Taking the dread out of hip replacement
Mention hip replacement to anyone over age 60 and the reaction will be pretty consistent: dread. So why is a procedure that offers significant pain relief and the potential to resume a normal life looked upon with such fear?
“Traditional hip replacement usually means weeks of activity restrictions to prevent joint dislocation, three to six months of muscle healing and, sometimes, a stay in a nursing home or rehab facility,” said orthopaedic surgeon Gerry Trinidad, M.D.
It doesn’t have to be that way.
A newer approach to hip replacement, called direct anterior approach, or DAA, is making it possible for patients to get out of bed within hours of surgery, go home in 24 to 48 hours and get back to their normal lives in a matter of days.
And now Dr. Trinidad is performing DAA at King’s Daughters Medical Center Ohio.
Traditional hip replacement surgery involves a lateral (side) or posterior (back) approach to the hip in which the major muscles that support the joint (the glutes) are cut.
In DAA, the surgeon approaches the hip joint from the anterior (front) of the body, spreading muscle tissue rather than cutting it. As a result, there is less trauma and blood loss, shorter healing times, less pain and few or no restrictions on physical activity following surgery, Trinidad noted.
A special surgical table, called the Hana table, makes it possible to position the patient for DAA, Trinidad said. Because components of the table are invisible to x-rays, the surgeon can use technology to ensure proper placement of the implant and avoid a common complication of traditional hip replacement – unequal leg lengths.
“That makes a huge difference for patients,” Trinidad noted.
The U.S. Centers for Disease Control and Prevention reports that 332,000 hip replacement surgeries were performed in 2010. That number is expected to grow as the population ages.
“Currently, traditional approaches are favored by most orthopaedic surgeons because it’s what they know. They can do these quickly, they don’t have to have additional training and the hospital doesn’t have to purchase an expensive surgical table,” Trinidad noted.
DAA takes more time to perform, is more complicated and requires specialized training and instrumentation. But because DAA offers significant benefits for patients, Trinidad’s goal is to perform the vast majority of hip replacements using the direct anterior approach when appropriate.
“It’s just better for patients all the way around,” he said.
“It’s important for people to know that hip replacement, no matter the approach, is not the first thing that you do to treat hip problems,” Trinidad said. He favors a step-by-step, conservative approach with includes rest, activity modification, weight management, physical therapy/exercise, non-steroidal anti inflammatories, steroidal injections and canes/walkers.
Typically patients will choose a hip replacement only after trying conservative approaches first.
“It really comes down to the patient saying they no longer have a quality of life. They can’t sleep because of the pain and they can’t do the things they want because of it,” Trinidad noted.
For more information about direct anterior hip replacement, contact King’s Daughters Medical Center Ohio at (740) 991-4000 or call Dr. Trinidad’s office at (740) 351-0980. A physician referral is not required.