Hip Replacement


Many people suffering from arthritis of the hip find relief in medicines, exercises, and weight management programs. However, several patients experience intense pain and discomfort. Doctors may recommend hip replacement surgery for patients who do not get relief from other treatments.

Total Hip Arthroplasty (THA) is one of the most successful surgeries performed in orthopedics. THA provides reliable outcomes such as pain relief, restoration of the joint up to functionality, and overall improved quality of life.

The traditional surgical approach to total hip replacement uses a single, long incision to view and access the hip joint. Another variation is a minimally invasive procedure in which one or two shorter incisions are used to reduce pain and promote a speedy recovery. But, it is not suitable for all patients. You need to discuss different surgical options with your orthopedic surgeon based on your condition.

Traditional hip replacement surgery involves making an incision of 12-18 inches along the patient’s thigh. The doctor then removes the diseased hip joint and replaces it with an implant. THA is a major surgery that requires ample time for the tissue in the body to adapt and adjust to the new implant. The point of the incision also needs time to heal as the muscles and tissue in the leg are disrupted.

Only an orthopedic surgeon can determine whether the patient can opt for a minimally invasive hip replacement procedure. Like every other surgery, a hip replacement procedure comes with its risks. Some of the most adverse events that occur post-surgery are loosening, deformation or infection, fracture of the bone or components, etc.

Advances and Innovations in Total Hip Replacement

  • Virtual Reality

Thanks to virtual reality, it is possible to replicate the exact feeling of being inside an operating room. The virtual simulation allows for unlimited practice, paving way for the surgical technique to be mastered with great precision, thus reducing potential errors in the procedure. Moreover, multiple operators can simultaneously work on the same surgery, remotely.

Virtual reality opens up new avenues in total joint arthroplasty as it can be used to try new surgical techniques and get familiarised with new instruments and devices.

  • 3D printing technology

In recent years, 3D printing technology is a major advancement in the field that has increasingly been used in total joint arthroplasty. The technology is used to create patient-specific guides, allowing the surgeon to position the implants with precision according to the pre-operative plan. This is called PSI or Patient-specific Instrumentation.

This technology uses CT scans to personalize a preoperative plan for each patient’s anatomy. It aids the operative surgeon to plan and execute with great precision the positioning of the acetabular implant while preserving hip stability.

The development of computer navigation and robotics has led to the minimization of human error and improved the accuracy of implant positioning and restoration of the native hip biomechanics.

  • Robotic Total Hip Replacement

Robots have different functions. While some operate autonomously, others are active-constrained, i.e the surgeon is in control. In the latter system, a 3D plan based on CT scans is handed over to the operating surgeon based on which they can optimize the surgery. The goal is to complete the procedure with precision to deliver patient-specific operative plans.

Although the role of the surgeon is critical, the robotic arm delivers surgeon-led procedural plans that are based on a complete understanding of the patient’s anatomy to give an accurate outcome to the patient. 

Benefits of new technology and advancements in Total hip replacement surgery

  • Precision

The new advancements in Total Hip Replacement Surgery have led to aiding the medical procedure to be completed with greater precision and hence, results derived for patients are better. The new technology is patient-centric and helps the surgeon understand the particular patient’s anatomy better, thereby delivering what the patient needs. Moreover, as compared to total knee replacement, total hip replacement surgery reduces stress on the bones and increases the life of the implants.

  • Long term results

Total hip replacement is a long-term solution that enjoys a higher success rate. Evidence shows that 80-85% of hip replacements still function after 20 years of insertion.

  • Less recovery time & minimally invasive technique

New advancements have resulted in minimally invasive surgeries that require less recovery time. It is likely that the patient may lose less blood and may experience less muscle damage or soreness.

  • Data from CT scans

Robotic technology presents the potential to capture data from CT scans for processing of the pre-op plan, and final execution of the hip replacement and implant positioning. Using this data and artificial intelligence allows us to tailor our approach to deliver personalized solutions.

  • Improved Quality of Life

With minimally-invasive and precise procedures becoming possible, thanks to these advancements, the patient can recover sooner and return to their normal lives faster as compared to traditional surgery. Lesser side effects and lower chances of complications also contribute to a fuller, speedy recovery and better quality of life.

Total hip arthroplasty is a safe procedure, resulting in substantial improvements for patients. However, there is a significant increase in the number of THAs in the world, with an even more evident increase in younger patients undergoing the surgery. It is important to note that it is imperative to achieve the best functional outcomes as the population demands utmost functionality post-surgery. To achieve this, the advancements and innovations in the field showcase substantial potential, where improvements are still in process.

Hip replacement is a surgical procedure in which a surgeon removes the damaged and painful sections of the hip joint and replaces it with an artificial one that is usually made from metal, ceramic, and High density  plastic components. This procedure is undertaken to reduce pain and improve one’s joint movement and function. The artificial joint is known as a prosthesis.

Hip replacement is usually done when other, less invasive methods have failed to provide relief to the patient. Also known as Hip Arthroplasty, hip replacement is also considered if the hip pain interferes with one’s daily activities. Damage caused due to Arthritis is one of the most common reasons for Hip Replacement Surgery. Some conditions that may require hip replacement surgery to treat it are:

Osteoarthritis: Also known as wear-and-tear arthritis, this condition damages the protective cartilage that cushions the ends of your bones which helps the joints move smoothly.

Rheumatoid Arthritis: This is an autoimmune disease in which there is inflammation in the joints, which in turn leads to bone erosion and joint deformity.

Osteonecrosis: Osteonecrosis occurs when there is no adequate blood supply to the ball portion of the hip joint, which might occur due to dislocation of the hip bone or hip fracture.

Does an artificial hip work better after a hip replacement?

Hip replacement offers the greatest benefit of pain relief. Along with that, there is an improvement in movement, strength, and coordination of the lower body. It also helps you to get back to your active life. But, despite being highly effective, an artificial hip is associated with certain limitations.

1. Durability: Though majority the of the artificial hip implants last for 15 to 20 years, one cannot guarantee smooth functioning in every case of certain situations such as infections or trauma, an artificial hip can get worn out quickly, making it necessary for a second replacement. Normally, an artificial hip can work for up to 15 – 20 years, without any major trouble.

2. Susceptibility to allergy: Though these problems are rarely seen, they can occur. The patient may display signs of metal allergy after the surgery. This is characterized by skin rash, itching sensation, and discoloration in the area where the artificial joint has been fixed. 

3. Weather problems: In some patients, the natural bones surrounding the hip implant take more time to adapt to the metallic nature of the hip, leading to increased weather sensitivity in the patient. Due to this phenomenon, a patient may feel increased pain and stiffness in the artificial hip in certain seasons like monsoon or winter.

4. Caution in future dental visits: You need to take care while visiting your dentist after your hip replacement as you could catch an infection. Preferably, you should take a prophylactic antibiotic.

What type of permanent restrictions will one have after a hip replacement surgery?

Every patient’s experience with Hip Replacement Surgery is not the same. Hence, it is not possible to predict whether a particular patient will have permanent movement restrictions after hip replacement or not. Most of the patients can return to a normal daily routine without any permanent restrictions, albeit with less pain and discomfort. However, a risk always prevails regarding an implant getting worn out, in which case the patient might need a second replacement. Though there are no permanent restrictions in most cases, there are certain activities one has to avoid for a certain period. These restrictions are also known as posterior hip precautions. They are:

  1. Cross your legs: One should not cross their legs past the midline of the body after a hip replacement surgery. To avoid crossing your legs, the surgeon may also advise sleeping on your side or keeping a pillow between the legs.
  2. Forward bending: It is also important to ensure that you do not bend your hip beyond 90 degrees after a hip replacement. Your knee must be below your hip joint. You can utilize cushions and pillows to elevate your seat, to ensure that your knees are positioned lower than your hips.
  3. Positioning your feet: Ensure that you keep your feet and your knees pointed straight ahead, in the front. Do not try turning them in or out. Also, avoid sitting in the same position for more than 30 40 minutes.
  4. Seating arrangement: Make sure that you are using a firm chair with a straight back and armrests. Avoid chairs that are too soft, rocking chairs, recliners, and stools.
  5. Climbing the stairs: Avoid climbing the stairs very frequently, as it will put a strain on the artificial joint.

Even after the joint has completely healed strenuous physical activities like sports must be avoided. It is important to keep in mind that the prosthetic joint has only been designed to withstand day-to-day physical activities. You can work with a physical therapist to learn various techniques and guidelines while performing various activities. If you do not follow the above-mentioned restrictions, you may run the risk of dislocating your joint, leading to second replacement surgery. Hence, you must be well-informed and take precautions with utmost care as suggested by your surgeon.

Today, the healthcare industry is simmering with innovation and new ideas. Transformation is happening at an astonishing pace and redefining the way in which patients are treated for any health-related issues. New-age technologies have boosted the success rate and are also turning out to be less invasive as compared to older methods. Especially, when it comes to treating hip pain and improving patient’s quality of life, hip replacement surgery is one of the most advanced and successful procedures in today’s medical space. Traditionally, Orthopaedic surgeons use to prefer a total hip replacement surgery by incising back or on the side of your hip. However, in recent times, surgeons prefer incising a cut in the upper part of the front thigh. This approach is called an anterior approach or anterior hip replacement. These surgeries may likewise be called small mini, modified, minimally invasive, or muscle-saving surgeries. The procedure involves replacing a damaged hip joint with an artificial hip that can be of metal or ceramic.

Though there are various approaches to the hip that can provide an exemplary outcome, over the past several years, the anterior approach has become more popular because of its minimally-invasive technique. Also, it lowers the risk of complexity before, amid and after the surgery. However, adopting this technique is highly preferred in patients with arthritis, but can also be used for patients undergoing THR due to any other reason like hip fracture, disorders that cause unusual bone growth (bone dysplasias), etc. A lateral or posterior hip replacement surgery and anterior hip replacement approach vary in certain ways but both the approaches share the same objective. Both the approaches are devised to provide adequate pain relief from the hip joint and allowing the patient to perform their normal chores with great comfort. Now let’s take a look at some benefits of Anterior Total Hip Replacement.

Benefits of anterior Total Hip Replacement

  • Compared to ancient science, after anterior THR, a patient suffers from less pain without causing much damage to surrounding tendons and muscles, which leads to a rapid and smooth recovery.
  • The patient will no longer need to be kept under observation post-surgery and can be allowed to go home immediately as per doctor’s advice.
  • Once the surgery is completed, it allows an option for the patient to walk out of their bed and cover small distances independently using any walking aid as soon as it’s comfortable.
  • The patient can also navigate through stairs with ease and comfort. While pursuing the stairs, lifting the stronger leg first onto the steps and starting with the weaker leg when coming back down through the stairs helps in preventing dislocation of the new implant. It is common for the patients to use cane, walker or any other equipment for walking assistance immediately after the surgery.
  • With the lateral or posterior approach, patients have to avoid bending and even sitting with their legs crossed for 6 – 8 weeks as this could result in hip dislocation. But with anterior approach patients are not restricted from any of these activities.

Life after anterior Total Hip Replacement

After implementing a successful anterior THR surgery, patients are able to bear weight on their new hip and can walk easily using any walking aid as per their support. The only thing that patients need to make sure is that their home stairs have a guardrail or banister installed, as to avoid any temptation of walking up or down the stairs unsupported. However, patients will need a personal trainer to restore the strength and movement in their joints and surrounding muscles. Mostly it will take up to 4-6 weeks to gain ample strength for the movement and performance of the daily routine activities. One can resume work after anterior THR, as it allows the majority of patients to start working after a month but we would recommend waiting for up to 3 months if it involves physical labour. Patients can expect their lifestyle to be a lot like how it was before having surgery but without the pain.

Summing up, anterior hip replacement by far is less painful and leads to a faster recovery of mobility and strength compared to a lateral or posterior approach. However, the recovery process still involves distinct phases to ensure the tissue is healing properly which will allow optimum functionality. It is important for every patient to know that every case is unique and the progression will completely depend on their unique set of circumstances. But, an anterior hip replacement approach is mostly likely to add more quality to a patient’s life.

Whether you have just commenced exploring treatment options for your hip pain or already have decided to go for a hip replacement surgery, we’ve got some information that might help you in your decision making. It has been proven that hip replacement surgery is one of the most successful procedures performed by orthopaedic surgeons for relieving chronic hip pain. With more than 90% success rate, hip replacement implants have managed to drastically reduce pain and improve function for people with damaged joints. The most conventional reason for having a hip replacement is osteoarthritis while other possible reasons include rheumatoid arthritis, a hip fracture or hip dysplasia; a condition where the hip joint hasn’t developed properly. It is essential to understand that a hip replacement implant is usually done when all other options including medication have failed to provide sufficient pain relief. The main objective behind the procedure is to relieve a sore hip joint, thus making walking and other activities easier.

The surgery involves taking off parts of the hip joint that are problem causing (usually the ball and socket) and then replacing them with new parts made from metal, plastic, and ceramic. Many people undergo this surgery every year and it usually brings great effects in terms of enhanced strength and well-being. However, it’s always vital to discuss with your doctor about the probable risks involved in it.

The material for the hip implant is normally selected by your surgeon depending on your medical condition and unique requirements. Full metal implants are now not readily preferred by surgeons due to the high risk of metal poisoning. Thus came titanium metal and ceramic implants at your rescue. Let’s find out how both of these are different from each other and which one can be the right fit for you.

Ceramic Implants

Ceramic hip implants are among the latest type of prosthesis being used for hip replacement, giving greater resistance to damage and smooth movement of the joint. For those who are not aware of Ceramic material, it’s a tough substance and does not get worn out easily as compared to metals and plastic. However, ceramic is also not completely devoid of problems. They tend to develop cracks and breaking down easily. However, newer ceramic materials have demonstrated lesser problems but, long-term clinical outcomes with ceramic implants are less published contrary to the metallic implants. This fact somewhat restricts the preference for ceramic implants.

Titanium Implants

Most hip implants these days consist of Titanium. Both the ball and the socket of the hip joint are replaced with a titanium implant, and a plastic spacer is placed in between. Titanium metal has a long history of established effectiveness in hip replacement and continues to be preferred by many surgeons. Based on current practice, metal (Titanium) implants are preferred in aged patients, while ceramic implants are being increasingly recommended in younger candidates due to their reliable durability.

Despite rising concerns over metal and other material implants used in the surgery, the majority of the hip replacement implants have been successful and have improved the quality of life and function.

To round off, when it comes to choosing the best material, both have their pros and cons. While ceramic does not get as worn out as metal or plastic, they can develop cracks or break suddenly.  It will eventually depend on the surgeons to pick the best one for you after analyzing the risks and benefits of various implants.

Hip pain is not normal and can cause serious trouble if not treated wisely. Any discomfort or painful sensation near the thighbone or pelvic girdle can be termed as hip pain. The hip joint is a ball and socket synovial joint that is responsible for providing a wide range of motion for the lower torso. It is because of the hip joint one can stand, walk, dance or lift. It is also considered as one of the most important joint when it comes to stability. However, as the person ages, the joint may undergo wear and tear.

Though hip pain to an extent can be treated with medication, injections and physical therapy, hip replacement surgery is the safest and the best option to treat hip-related problems when nothing else finds success in relieving the pain. A hip replacement could be recommended to any patient, in case they are suffering from chronic hip pain which is hindering their daily activities and other non-invasive methods of pain reduction have proved to be ineffective or are no longer effective to improve their condition. A patient with symptoms of severe hip arthritis, including as stated below, could be suggested to go for Hip replacement surgery.

1) Hip pain: An aching hip can make any patient’s life miserable. The most vital factor in selecting to have a hip replacement is quantifying the extent to which pain is affecting a patient. Pain that leads to interference in performing daily activities, even not letting anyone have a sound sleep, and is restricted between hip and knee could indicate arthritis of the hip. Some patients need the support of a cane or are also seen limping. A set of such patients regularly rely on pain-killer consumption to deal with their pain. In such cases, doctors usually suggest a patient with a replacement surgery to get long-lasting relief.

2) Stiffness: Difficulty in performing certain normal activities like doing weight training, cycling or even bending down for picking basic objects

3) Sprain: A sprain in a muscle occurs when the ligament is stretched than the usual limit causing the area to swell. A sprain can be caused by any sudden fall, twist, and turn of the muscle groups/joints.

 4) Difficulty in weight-bearing: In case a patient is not able to stand on his/her paining leg even for a minute with support, it indicates that their hip’s condition is very bad and they need a total hip replacement surgery.

5) Muscle stress: When the body is stressed, muscles tense up. Muscle tension is the body’s way of guarding against injury and pain. For e.g when you sit in one position for some time, you may end up making them stressed. This causes a change in the body’s nervous system by contracting blood vessels and reducing blow flow.

6) Fractures. A hip fracture is a fracture of the upper region of the femur or the thighbone. Fractures lead to swelling, difficulty in walking, sitting, etc causing severe pain.

Also, if the patient is suffering from Osteoarthritis or Osteoporosis, they can be advised to undergo a Total Hip Replacement. With Osteoarthritis, the joints become stiff and swollen due to inflammation and a breakdown of cartilage, causing pain and deformity are observed. Talking about Osteoporosis, it is a bone disease that occurs when the body loses too much bone, makes too little bone, or both.

So, in case you are experiencing severe pain with no sign of pain killers bailing you out of the dreadful situation, a hip replacement surgery then can be regarded as the best treatment option. Remember that the surgery option should only be considered when all other conservative treatment options have failed to provide relief from continuous hip pain and restricted mobility.

Also, remember that whatever the cause is, hip pain is more common as you grow older. And over time, your joint will see a lot of wear and tear. So make sure you are taking adequate care of the joints by eating healthy and doing the right exercises to keep your bone health at its best.