By: Dr. Barry Kraushaar
When a patient has arthritis of the hip, there really are only a few choices available for treatment. Most people try to ignore pain or live with it as long as they can. Once daily life is affected, it becomes necessary to discuss other options.
The non-operative care of the arthritic hip is rather limited. Options include:
- Oral non-steroidal anti-inflammatory (NSAID) pills.
- These can help briefly, but they do not address the underlying problem, and they can cause bleeding, ulcers, kidney disease and high blood pressures,
- Physical therapy
- This may help especially if there are surrounding thigh and low back issues
- Hip joint injections
- Cortisone may briefly help
- Less traditional measures
- Acupuncture, topical ointments and rubs, chiropractic care, prolotherapy, stem cell treatments, etc., though these are not proven to work by scientific standards
For those patients who do not improve with conservative measures, hip replacement surgery may be necessary. When this decision is made, a patient has two general choices about the surgical approach to the hip: Anterior or Posterior
- Anterior hip replacement – this procedure is done with the patient lying face upward on the table. A special table may (or may not) be used to help the surgeon optimize the procedure. The approach allows the use of a video-type fluoroscope imaging system which permits real-time optimization of the process of implanting the joint. The surgery is performed by entering the hip between muscles, and no muscle is cut in the process. This procedure is optimal for some patients – ask your surgeon. Some patients report a more rapid return to walking and activities after the anterior approach – compared to the posterior approach. Also, after this approach there is no restriction to bending over, and patients are not required to follow “hip precautions” as is necessary in the posterior approach. Some patients feel the anterior approach is less painful in the early post-operative time period.
- Posterior hip replacement – this approach has been the more traditional method, and the duration of a routine case may be a bit shorter than the anterior approach. The posterior approach does not require any special table to perform. It is “tried and true” and some surgeons perform only this procedure because it is so reproducibly good that they prefer to stay with it exclusively. The posterior approach involves crossing some fine-control muscles on the way into the hip joint. The ligaments in the rear of the hip are opened, so after the procedure is done, patients need to observe hip precautions, usually for three months. They are not allowed to bend past 90-degrees and should sleep with a pillow between the knees, among other restrictions. The fluoroscope cannot be used real-time during the case, but plain x-rays can be taken during the case to confirm that components are going in correctly. The posterior approach is felt by some surgeons to be best in difficult cases because it is easier to manage difficulties (such as a stress fracture) from this direction.
By 6 weeks most patients with either approach are doing similarly well. Infection rates are similarly low. Dislocation rates are slightly less with the anterior replacement according to some reports. Blood thinners are used in the same manner postoperatively for either approach.
Northeast Orthopedics and Sports Medicine has surgeons who perform both the anterior and posterior approaches to hip replacement. We are happy to answer your questions, so contact us today to schedule your consultation.