Anterior Hip Replacement Procedure

Recent advances are enabling hip replacement to take place with much less disturbance of the muscle and soft tissues around the hip. Along with improvements in anaesthesia, and the implants and instruments used, this is leading to easier and more rapid recovery after hip replacement surgery.

The anterior approach to the hip is not new to orthopedic surgery. This approach has been performed for decades in orthopedics, but it has only recently been applied to hip replacement surgery in North America. This interest has occurred due to advancements in instruments and implants as well as the normal progression that occurs with surgery.

The anterior approach for hip replacement has been adopted by surgeons for a number of reasons. These reasons include:

less chance of posterior dislocation due to decreased trauma to the capsule, ligaments and muscles at the back of the hip
less pain after surgery due to decreased soft tissue disruption
easier rehab after surgery
improved precision of implant placement with the use of x-ray during the procedure

The anterior hip replacement procedure is usually performed with a spinal anaesthesia. Reasons for recommending a spinal anaesthetic include:

relaxes the muscles about the hip
reduce risk of blood clot
reduced blood loss during surgery
easier transition after surgery where patient remains more aware and in control

The procedure is usually performed with the patient lying flat on the operating table. A skin incision is made over the front/outside at the top of the thigh bone. The size of the incision is kept to a minimum, but made large enough to see what needs to be seen. Pain after surgery is less dependent on incision size, and more on the trauma to soft tissue structures under the skin.

After incising the skin, muscles are spread to gain access to the hip joint. No muscles are removed or detached, allowing faster recovery. The capsule is incised to expose the underlying bones of the hip. The bone is then prepared much the same as a traditional hip replacement. The implants are placed in the bone, using x-ray to decrease the variability in implant positioning. The soft tissues are closed and covered and patient brought to the recovery room.

After surgery, the patient is encouraged to walk and move. There are no restrictions on weight bearing or movement during the recovery time. Pain is the main dictator of activity. Patients are encouraged to place ice over the hip, and elevate the leg above the heart in a lying position to avoid swelling. Discharge home occurs once the patient can go the bathroom and do stairs. Usually the stay in hospital is 1 to 2 nights depending on other medical conditions.

Hip Impingement Treatment

The pain of impingement may progress to the point where it interferes with activities of daily living. Treatment first consists of trying to control the pain with over the counter anti-inflammatory medications and Tylenol. If this does not control the pain sufficiently, surgical treatment may be warranted.

Hip Arthroscopy

Hip arthroscopy involves correcting the cause of impingement and dealing the damage that has occurred the hip labrum as well as possible cartilage of the hip joint. Hip arthroscopy is the most common method of accessing the joint. The procedure allows the surgeon to visualize as well as treat the damaged area. Damage to the labrum is addressed with partial removal and possible repair.

The bony problems leading to this impingement are then addressed. This may involve removing a portion of the bone in the front of the hip socket. X-ray is used during the procedure to remove the correct amount as well as to visualize the motion of the hip during bone shaping.

Bone at the junction of the head and neck of the thigh bone are then visualized, and the bone is shaped to create the proper offset necessary for smooth movement. Again, x-ray and hip motion are used to correctly remove bone in the critical area.

In cases of more severe malposition of the hip socket, a redirecting procedure, called a periacetabular osteotomy (PAO) may be required. This is in more severe cases of impingement where bone removal alone would not adequately address the problem.

Hip Dysplasia Treatment

The goals of treatment for hip dysplasia are to decrease pain and prevent the early development of degenerative arthritis. Once pain becomes enough to interfere with normal activities, it may be advised to treat the dysplasia surgically.

Surgery is performed to redirect the socket and also rarely the upper femur. The socket is redirected using a periacetabular osteotomy (PAO) or Ganz Osteotomy. In severe cases, the upper femur is also addressed using a proximal femoral osteotomy. This redirection positions the joint such that body weight is spread over a larger area, therefore decreasing pain and slowing the progression of arthritis.

Periacetabular Osteotomy

The PAO is performed with the patient laying flat on the operating table. A spinal or general anesthetic is used during the procedure. An incision is made over the front of the hip, exposing the inside of the pelvis and front of the hip joint. The bone around the socket is then cut. These cuts release the socket from the pelvis, enabling repositioning.

The socket is then repositioned to cover more of the femoral head and is fixed with screws. These screws hold the bone fragments while they heal. This bone healing begins immediately, but doesn‘t have significant strength until 2 to3 months after surgery, similar to fracture healing.

Usually patients stay in the hospital for 3 to 4 days. Therapy begins immediately to strengthen the muscles around the hip joint. Weight bearing is restricted to toe touch, as too much weight bearing too early can cause breakage of the screws and change in the socket position. At six weeks, weight bearing is increased gradually to full as pain permits. Once bone healing has occurred, activity can be resumed unrestricted.

The goals of this surgery are to decrease pain and slow or stop the progression of hip degeneration. This hip socket remains shallow, but is repositioned such that it better supports weight and decreases the damaging strain on the cartilage.

Keep Your Parts Moving – Orthopedics and Heart Health

Orthopedic Health

Every day, advances are being made in the world of orthopedic health and disease treatment for our bones, muscles, tendons, ligaments, and related connective tissues.

Reduction in the crippling pain of arthritis and the advances of knee and hip replacements from musculoskeletal research is changing how well and how long we can live active, healthier lives.

The human body has more than 200 bones and more than 200 joints that connect the bones.

Until something goes wrong with one or more them, most people take their bones and joints for granted.

Almost half a million hips or knee replacements occur in the United States each year; in fact, many of the diseases related to joints and bone problems affect women and minorities more severely.

Consider these facts:

The most common joint problems come from arthritis and injuries. Arthritis literally means joint inflammation. Although joint inflammation describes a symptom or sign rather than a specific diagnosis, the term “arthritis” often refers to any disorder affecting the joints.
These disorders fall within the broader category known as rheumatic diseases, of which there are more than 100 kinds, and are characterized by inflammation as well as loss of function of one or more connecting or supporting structures of the body.
More than 46 million people in the United States have arthritis or other rheumatic conditions. By the year 2020, this number is expected to reach 60 million.
These diseases more frequently limit activity than do heart disease, cancer, or diabetes.
The most common form of arthritis is osteoarthritis. It is seen especially among older people and is sometimes called degenerative joint disease.
In osteoarthritis, the surface layer of cartilage (the hard but slippery tissue that covers the ends of bones) breaks down and wears away, causing pain, swelling, and loss of joint motion.
About 435,000 Americans have a hip or knee replaced each year. Because of its structure and weight-bearing capacity, the knee is the most commonly injured joint.
In the case of hip joint damage, osteoarthritis is the most common cause.
Young adults who have had a previous joint injury are more likely to develop osteoarthritis.

Prevention

Regular exercise, a balanced diet, and a healthful weight can help you reduce your risk of developing osteoarthritis, especially in the hips and knees, or suffering sports injuries.

Exercise helps bone density, improves muscle strength and joint flexibility, and enhances your balance. Take part in regular walking, strength training, swimming, dancing, tai chi, gardening, and similar low-impact activities.

A bone-healthy diet should be rich in calcium and Vitamin D. Check to see if your favorite foods are fortified, and consider taking a daily vitamin or mineral supplement. Several medications are available to prevent osteoporosis.

Ask your orthopedic surgeon which medications can best help you minimize additional bone loss and reduce your risk for fractures.

If you believe you are suffering from arthritis, knee or hip-related injury and need specialized orthopedic care, the surgeons at Orthopedic Specialists of Seattle provide excellent treatment options available for you.

Slippery When Wet – Pedestrian Safety on the Streets of Seattle

The snow flurry that came and went over this Thanksgiving holiday in Seattle gave way to icy roads, wet and slippery sidewalks and driveways across our fair city. As challenging as winter can be in the Pacific Northwest, it is equally a challenging time of year for pedestrians who navigate this great city on two feet.

Most fractures are caused by falls, including fractures of the spine and hip.

Over 95% of hip fractures are caused by falls, and the rate of hip fractures is twice as high for women as it is for men.

The injuries caused by these falls can make it difficult for anyone to enjoy the normal activities of daily living like walking.

Pedestrian Safety Tips

Seattle OSS has a few tips for you to keep in mind while navigating the streets of Seattle including:

Proper footwear – Pedestrians should wear the proper footwear for the weather conditions, such as shoes and boots with appropriate traction. Rain, frost, ice, and snow can make walking on footpaths very dangerous, so proper footwear can help prevent a dangerous slip and fall. Also, walkers should wear gloves in order to break their fall if they do slip, and keep gloved hands out of their pockets for the same reason.
Proper clothing – Wear high visibility clothing to make yourself more visible to vehicles.
Avoid walking on the streets – Freezing weather tends to turn roads into an icy hazard. Be aware of your surroundings and stay on the sidewalks or clear, cleaned paths.
If you can’t avoid ice and snow, take shorter, slower steps to reduce the risk of a slip and fall and subsequent injuries, particularly when using the steps at any building as these can be dangerous when covered with snow or ice.

If you experienced a fall and need specialized orthopedic care, the surgeons at Orthopedic Specialists of Seattle provide excellent treatment options available for you.