Hip Joint Replacement

Orthopedic surgeons in the Sutter Health network specialize in advanced hip replacement techniques that can help ease hip pain and restore mobility in people with severe arthritis. If you’ve tried alternatives to hip replacement without success, talk to a doctor about this common hip surgery.

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Depending on your health condition, orthopedic specialists may use the newer anterior approach to hip surgery or the traditional posterior approach. Several hospitals in the Sutter Health network also offer robotic-assisted surgery, which can help orthopedic specialists give you a more precise and personalized joint replacement. Here’s a brief description of these hip replacement techniques.

Robotic-Assisted Hip Replacements

Many orthopedic surgeons in the Sutter Health network use robotic arm systems such as MAKO™, NAVIO™ and VISIONAIRE™ to ensure your hip replacement is positioned and aligned correctly.

With robotic arm systems, your surgical team creates a 3D representation of the unique shapes and profiles of your knee. Using this information, doctors can then determine the size and position of your implant, which is critical to knee alignment and stability.

The robotic arm doesn’t actually perform surgery. Your orthopedic surgeon is still the skilled doctor controlling the robotic arm. The technology’s software creates a 3D model of your hip. This lets your surgeon choose the best size and position for your new joint, based on your anatomy. During surgery, your doctor guides the robotic arm based on your 3D model.

A review of research in the American Journal of Orthopedics⁽¹⁾ indicates that many surgeons using robotic arms are able to achieve more precise placement and orientation of new joints, compared to conventional joint replacement surgery. Robotic-assisted hip replacements are available at several hospitals in the Sutter Health network, including:

• California Pacific Medical Center in San Francisco
• Sutter Santa Rosa Regional Hospital in Santa Rosa
• Sutter Surgical Hospital – North Valley in Yuba City

Anterior Hip Replacements

Anterior hip replacements allow the orthopedic surgeon to reach the hip joint from the side of the body instead of through the buttocks. In this approach, the surgeon is able to move the muscles aside rather than cutting through them. This creates less damage and trauma to the soft tissues around the hip, typically allowing a quicker recovery time.

In addition, there is a lower risk of dislocating the new hip prosthesis when placed via the anterior approach, since the muscles used to support the hip joint remain strong.

The anterior approach is sometimes called a “minimally invasive” hip replacement because it requires a 3- to 6-inch incision, compared to a 6- to 10-inch incision used for the posterior approach.

Posterior Hip Replacements

Posterior hip replacements are still often the preferred technique for large or muscular people because their additional soft tissue can make it hard for a surgeon to access the hip joint.

Orthopedic surgeons have a direct and clear path to the hip with the posterior approach. The orthopedic specialist makes an incision through muscles at the back of the hip, and can easily access the hip joint. The muscles are repaired and reattached at the end of the surgery.

Your New Hip Joint

Regardless of the technique, all hip replacements involve replacing the stem (the long end of the bone) and the acetabular “cup” of your hip joint with artificial joints. The artificial femoral stem is often made of titanium or cobalt chrome, and is inserted into the hollow of your femur bone. The cups are often made of polyethylene, a form of plastic. The pieces are either held in place by cement or by “ingrowth” technology, in which the bone grows between small beads or mesh on the surface of the prosthetics. 

Typically people spend one to three nights in the hospital after hip replacement, but if you are healthy, strong and have support at home, your orthopedic surgeon may recommend outpatient surgery. Most commercial insurers will cover outpatient surgery, but at present Medicare does not. Check with your insurer if you’re considering outpatient surgery. 

Most people can walk normally – without an assistive device – three to six weeks after surgery, and can resume normal activities in six to 12 weeks. Recovery of full strength is gradual and may take six to 12 months.

About 80 to 85 percent of hip replacements last 20 years, even longer depending on your activity level, according to the American Association of Hip and Knee Surgeons.

1. American Journal of Orthopedics, 2016, March, 256-259.