Technological Advancements in Hip Treatment

by Chistopher Ellingson, MD, FAAOS, and Edward Lambert, DO

Technological Advancements in Hip Treatment

Let’s dive into a discussion about arthritic and non-arthritic hip conditions, focusing on the technology and treatment options we have at our disposal. In the sports medicine world, we obviously see athletic types of injuries, but that does not necessarily mean the patient is an athlete in the traditional meaning of playing a sport. A lot of these athletic types of injuries occur from daily activities such as gardening or taking care of kids.

Regarding hip pain and hip injuries, the hip pain patient can be difficult to diagnose accurately because there are a lot of things around the hip joint that can be the source. Most patients that we see are able to be treated with non-surgical measures. Of course, there are some conditions such as hip labral tears that need to be addressed surgically.

For the vast majority of patients who are treated non-surgically, we use simple anti-inflammatory medications, physical therapy, and sometimes injections to help with hip arthritis. If the more conservative options do not work, which happens in a small subset of patients, we move on to surgical options.

Hip replacements have been around a long time, with the first hip replacement being performed in England in 1962. A lot has changed since then, especially our surgical approaches and the technology used. Patients used to be in the hospital for weeks after receiving a hip replacement. Today, we perform hundreds of hip replacements throughout the year, and most patients go home the very next day. That being said, a hip replacement is still a big surgery to undergo.

Some of the technology that has made recovery for our patients better after a hip replacement include what is called a Hana table. This table is made of carbon fiber which means we can x-ray right through it during surgery, allowing us as surgeons to be much more accurate. This technology allows us to perform an anterior approach total hip replacement. The anterior approach involves an incision in the front of the hip where we don’t cut the muscles; we just separate them, allowing the patient to recover much quicker. Most of our patients are up the same day walking on their newly replaced hip, and as said before, the large majority go home the next day.

Another technology that has advanced our hip replacement capabilities is the Velys hip navigation. Before surgery we take an x-ray of the patient’s hip, and then we overlay the preoperative plan on top of their x-ray. The preoperative plan is made up of little tracings that show the size of the implants we intend to use. The Velys hip navigation is accurate down to the millimeter and can help surgeons indicate whether a patient’s leg needs to be lengthened or shortened for instance. Previously when placing a hip implant into a patient, we would have to use our best judgement to get the implant in the right position. Now, we have some objective feedback through imaging technology that can tell us exactly where the implant needs to be placed.

Frequently asked questions

What is the usual recovery time after a hip replacement?

Some patients can recover as quickly as three to four weeks, but most patients take about six weeks to recover. The goal in terms of recovery for all hip replacement patients is when they come back for a follow up appointment at six weeks after surgery, they’re walking with no pain, no crutch, and no pain meds.

Having a right hip replacement takes a little longer to recover compared to the left, specifically due to driving. The brake foot is important obviously, so we don’t like our patients to drive until they’re comfortable moving their right foot from the gas to the brake.   

What are the best exercises or stretching routines to help prevent hip pain?

There are a lot of exercises that can be done to help prevent hip pain. Prevention is much better than going through a big surgery like hip replacement.

We often prescribe that our patients see our incredible physical therapists who can give you a list of beneficial exercises and can help ensure that you are performing them properly. If you are doing the exercises incorrectly, those movements can actually make the hip problem worse.

When both hips need to be replaced, what’s the length of time between those two replacements?

The easiest way is we do one hip replacement, and the patient fully recovers after about three months. Then, we go back and perform the replacement on the other hip and do the recovery process again.

Many patients will receive a replacement on one side and feel good enough to not need a replacement on the other. On a very particular patient who’s very healthy and who does have some specific criteria, we can perform both hip replacements at the same time. However, this scenario is for a very specific type of patient who can undergo two surgeries at the same time and recover well.

Is there a connection between hip issues and the spine?

There are absolutely connections between the hip and the spine.

All the parts of your body are connected. We as physicians try to zero in on the part that’s causing most of the problems. In general, the back can cause problems within the hips, and the hips can cause problems in the back. Figuring out which one is the so-called pain generator is one of the things we do every day in the office, and it can be challenging.

There are many techniques we use to determine if the pain is coming from someone’s back or if it is coming from their hip. These techniques range from a physical examination to x-rays, MRIs, and injections.

If I have arthritis in my hips, how long do I wait before having them replaced?

The short answer is three months, but it depends on the patient. Some patients will have one hip that’s arthritic; they get it replaced; they’re very happy. They keep their one good hip and one bad hip for many years.

Other patients are in such a hurry and meet very specific criteria that they have both hip replacements done at the same time. That is performed rarely.

Can hip arthritis mask hip abductor issues?

Yes.

There’s a lot of overlap with hip symptoms in general, and that can be one of the challenging aspects of evaluating patients with hip pain or pain around the hip area. There can be overlap and conditions that occur in simultaneous fashion.

Hip arthritis and hip abductor issues can be occurring at the same time, but we are usually able to differentiate the two during the physical examination. Also, we can generally determine what is causing the issue by just speaking with the patient and going through their history of what their symptoms are like, when they occur, and what activities make them worse.