• Total Knee ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Partial Knee ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Total Hip ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Revision Hip ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Revision Knee ReplacementNicholas B Frisch MD Nicholas B Frisch MD

Hip Replacements

Total Hip Replacement

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. The hip joint is one of the body's largest weight-bearing joints, located between the thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint.

Several diseases and conditions can cause damage to the articular cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.

Disease Overview

Arthritis is inflammation of the joints resulting in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability. The three most common types of arthritis that affect the hip are:

  • Osteoarthritis: It is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage wears down, the bone ends rub against each other and cause pain in the hip.
  • Rheumatoid arthritis: This is an autoimmune disease in which the tissue lining the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). This leads to loss of cartilage causing pain and stiffness.
  • Traumatic arthritis: This is a type of arthritis resulting from a hip injury or fracture. Such injuries can damage the cartilage and cause hip pain and stiffness over a period.

Symptoms

The most common symptom of hip arthritis is joint pain and stiffness resulting in limited range of motion. Vigorous activity can increase the pain and stiffness which may cause limping while walking.

Diagnosis

Diagnosis is made by evaluating medical history, physical examination and X-rays.

Nonsurgical Treatment

  • Weight loss
  • Activity modification: avoid high impact activities and those that exacerbate your symptoms
  • Physical therapy
  • Anti-inflammatory medications
  • Injections
    • Corticosteroids
    • Viscosupplementation
  • No narcotic (opioid) pain medication. If you are currently being treated with opioid pain medication for your chronic joint pain you should discuss this with your surgeon. We do not advise chronic use of opioid pain medication for the treatment of arthritis and recommend you discuss alternative treatment options before prolonged use.

Surgical Procedure

Surgery may be recommended, if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms.

The standard approach for performing hip replacement surgery is a posterior approach (from the back of the hip). We utilize a minimally invasive, mini-posterior approach to the hip. This approach is smaller, typically 3-4 inches long and prevents excessive soft tissue dissection and damage to the muscles and tendons. The surgery is performed under general or regional anesthesia. During the procedure, a small surgical incision is made over the hip to expose the hip joint and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone is removed. The acetabular component is inserted into the socket to achieve a press fit and occasionally screws or bone cement is used. A liner made of plastic, ceramic or metal is placed inside the acetabular component. The femur or thigh bone is then prepared by removing the arthritic bone using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. The soft tissues around the new joint are repaired and the incision is closed.

Post-operative care

After undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. These precautions vary depending on the type of hip surgery you had.

Some of the common precautions to be taken include:

  • Avoid combined movement of bending your hip and turning your foot inwards
  • Keep a pillow between your legs while sleeping for 6 weeks
  • Never cross your legs and bend your hips past a right angle (90)
  • Avoid sitting on low chairs
  • Avoid bending down to pick up things, instead a grabber can be used to do so
  • Use an elevated toilet seat

Please contact us prior to undergoing any dental procedures or other invasive surgical procedures. Appropriate antibiotics are often indicated in these situations and should be discussed with our team as well as your dental or surgical provider.

Risks

As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement include:

  • Infection
  • Dislocation
  • Fracture of the femur or pelvis
  • Injury to nerves or blood vessels
  • Formation of blood clots in the leg veins
  • Leg length inequality
  • Hip prosthesis may wear out
  • Failure to relieve pain
  • Scar formation
  • Pressure sores

Total hip replacement is one of the most successful orthopaedic procedures performed for patients with hip arthritis. This procedure can relieve pain, restore function, improve your movements at work and play, and provide you with a better quality of life.

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Additional Resources

Minimally Invasive Total Hip Replacement

The hip joint is one of the body's largest weight-bearing joints and is the point where the thigh bone (femur) and the pelvis (acetabulum) join. It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage that cushions and enables smooth movements of the joint.

Hip arthritis is one of the painful and common diseases of the hip joint caused by damage to the cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.

Traditionally, total hip replacement will be performed through a 10–12-inch-long incision made on the side of the hip. A minimally invasive approach has been developed in recent years where surgery is performed through smaller incisions rather than the single long incision as in the traditional approach. Advantages of the newer approach are lesser muscle dissection, minimal pain, quicker recovery, and faster rehabilitation.

Arthritis is inflammation of the joints resulting in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability. The most common type of arthritis affecting the hip is osteoarthritis which is characterized by progressive wearing away of the joint cartilage. As the protective cartilage wears down, the bone ends rub against each other and cause pain in the hip. It is more common in individuals aged above 50 years and tends to run in families.

Symptoms

The most common symptom of hip arthritis is dull, aching joint pain and stiffness resulting in limited mobility. There may be pain in the groin, thigh and buttock area and sometimes pain may be referred to the knee. Vigorous activity and walking for long distances can increase the pain and stiffness which may cause limping while walking.

Diagnosis

Diagnosis is made by evaluating your symptoms, medical history, physical examination and X-rays. Sometimes, additional imaging tests such as MRI and CT scans may be needed to confirm the diagnosis.

Surgical procedure

Surgery may be recommended in patients with severe cartilage damage and if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms.

For minimally invasive hip replacement, the surgical technique and artificial implants remain the same as traditional hip replacement however the difference is smaller incisions and minimal soft tissue dissection. The surgery is performed through a smaller incisions. The procedure is performed under general or regional anesthesia.

In a minimally invasive approach, your surgeon makes a 3–4-inch incision over the hip to expose the hip joint. The muscles are minimally dissected to reach the joint. The femur is dislocated from the acetabulum. The surface of the socket is cleaned and the arthritic bone is removed using a reamer. The acetabular implant is inserted into the socket, occasionally using screws. A liner material of plastic, ceramic or metal is placed inside the acetabular component. The femur or thigh bone is then prepared by removing the arthritic bone using special instruments and shaped to exactly fit the new metal femoral component. The femoral stem is then inserted into the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place using special cement. The muscles and tendons around the new joint are repaired and the incision is closed.

Advantages

The advantages of minimally invasive total hip replacement as compared with traditional total hip replacement may include:

  • Smaller incisions
  • Shorter hospital stay
  • Less trauma to the surrounding tissues
  • Quicker recovery
  • Less blood loss
  • Less scarring
  • Faster rehabilitation
  • Minimal post-operative pain

Post-operative precautions

After undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. These precautions vary depending on the type of hip surgery you had.

Please contact your surgeon prior to undergoing any dental procedures or other invasive surgical procedures. Appropriate antibiotics are often indicated in these situations and should be discussed with our team as well as your dental or surgical provider.

Risks and Complications

As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. They include:

  • Dislocation
  • Infection
  • Limb length inequality
  • Injury to nerves and blood vessels
  • Formation of blood clots in the leg veins
  • Implant malposition
  • Fracture of the femur or pelvis
  • Failure of the implant

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Outpatient Hip Replacement

Hip replacement surgery is among the most common orthopaedic surgery performed. It involves the replacement of the damaged hip bone (ball shaped upper end of the femur) with a metal ball attached to a metal stem that is fixed into the femur and attached to the pelvic region. Traditionally, the surgery was performed with a large, open incision and required the patient to stay in the hospital for several days. With advanced techniques, it is now possible to perform this surgery on an outpatient basis, where the patient goes home on the same day. Outpatient hip surgery uses the same implants as traditional surgery, but often utilizes minimally-invasive techniques with a smaller incision when compared to the traditional procedure. This type of surgery is less invasive to the tissues and bones and involves a much shorter hospitalization time, where the patient can go home the same day.

Indication

Outpatient hip surgery is mainly targeted at treating the joints damaged by arthritis and injuries. Chronic joint pain due to erosion of cartilage, damage due to accidents and autoimmune diseases, or bone death leading to the destruction of cartilage, are also treated with the help of this surgery.

Procedure

Whether or not the surgery is performed in the hospital or in an outpatient setting, the implants and surgical techniques are the same. You will typically be in the recovery area for a few hours and start walking on your new joint immediately with physical therapy and nursing staff. Once your pain is well controlled and you are able to walk safely, most patients will be discharged home that day.

Not every patient is a candidate for outpatient joint replacement. The decision to undergo outpatient joint replacement should be made with your surgeon and family. For those patients who are candidates for outpatient surgery it can provide a streamlined experience and allows you to recover in the comfort of your own home.

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Additional Resources

Posterior Hip Replacement

Posterior hip replacement is a minimally invasive hip surgery performed to replace the hip joint.

The posterior approach is traditionally the most common approach used to perform total hip replacement.

In posterior hip replacement, the surgeon makes the hip incision toward the back of the hip close to the buttocks. The incision is placed so the abductor muscles, the major walking muscles, are not cut.

Indications

Hip replacement is indicated in patients with arthritis of the hip joint.

Arthritis is a condition in which the articular cartilage that covers the joint surface is damaged or worn out causing pain and inflammation. Some of the causes of arthritis include:

  • Advancing age
  • Congenital or developmental hip diseases
  • Obesity
  • Previous history of hip injury or fracture
  • Increased stress on hip because of overuse

Symptoms

Patients with arthritis may have a thinner articular cartilage lining, a narrowed joint space, presence of bone spurs or excessive bone growth around the edges of the hip joint. Because of all these factors arthritis patients can experience pain, stiffness, and restricted movements.

Diagnosis

Your doctor will evaluate arthritis based on the characteristic symptoms and diagnostic tests. Your orthopaedic surgeon will perform a physical examination; order X-rays and other scans, and some blood tests to rule out any other conditions that may cause similar symptoms.

Procedure

We use a mini-posterior approach to the hip with minimally-invasive techniques. Posterior hip replacement surgery involves the following steps:

  • The procedure is performed under general or regional anesthesia.
  • You will lie sideways on the operating table.
  • A small incision is made on the side of the hip, close to the buttocks beyond the abductor muscles.
  • The surgeon separates the muscles and tendons to gain access to the hip joint.
  • The thigh bone or femur is separated from the hip socket, acetabulum.
  • The damaged femoral head is cut off and the bone is prepared to receive the femoral component of the prosthesis.
  • The acetabular surface is then prepared and the acetabular component of the prosthesis is inserted.
  • A liner made up of plastic, metal or ceramic is placed inside the acetabular component to provide a smooth, gliding surface.
  • Then the new femoral component is inserted into the femur bone and the femoral head component is placed on the stem.
  • Once the artificial components are fixed in place, the instruments are withdrawn, soft tissues are re-approximated, and the incisions are closed with sutures and covered with a sterile dressing.

The advantages of the mini- posterior approach include:

  • High success rate
  • Minimally invasive
  • Smaller incision
  • Minimal muscle damage
  • Precise placement of implants
  • Allows excellent visibility of the joint

Risks and Complications

All surgeries carry an element of risk whether it is related to the anesthesia or the procedure itself. Risks and complications are rare but can occur. Below is a list of complications that can occur following any hip replacement procedure:

  • Dislocation
  • Infection
  • Fracture
  • Nerve damage
  • Hemarthrosis - excess bleeding into the joint after the surgery.
  • Deep vein thrombosis (blood clot)
  • Leg length inequality

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Anterior Hip Replacement

Total joint replacement surgery is one of the most advanced successful procedures in patients dealing with severe hip and knee pain. The goal of the surgery is to relieve pain and restore the normal functioning of the joint and help patient resume normal activities.

What is anterior approach hip replacement surgery?

Anterior Hip Replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles or tendons. It utilizes an incision from the anterior (front) hip, as an alternative to the traditional approach from the posterior (back) hip. There are different anterior approaches to the hip including the direct anterior approach, a modified (muscle sparing) anterolateral approach, and a traditional anterolateral approach (Watson-Jones).

There are advantages and disadvantages to each approach and you should have a discussion with your surgeon regarding which approach is best for you. Regardless of the approach utilized, the pain protocols, hospital length of stay and postoperative rehabilitation are typically the same.

One potential advantage of an anterior approach to the hip is that hip precautions are usually not necessary for stability post-operatively.

Complications

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Revision Hip Replacement

Revision hip replacement is a complex surgical procedure in which all or part of a previously implanted hip-joint is replaced with a new artificial hip-joint. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities. During total hip replacement, the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. At times, hip replacement implants can wear out for various reasons and may need to be replaced with the help of a surgical procedure known as revision hip replacement surgery.

Indications

Revision hip replacement is advised in patients with the following conditions:

  • Increasing pain in the affected hip
  • Worn out plastic or polyethylene prosthesis
  • Dislocation of previous implants
  • Loosening of the femoral or acetabular component of the artificial hip joint
  • Infection around the hip prosthesis causing pain and fever
  • Weakening of bone around the hip replacement (Osteolysis)

Revision hip replacement surgery is performed under general or regional anesthesia.. Revision surgery may involve simply replacing the hip liner, removal and replacement of one or both components. During the procedure, your surgeon will make an incision over the hip to expose the hip joint. The decision on which surgical approach to use will be variable and may ultimately depend on which approach was utilized for the original hip replacement procedure. Typically, the posterior approach has been favored during revision surgery, however if an anterior approach was used it is reasonable to consider revision through the original anterior incision. Once the incision has been made and the hip joint is exposed, the femur is dislocated from the acetabulum so that the old plastic liner can be removed from the cup.

If the metal cup requires removal, it will be done carefully to avoid excessive bone loss. After removal, the acetabulum is assessed and prepared to accommodate a new metal cup. In the event of significant bone loss, additional bone or metal augments may be used to recreate the acetabulum in order to accommodate a new metal cup. Then the new metal cup is inserted into the socket. Typically screws or special cement may be used to increase the stability of the new cup. A liner made of plastic, ceramic or metal is placed inside the metal socket.

If the femoral component requires replacement, every attempt is made to do so carefully to avoid bone loss. In some cases, depending on the implant or the bone quality, it is necessary to remove part of the bone in order to take the femoral component out. The bone is cleaned of any debris and the new femoral implant is inserted into the femur either by a press fit or using bone cement. If it was necessary to remove part of the bone, those segments are carefully placed back over the new implant and typically secured with surgical cables or wires. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new components are secured in place to form the new hip joint. The muscles and tendons around the new joint are repaired and the incision is closed.

After undergoing revision hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. The specific precautions will vary depending on the extent of the revision procedure and the approach used. Some of the common precautions to be taken include:

  • Avoid combined movement of bending your hip and turning your foot inwards because it can cause dislocation
  • Keep a pillow between your legs while sleeping for 6 weeks
  • Never cross your legs or bend your hips past a right angle (90 degrees)
  • Avoid sitting on low chairs
  • Avoid bending down to pick up things, instead a grabber can be used to do so
  • Use an elevated toilet seat
  • In some circumstances, weight bearing may be limited initially after surgery to ensure maximum stability and reduce the risk of implant failure or dislocation
  • If there is extensive soft tissue damage or debridement necessary it may be necessary to wear a special brace for a period of time after surgery

Risks

As with any major surgical procedure, there are certain potential risks and complications involved with revision hip replacement surgery. The possible complications after revision hip replacement include:

  • Infection
  • Dislocation
  • Fracture of the femur or pelvis
  • Injury to nerves or blood vessels
  • Formation of blood clots in the leg veins
  • Leg length inequality
  • Hip prosthesis may wear out
  • Failure to relieve pain

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Additional Resources

Credibility Links

  • American Academy of Orthopaedic Surgeons
  • American Medical Association
  • American Association of Hip and Knee Surgeons
  • Mid-America Orthopaedic Association
  • Crittenton Hospital Medical Center
  • DeClaire LaMacchia Orthopaedic Institute
  • Michigan Institute for Advanced Surgery Center