Hip replacement surgery, or total hip reconstruction, is one of the most common joint replacement procedures performed in the United States. In fact, by 2030 approximately 850,000 patients are expected to undergo the procedure each year.
“As Baby Boomers age and average life expectancy increases, hip replacement is becoming more and more of a popular option,” says Jonathan Vigdorchik, M.D., an orthopedic surgeon at Hospital for Special Surgery who specializes in adult hip replacement and hip revision surgery (which is a repeat operation).
Why do people need hip replacement surgery? Osteoarthritis is the most common culprit. As you get older, your joints begin to wear down and, as a result, you are more likely to develop osteoarthritis in your hip joints, which can be painful.
While it’s a major surgery—and one not without potential complications or need for revisions—advances in technology have made it more effective and safer than ever. Here is the latest information about the procedure, plus how Johnson & Johnson is making advances in hip replacement diagnostics, technique and technology.
1. Most hip replacement procedures lead to positive outcomes.
The hip itself is not that complex. “It's a basic ball-and-socket joint, unlike the knee, which is more intricate,” says Dr. Vigdorchik. In total hip replacement, the worn-out and damaged sections of the hip are—as the name implies—totally replaced. The socket is swapped with a durable plastic cup, while the femoral head (the ball of the hip joint) is replaced with ceramic or metal. Surgery takes less than an hour and is commonly performed as an outpatient procedure. But it was not always that way.
In the 1960s, “hip replacement surgery took five to six hours and involved a three-week hospital stay,” he says. But thanks to the evolution of hip implants themselves and innovative technology, that is no longer the case. “Today’s hip implants are made of a stronger polyethylene and tend to last longer and are easier to insert during surgery,” he explains.
While most hip replacement procedures lead to positive outcomes, complications, though rare, can happen that may necessitate a revision in some patients.
2. More and more younger people are having total hip replacement surgery.
This procedure used to be reserved for people over the age of 65, but the rate of total hip replacement has more than doubled among 45- to 54-year-olds. How come? At least some of this can be attributed to early-stage arthritis from years of playing sports, says Dr. Vigdorchik.
Hip dysplasia—a condition common in women in which the hip socket is too shallow—is also to blame. “Women in their 40s or early 50s come in like clockwork with it," he notes. "But while in the past they may have been told they were too young for hip replacement, now it’s a reasonable alternative."
And thanks to better-quality materials, the odds are good that a new hip will last a long time: at least 25 years in roughly 77% of patients undergoing hip replacement.
3. Research suggests that about half of all revision total hip replacement surgeries are avoidable.
“Many revisions are due to dislocation from suboptimal cup positioning,” explains Dr. Vigdorchik. “We know that about 20% of patients who undergo total hip replacement have an abnormal pelvic tilt, or abnormal motion between their spine and pelvis, which can make it harder to position the cup correctly.” Unfortunately, many hip surgeons are not aware of pelvic tilt, or how to spot it.
But now there is a way to identify the positioning. The CUPTIMIZE™ Hip-Spine Analysis*—from DePuy Synthes, a Johnson & Johnson MedTech company—is a digital screening tool surgeons can use pre-surgery to analyze X-rays of a patient when they sit and stand, to try to identify changes in pelvic tilt. This also helps the surgeon to place the cup for the best results. As Dr. Vigdorchik puts it: “You need to know where your target is to hit the bullseye."
CUPTIMIZE Hip-Spine Analysis enhances the surgical planning of VELYS™ Hip Navigation, a digital technology for non-invasive hip navigation designed to help surgeons with accuracy and precision. “It allows us to look at every patient uniquely so that we can deliver the most personalized care possible,” notes Sharrolyn Josse, Worldwide President, VELYS Digital Surgery & Capital at DePuy Synthes. “And if we can achieve better placement of hip implants, it reduces the need for repeat surgery.”
VELYS Hip Navigation also has another advantage, adds Josse: More than a quarter of all patients report one leg being longer than the other after a total hip replacement, which can cause low back pain and trouble walking. VELYS Hip Navigation with CUPTIMIZE Hip Spine Analysis takes patients’ unique spinopelvic characteristics into account such that there is the potential to correct discrepancies between leg lengths. When the discrepancy is corrected, it can lead to better hip stability and preservation of natural movement, says Dr. Vigdorchik.
4. Recovery is relatively quick.
Unlike a knee replacement, which usually requires four to six months of recovery, most people are back to regular activity after a hip replacement within roughly a month, says Dr. Vigdorchik. It is common to begin walking with a cane, walker or crutches a day or two after surgery.
It’s recommended that people initially walk for 5 to 10 minutes three to four times a day and build up to 20 to 30 minutes two to three times a day as their strength and endurance improve. They may also require physical therapy for a few weeks to strengthen the hip muscles and get used to the new joint. Most people can resume driving and go back to work within a couple of weeks; they also should be back to regular activities like the gym within four to six weeks, says Dr. Vigdorchik.
Today’s Technologies Enable a More Personalized Care Experience
Josse adds: “This is an exciting time in orthopaedics. The rapid advancements in digital technology like CUPTIMIZE Hip-Spine Analysis are enabling more-personalized care experiences and addressing important unmet needs.”
For anyone who might be struggling with hip pain that is interfering with daily living, Dr. Vigdorchik encourages those individuals to talk with their doctor to explore treatment options. Today’s replacements, along with new surgical technologies, are helping to improve patient care and getting them back to doing the things they love, he says.
Important Safety Information:
It is important to remember that the performance of joint replacements 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 these surgeries. Only an orthopaedic surgeon can determine if joint replacement is necessary based on an individual patient’s condition.