When debilitating pain and stiffness in the hip limits daily activities, a total hip replacement may be needed. The development of total hip replacement began over 40 years ago. In 2007, more than 270,000 people in the United States underwent traditional hip replacement surgery to help relieve pain and restore mobility.1

Hip pain

The most frequent cause of discomfort and chronic hip pain is arthritis. Arthritis is the leading cause of disability in the United States. In fact, it’s estimated that 1 in 5 people in the United States has some form of arthritis. Two thirds of the people who have been diagnosed with arthritis are under the age of 65.2

When medication, physical therapy and other conservative methods of treatment no

longer relieve pain, total hip replacement may be recommended. Total hip replacement helps relieve pain and may allow patients to perform some activities that may have been limited due to hip pain. A doctor carefully considers factors such as the patient’s condition, weight and activity level before determining the best treatment method.

The hip joint

The hip joint forms where the top of the thigh bone (femur) meets the socket of the

pelvic bone (acetabulum). The top of the femur is shaped like a ball and fits snugly in the socket formed by the acetabulum. The hip bones are covered with a layer of slick cartilage, which cushions and protects the bones while allowing smooth movement. Ligaments connect the bones of the joint to hold them in place and add strength and elasticity for movement. Muscles and tendons play an important role in keeping the joint stable and mobile.

Traditional total hip replacement

Total hip replacement, also called total hip arthroplasty, is the surgical replacement of the ball and socket of the hip joint with implants. There are three main components used in total hip replacement. The acetabular shell replaces the hip socket. The femoral stem and ball replace the top of the femur. These components may be made of any number of materials, including metal, ceramic and/or polyethylene (medical-grade plastic).

In traditional hip replacement surgery, a surgeon makes an incision along the side of the leg to access the hip joint. The natural acetabulum (ball portion) of the femur (thigh bone) is removed during surgery. The remaining preparation of the femur and acetabulum (socket) involves reshaping to allow solid, accurate alignment of the hip components. The femoral stem is inserted inside the thigh bone, and the acetabular shell is inserted inside the socket of the pelvis.

The Anterior Approach – potential benefits and risks

The Anterior Approach to total hip replacement is an alternative to traditional hip replacement surgery that provides the potential for less pain, faster recovery and improved mobility. Unlike traditional hip replacement surgery, this technique allows the surgeon to work between the muscles and tissues without detaching them from either the hip or thighbones. The potential benefits of the Anterior Approach are:

• Possible accelerated recovery time because key muscles are not detached during the operation.

• Potential for fewer restrictions during recovery. Although each patient responds differently, this procedure seeks to help patients more freely bend their hip and bear their full weight immediately or soon after surgery.

• Possible reduced scarring because the technique allows for one relatively small incision. Since the incision is on the front side of the leg, the patient may be spared from the pain of sitting on scar tissue.

• Potential for stability of the implant sooner after surgery, resulting in part from the fact that the key muscles and tissues are not disturbed during the operation.3-5

Advanced surgical table & instruments

The Anterior Approach takes advantage of a technologically advanced surgical table and special instruments.3,4 A high-tech operating table is used to help improve access to the hip and achieve proper alignment and positioning of the implant.

Important safety information

Every surgical approach has risks and benefits. The performance of a hip replacement depends on age, weight, activity level and other factors. There are potential risks, and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only an orthopaedic surgeon can tell if hip replacement is an appropriate course of treatment

© DePuy Orthopaedics, Inc. 2009

References

1. Thomas Healthcare, MarketScan Research Data, 2007.

2. Hootman J, Bolen J et. al. Prevalence of Doctor-Diagnosed Arthritis and Arthritis- Attributable Activity Limitation–United States, 2003-2005. MMWR Morb Mortal Wkly Rep. 2006;55(40):1089-1092.

3. Matta JM, Shahrdar C, Ferguson T. Single-Incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table. Clin Orthop. December 2005;441:115-124.

4 DePuy Orthopaedics, Inc. Data on file.

5. Matta, J.M. and T.A. Ferguson. “THA After Acetabular Fracture.” Orthopedics 28(9), September 2005: 959-960