Total Hip Replacement

Total Hip Replacement in Auburn Hills and the Detroit, Michigan Area

Total hip replacement is surgery that removes the damaged cartilage and bone in your hip joint and replaces them with artificial components. It helps people whose hip arthritis or joint damage causes pain and stiffness that limit walking, climbing stairs, getting in and out of a car, and other daily activities after nonsurgical treatments stop working.

Nicholas B Frisch, MD | MBA, is a fellowship-trained, board-certified orthopedic surgeon specializing in hip and knee replacement, outpatient surgery, robotic-assisted procedures, complex revision, and advanced technology. From his Auburn Hills office, Dr. Frisch treats patients from Rochester Hills, Troy, Pontiac, Bloomfield Hills, Birmingham, Lake Orion, Clarkston, Sterling Heights, and communities across Southeast Michigan.

Total hip replacement is one of the most successful orthopedic procedures for hip arthritis. It can relieve pain, restore function, and help you move more comfortably at work and play.

Outpatient Hip Replacement

Outpatient hip replacement lets qualified patients have total hip replacement and go home the same day. The implants and surgical techniques are the same as a hospital procedure; the difference is that you begin your recovery in the comfort of your own home.

Hip replacement was traditionally performed through a large, open incision and required a hospital stay of several days. Advances in technique, including minimally invasive approaches with a smaller incision, now make same-day discharge possible for many patients.

What Your Surgery Day Looks Like

You typically spend a few hours in the recovery area and begin walking on your new hip right away with physical therapy and nursing staff. Once your pain is well controlled and you can walk safely, most patients are discharged home that day.

Are You a Candidate for Outpatient Hip Replacement?

Not every patient is a candidate for outpatient joint replacement. Dr. Frisch evaluates your overall health, home support system, lifestyle, and treatment goals. Good candidates are typically healthy, have appropriate support at home, have well-managed medical conditions, and are committed to following their recovery instructions. The decision is made together with Dr. Frisch and your family.

Potential Benefits of Same-Day Hip Replacement

• Recovering in the comfort of your own home
• Less time in the hospital
• Early mobilization, with walking on the day of surgery
• A streamlined surgical experience

Who Is a Candidate for Total Hip Replacement?

You may be a candidate for total hip replacement if arthritis or joint damage causes significant hip pain, stiffness, and reduced mobility that limit your daily life. Surgery is usually considered when conservative treatments such as medications, injections, physical therapy, weight management, and activity changes no longer provide adequate relief.

Conditions Treated with Hip Replacement

• Osteoarthritis: The protective cartilage in the joint gradually wears away, so the bone ends rub together and cause pain. It is the most common type of hip arthritis.
• Rheumatoid arthritis: An autoimmune disease that inflames the joint lining, leading to cartilage loss, pain, and stiffness.
• Traumatic arthritis: Arthritis that develops after a hip injury or fracture damages the cartilage.
• Avascular necrosis: Loss of blood supply causes bone death that leads to destruction of the joint cartilage.

Common Symptoms of Hip Arthritis

• Dull, aching hip pain and stiffness that limit your range of motion
• Pain in the groin, thigh, or buttock, which sometimes travels to the knee
• Pain and stiffness that worsen with vigorous activity or long walks
• Limping while walking

How Hip Arthritis Is Diagnosed

Dr. Frisch evaluates your symptoms, medical history, and a physical examination along with X-rays. MRI or CT scans and blood tests are sometimes used to confirm the diagnosis or rule out other conditions.

Nonsurgical Treatment Options

• Weight loss
• Activity modification, avoiding high-impact activities and those that worsen your symptoms
• Physical therapy
• Anti-inflammatory medications
• Corticosteroids

Dr. Frisch does not advise long-term use of opioid (narcotic) pain medication to treat arthritis. If you currently take opioids for chronic joint pain, talk with him about alternative treatment options.

Minimally Invasive Hip Replacement

Minimally invasive hip replacement replaces the hip joint through a smaller incision, typically 3 to 4 inches long, with less cutting of muscles and soft tissue. The implants and core surgical technique are the same as traditional hip replacement.

Traditional total hip replacement is performed through a 10- to 12-inch incision on the side of the hip. Whenever appropriate, Dr. Frisch uses a minimally invasive technique designed to limit disruption to the muscles and tendons around the joint and support a smoother recovery. Whether this technique is right for you depends on your anatomy, overall health, severity of joint damage, and goals.

Potential Advantages Compared with Traditional Hip Replacement

• Smaller incisions and less scarring
• Less trauma to the surrounding tissues
• Less blood loss
• Less postoperative pain
• Shorter hospital stay
• Quicker recovery and faster rehabilitation

How the Procedure Is Performed

• The surgery is performed under general or regional anesthesia.
• A small incision is made over the hip to expose the joint, and the ball of the thigh bone (femur) is separated from the socket (acetabulum).
• The socket is cleaned, the damaged bone is removed, and the new socket component is pressed into place, occasionally with screws or bone cement. A liner made of plastic, ceramic, or metal is placed inside it.
• The femur is shaped with special instruments, and the metal femoral stem is inserted with a press fit or bone cement. A metal or ceramic ball is placed on top of the stem.
• The soft tissues around the new joint are repaired and the incision is closed.

Anterior Approach Hip Replacement

Anterior hip replacement reaches the hip joint through an incision at the front of the hip instead of the back. It is a minimally invasive technique designed to replace the hip without cutting through major muscles or tendons.

There are several anterior approaches to the hip, including the direct anterior approach, a modified muscle-sparing anterolateral approach, and a traditional anterolateral approach (Watson-Jones). One potential advantage of an anterior approach is that hip precautions are usually not necessary for stability after surgery.

Not every patient is an ideal candidate for the anterior approach. Your anatomy, body type, overall health, previous surgeries, and the severity of your joint disease all help determine the most appropriate technique.

Posterior Approach Hip Replacement

Posterior hip replacement reaches the hip joint through an incision toward the back of the hip, near the buttock. It is traditionally the most common approach for total hip replacement, and Dr. Frisch uses a minimally invasive mini-posterior version.

With the mini-posterior approach, the incision is placed so the abductor muscles, the major muscles you use for walking and hip stability, are not cut. You lie on your side during surgery, and the muscles and tendons are gently separated to reach the joint.

Potential Advantages of the Mini-Posterior Approach

• Smaller incision
• Minimal muscle damage
• Excellent visibility of the hip joint
• Precise placement of the implants
• High success rate

Hip Precautions After Surgery

After hip replacement, you take special care to protect the new joint from dislocating while it heals. Precautions vary depending on the type of hip surgery you had and are typically followed for about 6 weeks. Common precautions include:

• Avoid bending your hip while turning your foot inward
• Never cross your legs or bend your hip past a right angle (90 degrees)
• Avoid sitting in low chairs
• Use a grabber instead of bending down to pick things up
• Use an elevated toilet seat
• Sleep with a pillow between your legs as instructed

Choosing the Right Hip Replacement Approach

No single hip replacement approach is best for every patient. Dr. Frisch reviews your anatomy, medical history, previous surgeries, and goals, then talks through the advantages and considerations of each option so you can decide together.

Both approaches can be performed with minimally invasive techniques, and both may be options for outpatient surgery if you qualify.

What to Expect Before, During, and After Hip Replacement

Good preparation leads to a better overall experience. Here is what typically happens in the weeks before surgery, on your surgery day, and when you return home.

Before Surgery

• Medical clearance and testing: Complete your medical clearance and preoperative testing no later than 2 weeks before surgery. Your family physician can perform these tests; make sure all results are sent directly to Dr. Frisch's office.
• Dental work and injections: Cancel any dental appointments that fall within 3 weeks before surgery and 3 months after. Avoid injections into the surgical joint for 3 months before surgery.
• Preoperative exercises: Stay active as tolerated and follow the preoperative exercise program. Patients who build strength before surgery often find it easier to regain strength afterward.
• Skin preparation: Wash with Hibiclens surgical soap for the 3 days before surgery, and shower with it the morning of surgery, leaving it on the surgical area for 3 to 5 minutes. Do not use lotions, perfumes, or powders.
• Nasal screening: Your preoperative lab work includes a test for bacteria in the nose. If it is positive, you will be prescribed a nasal ointment to use before surgery to help reduce infection risk.
• Illness or skin problems: Contact the office if you develop a fever, cold, sore throat, flu, or other illness, or if you have broken skin or a rash before surgery.
• Home preparation: Place a non-slip mat in your tub or shower, remove throw rugs and secure cords, add night lights, prepare meals in advance, arrange help with housework and outdoor work for at least 2 weeks, set up a spot to elevate your leg, and arrange help with pets for the first few days.
• Transportation: Plan your ride home. You will not be permitted to drive while taking narcotic pain medication.

The Day of Surgery

• What to bring: Your photo ID and insurance card, and a friend or family member. Wear loose clothing, such as shorts or wide-leg sweatpants, that fits over your bandage.
• Check-in and preparation: You check in at surgical registration and move to the preoperative area, where an IV line is started for fluids and medications.
• Anesthesia: You meet with the anesthesiologist and their team to decide which type of anesthesia, such as spinal or general, is best for you.
• Meeting Dr. Frisch: Dr. Frisch meets with you before you go to the operating room, marks your surgical site, and answers any questions. You also meet your nurse and the team who will be in the room with you.
• Recovery room: After surgery, nurses monitor your vital signs in the Post Anesthesia Care Unit (PACU) and place an ice pack on your new joint. Once you tolerate liquids, you may move to oral pain medication.
• Going home: If you are having outpatient surgery, you go home once you are tolerating liquids, walking, and performing your physical therapy exercises safely. If you are staying overnight, you typically spend about an hour in recovery before moving to the hospital floor.

After Surgery

• Walking: You can put as much weight on your leg as you can tolerate right away. Most patients walk on the day of surgery, with or without a walker, crutches, or cane.
• Stairs: You can use stairs immediately after surgery once physical therapy shows you how. Limit stairs at first, since heavy use can increase swelling and discomfort.
• Swelling and bruising: Mild bruising and swelling are normal and can extend down your entire leg, including your foot. You may feel stiff, tight, and tired.
• Wound care: You may shower right away with your waterproof dressing on, but do not take baths or soak. Pat the dressing dry and do not clean the incision. Call if you notice significant drainage.
• Sleep: You may sleep on your back or on your side with a pillow between your legs. Your physical therapist will help you into a side-lying position the first time.
• Medications: Continue your blood thinner as instructed. If you need more pain medication, call the office and allow 24 hours' notice for pickup at the office.

When to Call Dr. Frisch's Office

In an emergency, dial 911. For a concerning problem after surgery, contact Dr. Frisch's team right away. Most concerns can be handled by the team, so avoid the emergency department for surgical issues unless necessary or unless the team instructs you to go. Call the office if you notice any of the following:

• A consistent fever above 101.5°F
• Increased drainage or swelling
• Pain not controlled by your pain medication
• Inability to bear weight on your surgical leg
• Severe insomnia
• Swelling in your foot or calf with coolness or decreased feeling in the foot
• Confusion or disorientation

After joint replacement, contact Dr. Frisch's office before any dental work or other invasive procedure. Antibiotics are often recommended in these situations and should be discussed with both Dr. Frisch's team and your dental or surgical provider.

Hip Replacement Recovery Timeline

Most patients walk on their new hip the day of surgery. The majority of recovery takes place in the first 4 to 6 weeks, and the rest comes gradually over the following year. Every patient is different, so increase your activity daily and let pain be your guide.

Returning to Work

Your return to work depends largely on the type of work you do.

Returning to Driving

You can usually resume driving once you are off narcotic pain medication and feel strong and safe enough to drive. Timing depends on which leg had surgery, so ask Dr. Frisch's team when it is safe for you.

Risks of Hip Replacement Surgery

Like any major surgery, total hip replacement carries potential risks. Complications are rare, and every measure is taken to minimize them, so discuss your individual risks with Dr. Frisch, your primary care provider, and your family before deciding on surgery.

Possible Complications

• Infection
• Dislocation
• Fracture of the femur or pelvis
• Injury to nerves or blood vessels
• Blood clots in the leg veins
• Bleeding into the joint
• Leg length inequality
• Implant malposition
• Wear or failure of the hip implant
• Failure to relieve pain
• Scar formation
• Pressure sores

Factors That Affect Your Risk

• Blood clots: Clots can form in a leg vein or the lungs and can be dangerous. They are more common in older patients and in patients with obesity, a history of blood clots, or cancer. A preventive treatment plan and moving after surgery lower your risk.
• Infection: Infection is very rare in healthy patients. Risk is higher with obesity, diabetes, liver disease, or some corticosteroid medications. Superficial wound infections are usually treated with antibiotics; deeper joint infections may require additional surgery.
• Bleeding into the joint (hematoma): Bleeding can occur right after surgery or later, causing pain and swelling that can slow your progress.
• Numbness: Numbness around the incision is common and usually, but not always, resolves within 6 to 12 months. It does not affect how the joint moves or functions.
• Wound healing: Incisions can heal more slowly if you take corticosteroids or have a condition that affects the immune system, such as diabetes. Smoking slows healing, so Dr. Frisch strongly encourages you to stop smoking before surgery.

Schedule a Total Hip Replacement Consultation

If hip pain is keeping you from walking comfortably, sleeping well, or enjoying the activities you love, a consultation with Dr. Nicholas Frisch can help you understand your options. He will review your symptoms, imaging, health, and goals and recommend whether total hip replacement, and which approach, is right for you.

Auburn Hills office:

3100 Cross Creek Parkway
Suite 200
Auburn Hills, MI 48326.

Monday to Friday, 8:00 am to 5:00 pm.