Medical Edge Newspaper Column

Hip Replacement Is Evolving, And Rehabilitation Is Getting Easier

February 28, 2008
Dear Mayo Clinic:
I would like to know more about hip replacement. I am curious if the muscles around the hip are moved or stretched. And what is the importance of therapy in returning to normal ease in moving after surgery?

Answer:
During hip replacement surgery, bone and tissue that are diseased or damaged are removed. The ball of the thigh bone, called the femoral head, and the socket of the pelvis (the acetabulum) are replaced with artificial materials. The ball and socket work together like a natural hip joint.

There are many variations in hip replacement surgery — different materials, different methods of fixing the implants to bone and different surgical approaches. The best surgical approach depends on the patient's circumstances.

I'm guessing that your question stems from recent attention to what's been called minimally invasive surgery, which gained notice about five years ago. There are many different so-called minimally invasive hip replacement approaches, but all focus on surgery through a small incision. Minimally invasive approaches are sometimes touted as a way to avoid cutting muscles, but any hip replacement surgery involves cutting (and then reattaching), or stretching some muscles around the hip.

Over the last five years, much has been learned about less-invasive hip replacement. Surgeons have learned that performing total hip replacement through a smaller incision than was used in the past is both possible and safe for most patients. Surgeons also have learned that trying to perform surgery through excessively small incisions may increase the risk of certain complications — in some cases it may actually increase muscle damage — and provides few, if any, advantages over moderate-length incisions, which now are used for the majority of patients.

After total hip replacement and while still in the hospital, patients typically work with a physical therapist to learn how to walk and manage their activities of daily living.

Depending on what resources are available at home, and how quickly an individual is recovering, some patients need to stay in a rehabilitation center to regain independence, while others may go directly home after surgery and recuperate with a regimen of walking and simple, self-directed exercises to strengthen lower-extremity muscles. Most patients won't need ongoing visits with a physical therapist after they are discharged from the hospital or rehabilitation center.

If you are considering hip replacement, talk with an orthopedic surgeon about the pros and cons of all the options available to better understand the best approach for you. Hip replacement surgery is successful more than 90 percent of the time — meaning easier movement and much less pain.

— Daniel Berry, M.D., Orthopedics, Mayo Clinic, Rochester, Minn.