I have been working as an Occupational Therapist at HHH for over 30 years. For most of my career I have supervised the therapy services on the Inpatient Orthopedic Unit where patients who have undergone joint replacement surgery are admitted to have rehabilitation before returning home.
When I was faced with the decision to consider having the Total Hip Replacement (THR) surgery, I had to weigh my options and consider what would be the easiest recovery and best long-term outcome for me. I reflected on the many patients I have observed over the years, recovering from THR surgery, and considered how they all recovered. Do they progress quickly in therapy, is there a lot of pain, is the pain manageable, do they have to follow post surgical precautions and how long does it take them to return to the activities of daily living they want to do? I had to carefully consider the benefits of the Anterior vs. Posterior approach to THR surgery before choosing a surgeon and making the final decision to have the surgery.
In the United States, there are over 200,000 Total Hip Replacements performed each year. The first THR performed in the United States was in 1969. Since then, significant improvements in the techniques and technology have drastically improved the surgical outcome and quality of life for those people undergoing this procedure.
Most people who undergo THR surgery are between the ages of 50-80. The most common reasons for undergoing THR surgery are severe pain and decreased mobility interfering with activities of daily living. These chronic disabling conditions are most often caused by some form of arthritis due to chronic wear and tear, trauma or disease in the hip joint. The hip joint is known as a “ball and socket joint” with the head of the femur (the ball) gliding against the acetabulum (the socket).
There are primarily two types of surgical approaches that can be performed, the anterior vs. posterior approach. These two approaches both have some risks and precautions that must be carefully considered. While the risks of complications with THR surgery are low, they include infection, nerve injury, blood clots, and stiffness. When choosing a surgeon it is important to consider the amount of experience the physician has had performing either procedure.
Before having the surgery, an orthopedic surgeon will complete an evaluation including, but not limited to reviewing past medical history, physical exam, x-rays of the hips and other tests as necessary. Careful consideration is given to how much pain a person is reporting (on a scale of 0-10), how often pain limits walking, bending and resting, if the pain can no longer be alleviated with anti-inflammatory medications or physical therapy and if stiffness makes it impossible to lift or move the leg.
When observing the patients going through their rehab, I noticed that the patients who underwent the anterior approach to THR surgery seemed to regain mobility quickly, with minimal pain. While they had to be cautious about the surgical leg, they did not have to follow specific precautions that would limit their functional ability for any period of time. When researching the differences between the anterior and posterior approach to THR. this is what I discovered.
During both procedures the damaged head of the femur is removed and replaced with a metal stem and a metal or ceramic ball and the damaged cartilage is removed from the socket and replaced with a metal socket. A plastic spacer is placed between the new ball and socket to allow for a smooth gliding movement.
With the posterior approach the hospital stay is three to ten days, the surgical incision is along the outer buttock and can be ten to twelve inches long. Some of the muscles around the hip joint need to be cut and repaired and the recovery following the surgery is approximately two to four months. People who have this procedure usually have to follow very specific total hip precautions for six to twelve weeks, which include no bending past 90 degrees, no internal rotation or turning the leg inward and no crossing the leg.
With the anterior approach, the hospital stay is two to four days, the surgical incision is along the front or slightly to the side of the hip and is four to five inches long. The muscles around the hip joint are not cut and the recovery time is two to eight weeks. There are no specific precautions that need to be followed. In addition, patients have less pain, less risk of dislocation, less leg length discrepancy and more rapid return to normal activities.
With both procedures, everyone needs to use either a walker or cane to walk and have physical therapy to improve strength, range of motion and mobility for some period of time after the surgery.
So after careful consideration and research, I picked a surgeon and I chose to have the anterior approach to the THR surgery. In the end, I had to have both my hips replaced. It’s a little over two years since my last surgery and I am doing great. I have no pain, very little stiffness and I have returned to all of my normal activities.
If you think you are a candidate for THR surgery, consult with your doctor, do the research and find a surgeon who specializes in this procedure.