Hip Replacement

Indications for Hip Surgery

Hip arthritis leads to pain and disability. There is no cure for the missing or damaged cartilage. Nonsurgical treatments are meant to decrease pain and or to allow someone to do more of their normal activities. They are short term methods and are not meant to cure the problem. Surgical treatment is a more permanent treatment. Hip replacement is a surgical treatment for hip arthritis, and it is very predictable in terms of decreasing pain and improving function. 

Hip replacement is surgical treatment for hip arthritis that is interfering with a person’s ability to do their normal activities.

Candidates for Surgery

Men, older than 70, and women over 55 are candidates for hip replacement. Younger patients may be candidates for Hip Resurfacing – a different surgical treatment offered to younger and more active patients.

Hip Replacement Procedure

Hip Replacement is a surgical procedure that involves removing the femoral head (ball) from the top end of the femur and replacing it with a metal stem that sits within the hollow part of the femur. A ball made of ceramic is placed on the top end of this titanium stem to create a replacement of the original ball. A metal socket is placed into the original hip socket. The metal is usually titanium with a liner of plastic.

This is considered major surgery, performed in hospitals or surgery centres. Patients will usually spend a night or two in the hospital or centre. Currently, some hip replacements are now done as a day procedure where the patient is discharged the same day of surgery. Hip replacement is a surgical treatment for hip arthritis that works to reduce pain and increase function.

Cemented and Uncemented Stems

The most common type of femoral stem used is a titanium stem that is inserted without cement or glue – termed “Uncemented”. A rough texture on the outside of the stem allows bone to grow into or incorporate into the metal surface. 

In some cases a Cemented stem is used. This is a more traditional technique which is used today as a result of low bone density or if the anatomy of the femur is not suited to the uncemented stem.  In this type of stem a special glue is inserted into the femur and then a metal stem is inserted into the cement. This is a very well-proven way of doing a hip replacement. 

All of the implants that Dr. MacKenzie uses for Hip Replacement have been in use for several years and have excellent track records.

Surgical Approach

There are many ways to do the “approach” to the hip joint. Older techniques involved a fairly long incision which results in releasing lots of muscles and tendons to be able to implant the artificial parts.

Newer approaches use smaller incisions which consequently involve cutting or releasing fewer muscles and tendons.

Direct Superior Surgical Approach

Dr. MacKenzie uses an approach called Direct Superior. The incision is on the side and posterior part of the thigh, which avoids the front of the leg where there can be issues with skin sensitivity and nerve damage. This “muscle sparing” approach to a hip replacement allows for a quick recovery. This approach can be converted into a more traditional approach if the need arises. 

Dr. MacKenzie also uses a technique called “SuperPath” in select patients. This has been popularized in the U.S. as a muscle sparing approach.

Activities after Hip Replacement

After surgery, most surgeons will instruct their patients to avoid activities that put excess stress on the hip replacement. This includes running, jogging and impact loading activities. Many need to avoid racket sports and risky activities such as skiing or mountain biking. There is a risk of a hip replacement dislocating. The ball which is used to recreate the femoral head is smaller than the original, and so there is increased risk of dislocation. This is important for people who do backcountry or wilderness activities as a dislocation could be a very serious situation in those environments.

Traumatic injuries such as a broken femur are much more difficult to treat once you have a hip replacement. This is because the stem of the hip replacement is in the way.