Hip Replacement Surgery: Then and Now
By Michael Anderson, M. D., Revere Health, Coral Desert Orthopedics
If you have been experiencing the pain of arthritis in one or both hips, be glad that you live now and not 30 years ago. Much has changed in virtually all aspects of hip replacement surgery. In this short article. I’m going to contrast the differences between hip replacement surgery 30 years ago to hip replacement surgery today.
LENGTH OF STAY IN THE HOSPITAL
Let me begin with the length of stay in the hospital. When I first began my training 30 years ago in hip replacement surgery, it was common for patients to be in the hospital for 5 to 7 days—sometimes longer. During that time. patients were in bed for at least the first three days and then gradually mobilized. Contrast that with my experience now in which my patients are discharged from the hospital, on average, less than 24 hours after surgery. I have even had some patients go directly home the same day as their surgery. Much of this has to do with the efforts that we place in preoperative teaching. I developed a program that is called Quick Recovery Surgery (QRS). It is in this program that we conduct extensive preoperative teaching. We explain in detail every step of the surgery, so you know what to expect before, during, and after the surgery. There are no surprises. A well-educated patient is usually a very good patient. I find patient’s generally like knowing the details of their surgery, which reduces the mystery and fear associated with it..
30 years ago, it was expected that there would routinely be a substantial blood loss with hip replacement surgery. Anticipating this, we often had patients donate blood for themselves the month before surgery. At the very least, the patients were typed and crossed (taking a blood sample and sending it to the blood bank to prepare for a blood transfusion, if needed). Nationally, the transfusion rate for hip replacement surgery 30 years ago was well over 50%. Our techniques have improved to the point now that it has dropped to as low as 16%. My current transfusion rate in the past year is a little under 4%.
ARTIFICIAL HIP MATERIALS
Like the surgical technique, the materials used to make the artificial hip have evolved. In the past, many surgeons would give patients estimates as to the longevity of their new hip. Their estimates were usually in the range of 12 to 15 years before the patient would expect to have the hip redone. The weak link in the assembly always seemed to be the polyethylene (plastic) portion of the acetabular component. In 1999, 21 years ago, a method was devised to make the plastic more durable by a factor of 10, meaning it could last 10 times longer. This makes the artificial hip much more reliable and sturdy so that it can conceivably last a lifetime.
APPROACH FOR THE SURGERY
The typical surgical approach in doing the hip replacement 30 years ago involved going through the posterior or backside of the hip. In that surgery, three muscles would be cut to gain access to the joint. At the conclusion of the surgery, those muscles would be reattached, and over time, they would heal. Another approach, one that I use and usually recommend, involves coming at the hip from the front. One nice thing about this method, even though it’s more technical, is that you go between tissues and don’t have to cut any muscles in the course of the surgery. As a result, the immediate postoperative pain seems to be dramatically less and the early recovery much quicker than with the posterior approach.
MOBILIZATION FOLLOWING A HIP REPLACEMENT
Years ago, the patient would be kept in bed following surgery for several days and then be gradually mobilized, non-weight-bearing, using a walker. Currently, I have my patients out of bed a couple of hours after surgery, ambulating with full weight-bearing, using a walker. As mentioned above, most people go home the very next morning.
There has been a justifiable concern in recent years about the use of narcotics, particularly among orthopedic patients. My recent experience has been that my hip replacement patients, some of whom are already on narcotics prior to the surgery, take fewer narcotics after the surgery than they did before. Some find their pain after surgery so minimal that they take only a dose or two of narcotics and then move on to just Tylenol® to control the discomfort. By minimizing the use of narcotics, they avoid the side effects of constipation, sedation, and risk of addiction. Many patients are entirely off narcotics within one week following the hip replacement through an anterior approach.
Yes, there has been many changes in hip replacement surgery over the last 30 years. It makes one wonder what it will be like 30 years from now. At this point in time, people don’t necessarily have to live with pain from arthritis. Despite the advancements in hip replacement surgery, it may not be for everyone. However, it is certainly worth getting an opinion from an orthopedic surgeon with experience in joint replacement surgery.