Your implant will be immediately stable allowing for full weight bearing after surgery. If we use cement to affix your implant to bone, there is no time needed for “ongrowth.” However, if we use cementless implants, there is a 6 week period which the body needs to allow for “ongrowth” fixation of the bone affixing to the implant. However, during this time, there is no change in outcomes, recovery, or treatment plan. Cementless fixation offers the ability to have longer lasting fixation of the implant to bone, whereas theoretically, the cement bone interface can loosen over time. While in patients with poor bone quality, the cement offers a lower fracture risk. Both implants have the same outcomes overall, and will be monitored with X-rays for a period of time after placement.

We use both cemented and cementless femoral components, and then all cementless acetabular components. For hip fractures leading to replacement, we will likely use a cemented femoral component. For elective total hips, cementles components are preferred in men of all ages, and women under 65-75. For women over 75-80, we will likely use cemented fixation for all patients. However, we always have both options available, and will be able to make an intraoperative determination based on your bone quality in surgery.

We do not have any specific restrictions after surgery. Our only recommendation is using a walker longer than you think is needed, and to limit extreme range of motion (including twisting/pivoting) on your operative hip. For older patients (>75yrs old), we recommend using a walker for at least 3-4 weeks to prevent falls.

This is a topic of much debate. Ultimately, I recommend using the approach that your surgeon is most comfortable with. Personally, I am comfortable with both the direct anterior approach and the posterior approach. For most patients, I will use the direct anterior approach (without BMI restrictions) due to lower dislocation rate and a small improvement in early recovery. However, this also is a slightly increased rate of intraoperative fracture and superficial skin numbness related to a skin nerve. For certain arthritis patterns, existing hardware, revision style implants, etc, I will use a posterior approach for improved access to the femur. I will perform revision from both the anterior and posterior approach, depending on the reason for revision.

We will use either a cementless or cemented femoral component and a cementless acetabular component. The cementless components are titanium, while the cemented component is cobalt chrome. The articulation will be a ceramic head ball with a polyethylene (plastic). We do not use metal-on-metal articulations.

AAHKS article detailing total hip arthroplasty implant options (Link)

We will only use ceramic on polyethylene articulations, as this is the current gold standard. 

We can perform a hip resurfacing; however, this is a technically challenging surgery with an extensile exposure that uses metal-on-metal components. There are significant downsides to a hip resurfacing as well as benefit. We will discuss this in detail if you desire a hip resurfacing. The only person who would be a realistic candidate for a hip resurfacing is a very high activity, young male. Otherwise, the data shows unacceptably high revision rates. There are newer hip resurfacing implants on the market with ceramic on polyethylene or ceramic on ceramic articulations, but these remain unproven, and need more evaluation prior to widespread adoption.

For total hip replacement, we do not do formal PT immediately after surgery. We will encourage daily exercises and walking multiple times daily. At the postoperative visit, if you think that therapy would be beneficial for you, then we will write it at that time. We hold off initially to allow the soft tissues to calm down and normalize before beginning (if needed), and a substantial number of people do not need PT after total hip replacement.

If you get a joint infection, we will first have to obtain blood and fluid from the hip to confirm the infection. We will then discuss different options for treatment. All patients will need at least 1 more surgery, a period of IV antibiotics, then long term oral antibiotics.  This will be a long road, but we will be here together. 

Yes, hip pain can refer to the knee causing knee pain. Some patients with hip arthritis only present with knee pain. While this is not as common as the typical groin or C-type pain in the hip, knee pain is a well-documented possibility for patients with hip arthritis.

This MAY help your back pain. When you have hip arthritis, the hip does not move freely, and places more stress on your lower back. A hip replacement should allow the hip to move more freely and decrease the stress in your lumbar spine. Thus, this is possible, but not a given.

Some patients with arthritis have shortening of the limb, while some have no changes. By doing a total hip replacement, we can add length (a few millimeters to a centimeter) back to your limb length. Our goal is to make your limb lengths equal, but sometimes we have to make your limb longer to make your hip more stable and prevent dislocation.

We use computer navigation and intraoperative x-ray to place the components in appropriate position. We also use alterations in limb length and offset to increase stability. Thus, sometimes your leg may be a small amount longer than the other side, to give increased stability to your hip. We also predominantly use the anterior approach with a lower dislocation rate, larger head balls with a lower dislocation rate, and “dual mobility” constructs to decrease dislocation rate in certain patients.

This can be due to a multitude of factors. However, if you need a revision, we will evaluate the reason and components being exchanged. We with then determine the appropriate approach. In general, we will place larger components, and there is higher risk of complications. The current components and reason for revision greatly affect the magnitude of surgery being performed. As with most things, not all revisions are created equal. 

Item descriptionThis is different for every patient. In general, the first 1-2 weeks are aimed at pain control and stability. Then weeks 2-4 are geared towards improving ambulation. At weeks 4-6, the goal is strengthening and getting back into daily life. Beyond week 6, the goal is to maximize your recovery and get you back to daily life and more strenuous activites. Following a total hip, you should significantly turn the corner at the 4-6 weeks after surgery. We will remove all restrictions by 10-12 weeks. Notably, your recovery after surgery is heavily dependent upon how well you were mobilizing/your strength prior to surgery. So, this can be slowed in some people.

This is a controversial topic. This is a much larger surgery with more risks. However, there is some benefit to only going through the recovery once. The ideal patient for this is a young, very healthy individual who is highly motivated. Older patients are not appropriate for this, given the physiologic burden of bilateral, simultaneous surgery. 

We have the ability to use both computer navigation and robotic assistance as needed. These have some benefits in patients with prior hardware, to avoid having to take out hardware and possibly a second surgery. However, largely these technologies only help with implant positioning, and have not been shown in any study not funded by industry to significantly improve outcomes or decrease revision rates. However, we have these technologies available, and will largely use these technologies in every patient, as this will allow is to more precisely place the implants in the desired position for the optimal outcome.

AAHKS article regarding technology usage in total hip arthroplasty (Link)

The entire goal of having hip replacement surgery being performed is to improve your quality of life, and to be able to perform the activities that you desire. With that said, our goal is to impose no restrictions upon you. For example, we know of numerous firefighters, SWAT officers, military members, weight lifters, distance athletes, etc. who still perform at a very high level following total hip replacement. We will just have a detailed discussion about the risks and benefits of these activities in clinic. We will impose some restrictions on you for 3-4 months, but then remove essentially all restrictions for you at that point. The key will be to listen to your body and slowly increase your activities to your desired level.

The most common complications are broke down into surgical and medical complications. The most common medical complications are: nausea/vomiting from medication intolerance, uncontrolled pain, constipation from narcotics, difficulty urinating, uncontrolled glucose levels after surgery, insomnia, and fatigue. The most common surgical complications are pain, stiffness, numbness over the lateral thigh, wound drainage, hypertrophic scarring, dislocations, fracture, and infection.

We can perform this version to total hip replacement for you. As with any incision, there is pros and cons to its usage. First, this is not an extensile incision, so in the unlikely event of complication, this will have the be made into a +-sign, and increase the risk of wound complications. Additionally, this can lead to increased thigh numbness from LFCN palsy. However, this has been found by patients to be a more aesthetically pleasing incision with fewer wound complications.

This can happen with placement of the femoral component. If this happens, we will see this in the OR and place a cable around the femur. Then you may still bear weight on your leg as normal, but we will just request you use a walker for 4 weeks after surgery.

You do not have to. However, if you desire, we can start within 2-4 weeks after surgery.

There are many places on the internet to obtain information regarding hip replacement with differing levels of reliability in the information being given. The American Association of Hip and Knee Surgeons has a patient-specific website for common concerns regarding hip replacement (Link). We encourage you to use this as a foundation for further information beyond this website.