has shown excellent long term survival of the implants.
Significant effort continues to be spent in research to improve THA. Improvements in materials over the past 10 years have yielded a bearing surface, highly crossed linked high molecular weight polyethylene (CL- HMWPE), which wears 90% less than previous versions. This one change may extend the functional life span of a THA by decades. The improvements of the femoral components, with the introduction of newer and tougher ceramics, along with CL-HMWPE have provided a very durable and long lasting implant combination for most patients. The use of CL-HMWPE and ceramics together maximize the benefits of both materials while minimizing the drawbacks of ceramic only implants (size options, fracture risk, joint squeeking), or metal on metal components (pseudotumor formation, pain, high revision rate from wear debris).
The approach to pain management has been revolutionized over the past 5 years. Preemptive use of non-narcotic medications, along with spinal anesthesia, can minimize the generation of pain from surgery even before the procedure begins. After surgery a combination of traditional and newer non-narcotic medications are used along with a minimal amount of oral narcotic medication. This multimodal pain control method allows the patient excellent pain control while avoid side effects caused by injections of narcotic medications. The side effects of narcotic medications (nausea, vomiting, itching, dizziness, constipation) are typically the reason that patients need to stay in bed and prolong recovery from surgery. Multimodal pain control methods, along with less invasive surgical techniques and aggressive physical therapy protocols have significantly lessened the hospital stay for all total joint replacement patients. These combined improvements have even made it possible for some patients to go home the day after, and even the day of, surgery. At the Norwalk Hospital joint replacement center the average hospital stay after joint replacement – for all patients – is only 2 days.
Surgical approaches have continued to be developed to decrease soft tissue injury at the time of surgery as well as minimizing pain after surgery while allowing more aggressive rehabilitation. The direct anterior approach (DAA) and direct superior approach (DSA) to THA have recently been developed as methods of minimizing soft tissue trauma during surgery. It is thought that both approaches allow earlier and less painful walking after surgery by avoiding the detaching of muscles required in more traditional approaches. These newer approaches, along with multimodal pain control, provide the following advantages:
- Less soft tissue damage (muscle/tendon)
- No need for hip precautions after surgery
- Shorter hospital stay
- Lower dislocation rate
- Less pain after surgery
- Minimal narcotic medication needs after surgery
- Less blood loss
- Smaller incision size
The physicians at Coastal Orthopaedics have been performing total hip arthroplasty for over 40 years. Both the direct anterior approach (DAA) and the direct superior approach (DSA) are currently performed by Coastal Orthopaedics surgeons working at Norwalk Hospital Joint replacement Center. Coastal Orthopaedics continues to be involved in the implementation of advanced techniques and methods into the care of patients with hip pain. Do not hesitate to schedule an appointment to discuss joint pain with one of our surgeons. We are happy to determine a diagnosis and create a plan of care with you to best address your problem.