The hip bone is connected to, well, just about everything you do. Taking a step. Going up and down stairs. Reaching for that just-out-of-reach backhand, or just-out-of-reach light bulb. The hip—which is really a joint, of course—is critical to both daily and athletic activities. Like every joint, it can wear down and cause a lot of pain. As we age, that pain can make life more challenging, and make you a more likely candidate for hip replacement surgery.
Total hip replacement is a common surgery where the upper end of the thigh bone is replaced with a metal ball and socket, usually made of titanium or ceramic. The hip socket in the pelvis is resurfaced for smoother joint movement and the prosthetic hip is then attached. The biggest variable is location: Is the surgical incision made in the back (posterior) or front (anterior) of the hip?
For Dr. Eric Smith, Chief of Arthroplasty in the Department of Orthopaedics at Tufts Medical Center, he finds one approach to be more successful: direct anterior hip replacement.
“Posterior hip replacement is still a wonderful approach,” says Dr. Smith. “But because the direct anterior approach goes in between—instead of through—the muscles, it provides a lot of benefits. Patients have much less pain, can walk almost right away and can go home sooner.”
A faster recovery
It’s not a surprise to see anterior hip replacement patients up and about the same day as surgery: Walking, climbing a few stairs and working with our Physical Therapy team. In fact, many patients are discharged the very next day, compared to three days for the posterior approach.
After returning home, patients will work with a physical therapist or nurse to increase strength and range of motion for about six weeks. While there usually isn’t too much pain, most patients need some pain medication for a few days or weeks after surgery.
And the results? Most anterior patients can return to work about two weeks after surgery, versus six weeks for posterior. As for returning to other activities, Dr. Smith advises:
- Strengthening at gym: 6 weeks
- Biking and low-impact sports: 3 months
- Tennis and high-impact sports: 4 months
Dr. Smith sums up the results best: “After six weeks, patients walk into the office and it’s hard for me to tell which hip was replaced.”
Working hard for our hardworking patients
Calling Dr. Smith “busy” is an understatement. He is Chief of Arthroplasty, Assistant Professor at Tufts University School of Medicine and the director of Tufts Medical Center’s Total Joint Replacement Program—named a Blue Distinction Center® by Blue Cross/Blue Shield of Massachusetts. He performs about 250 hip replacements every year, and an equal number of knee replacements.
One of the favorite parts of his job is talking to patients and families. About their concerns. About their treatment options. About what he can do better to help them heal. A few years ago, he realized one big thing he could do is to learn the relatively new approach of anterior hip replacement.
Few surgeons in the Boston area use this method because the training is so difficult and time-consuming. Yet as a former orthopaedic surgeon in the U.S. Army, and someone truly battle-tested on the war-torn fields of Afghanistan, Dr. Smith was up for the challenge.
Dr. Smith dedicated himself to studying—and perfecting—the surgical technique. Over the span of 18 months, he took five different training courses throughout the country and has been gradually phasing in the anterior approach for his patients. Today, he performs 70% of hip replacements this way.
“It’s taken me a long time to get to the level of competency I have and gain confidence in this approach,” says Dr. Smith. “I wanted to make sure that I was performing the hip replacement for all patients at the highest level.”
Candidates for anterior hip replacement
Nationally, the average hip replacement patient is around 60 years old, with roughly equal numbers between men and women. Yet people young or old can experience problems with their hips. “What’s unique about Tufts Medical Center is the age range we see here, which spans from 11 years old up to 93,” says Dr. Smith.
Candidates for anterior hip replacement do share some common threads. Those who are slimmer, more active, in good physical shape and who have greater flexibility in their spine are more likely to realize the benefits of the approach: Quicker mobilization and return to increased activities after surgery.
Says Dr. Smith: “If you participate in yoga, ice hockey, tennis or activities that would stress the soft tissue around the artificial hip, you are a good candidate because of the inherent stability of the anterior approach plus your ability to regain muscle tone and start walking again quickly.”
“I feel like a new man”
When Ronald Purcell limped into Dr. Smith’s office, he immediately fit the bill for anterior hip replacement: Young, physically fit and ready to live life without agonizing hip pain. As Dr. Smith puts it, “Ronald is someone who can take advantage of the benefits of this surgery and get mobilized quickly.”
At 44, Ronald has a physically demanding job as a welder for the Massachusetts Bay Commuter Rail. He has two kids, exercises often and loves to go for runs in his Dorchester neighborhood. Yet he was stopped in his tracks by severe hip pain.
“I always had back pain, but never associated it with my hips,” he says. “Then one day I went into work and couldn’t turn or maneuver, and had serious pain. Turns out my hips were bone on bone.” For someone who spent over a decade on the Big Dig, working hard is part of Ronald’s DNA. Yet it suddenly became nearly impossible to perform his job.
On the advice of his primary care physician, Dr. Laura Snydman, Ronald went to see Dr. Smith, who used the anterior approach to replace Ronald’s left hip in 2013 and his right hip soon after in early 2014. After his second surgery, Ronald was able to walk up the three flights of stairs to his apartment. Within a week, he was off of pain medication and started doing some light exercises. Results like these would have been impossible without the help of Dr. Smith and his team.
“I feel like a new man,” says Ronald. “The most important thing is that I wanted to be able to heal quicker. To get up and be just as strong if not stronger. Now I’m looking forward to getting healthy and getting back to life. To have no pain is just a miracle in itself.”