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Total hip replacements are an appropriate treatment for people who have significant arthritis or pain in the hip and who are no longer experiencing adequate relief from non-surgical treatment options. Total hip replacements can be used to provide relief from primary osteoarthritis, secondary osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, traumatic arthritis, avascular necrosis, failed prior hip surgery, arthritis secondary to congenital hip dysplasia, gout, pseudogout, certain tumors of the hip and, in certain instances, infection.
To determine if you are an ideal candidate for a total hip replacement, schedule a consultation with Dearborn & Associates — the Bay Area leaders in hip and knee replacement.
The first step of a traditional hip replacement (not used by Dr. Dearborn) is to make a 6-10 inch curved surgical incision on the side of the hip. In some cases, a surgeon may enter the hip joint from behind. Approaching the joint from the back decreases postoperative limping, but has a higher risk of dislocation. Approaching from the front has a lower risk of dislocation, but is associated with more post-operative limping.
After making the incision, the surgeon will then cut through or detach muscles and tendons to reach the hip joint. The femur head will be removed. The inside of the hip socket will be prepared for a titanium shell that goes inside. A channel is created inside the femur for an implant to which a new femoral ball will be attached. After the new ball and shell are installed, the detached tendons will be repaired and the superficial portion of the wound will be closed with dissolvable stitches.
The traditional approach was used from the 1970s through 2000, when the greater emphasis was on designing better implants and implanting them in reliable alignment. Less invasive methods have become the new focus, with Dr. Dearborn serving as a major contributor and international thought-leader since 2001. These techniques generally have smaller incisions, reduced soft-tissue trauma, and faster recovery times compared to the traditional approach. At Dearborn & Associates, we specialize in providing these minimally-invasive hip replacement methods. The primary less-invasive methods available include the following:
An incision is made on the front side of the hip, between natural muscle intervals. The muscles are then moved aside to reach the joint and allow the prosthetic components to be placed. This method results in a faster recovery compared with the traditional method and a similar recovery as the Mini-Posterior Method. Several published studies have shown higher complication rates compared to the mini-posterior method, including more blood loss, nerve injuries, and unrecognized intraoperative femur fractures that can hinder recovery (see links below).
Direct anterior approach is more likely to require early revision:
https://pubmed.ncbi.nlm.nih.gov/32769807/
Direct anterior has a higher rate of early femoral loosening – Stanford 2017:
https://www.ncbi.nlm.nih.gov/pubmed/27843039
More complications with direct anterior approach:
https://www.ncbi.nlm.nih.gov/pubmed/26118568
Direct anterior wound complications:
https://www.sciencedirect.com/science/article/abs/pii/S0883540314002940
Direct anterior has more blood loss and complications – Woolson:
https://www.sciencedirect.com/science/article/abs/pii/S0883540309001065
No advantage of direct anterior over posterior approach at 5 years:
https://pubmed.ncbi.nlm.nih.gov/34237041/
Direct anterior has a higher complication rate with no added benefit:
https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.101B6.BJJ-2018-1474.R1#_i2
Posterior approach has better function and fewer complications than direct anterior in first 12 weeks:
https://pubmed.ncbi.nlm.nih.gov/27687805/
After your operation, you can expect to spend about an hour in the recovery room, until the spinal anesthetic wears off. Within a few hours, we will have you up and moving. You will be ready to go home within 4-5 hours after surgery.
During your recovery process, medical assistive equipment such as a walker and cane will be needed. You can expect to have a physical therapist come to your house to assist you with an exercise program to promote proper healing. Follow up visits are also usually scheduled at the 2-week, 6-week, and 3-month marks.
In most cases, you should be able to walk independently by 2-3 weeks after surgery. At the 6-week mark, you will be able to resume most of your regular activities.
Schedule a consultation with Dearborn & Associates in Menlo Park today to see if a total hip replacement is the right treatment for you!
This helpful pamphlet describes hip replacement surgery in easy-to-understand terms, including the potential complications. It is required reading for our hip patients prior to surgery and has a section on minimally invasive hip surgery techniques.
Download PDF
Read here about the pros and cons of the various materials used in hip replacement surgery today, including ceramics and metal-on-metal bearings.
Download (24kb) PDF
This document reviews the pros and cons of anterior and posterior approaches to the hip joint during hip replacement surgery and answers questions raised by patients about the anterior approach, as well as the two-incision technique.
Download (28kb) PDF
Hip replacement is an artificial ball and socket which replaces the painful bone surfaces and restores smooth motion of the joint. The new socket fits into the pelvis tightly so that bone grows into the implant. A plastic liner locks into the socket as the bearing surface. Metal liners have been associated with early failures. Ceramic heads are currently favored over metallic ones in order to reduce the risk of corrosion developing at the taper joint.
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