Publications & Sites 
Questions to ask your doctor before getting a hip replacement
Dr. Benjamin Domb
Updated: September 24, 2012 6:03AM
At first, you could control daily hip discomfort with over-the-counter painkillers, but now even that doesn’t work, so you make an appointment to see your doctor, wondering if you need a hip replacement. To maximize the benefits of that appointment, here are three questions to ask your doctor: Do I really need a hip replacement? How accurate is the placement of the components? How minimally invasive is the surgery?
Below are the answers you should hear.
Do I really need a hip replacement?
First, your doctor should make every effort to help you avoid a hip replacement for as long as possible because hip replacements use artificial components, which have a shelf life. That means they will wear out and need replacing. Unfortunately, each time a surgeon replaces a hip, the patient loses some bone. Therefore, the goal is to preserve the natural hip for as long as possible and perform surgery only when it is strictly necessary.
Although various congenital disorders may lead to hip replacement surgery, the most common reason for undergoing one is arthritis. If a hip has only mild arthritis and no longer responds to non-steroidal anti-inflammatory medication and rest, your doctor may recommend physical therapy and/or injections to reduce inflammation, which may then alleviate stiffness, swelling and pain.
Are there any other options?
Another option for many hip injuries is hip arthroscopy. In this procedure, the surgeon inserts a camera into the hip through tiny incisions. Through this technique, the surgeon can often diagnose and correct the problem causing the trouble. Injuries such as a torn labrum, torn cartilage, impingement, snapping hip or muscle tears may be repairable through a hip arthroscopy. In many cases, this option should be explored prior to considering hip replacement.
How accurate is the placement of the components?
Hip replacement surgery is a challenging procedure; precise positioning is essential to maintain even leg length and normal muscle function. A recent study from Massachusetts General Hospital examined the placement of just the socket and discovered that approximately 50 percent were not in an ideal position. This was despite the surgeries being performed by outstanding surgeons at a renowned institution.
In a study looking at MAKOplasty, a minimally invasive robotic procedure, compared to standard hip replacements (those done without robotic guidance), the percentage of inaccurately placed sockets went from 50 percent to nearly zero. In short, almost all of the MAKOplasty hips were in ideal position. This is because the MAKOplasty procedure uses a highly advanced, surgeon-controlled, robotic arm to accurately align and position the implants. Best of all, almost anyone needing hip replacement surgery is a candidate for this procedure.
I believe that the robotic procedure will eventually replace traditional hip replacement surgery, especially since even age is no barrier to undergoing the procedure. In addition, the MAKOplasty hip behaves more like a normal hip, meaning the hip should last longer, too, thus lengthening the time between hip replacements.
Although many experienced surgeons can do an excellent job of performing a hip replacement without robotic or other forms of guidance, the data shows that the hand alone is less than ideal at least 50 percent of the time, and accuracy can be dramatically improved with robotics.
How invasive is the surgery?
The size of the incision is the area where most patients focus simply because that’s the only part they can see. However the length of the scar is probably least important when it comes to preserving hip function. What’s more important is the approach beneath the skin and how the soft tissues are handled. The goal is to spare them from being disrupted or traumatized during surgery. This yields less risk of dislocations, a minimal hospital stay, quick recovery and return to function.
With many minimally invasive hip replacement surgeries, patients can leave the hospital in 23 hours or less. They can usually bear weight and walk out of the hospital when they leave. Those who work desk jobs can return to work in as little as a week, but even for jobs that involve more activity, such as standing or walking, patients can usually return to work faster than with traditional hip surgery. By six weeks, patients are generally able to walk a mile everyday. Fortunately, the robotic procedure can be performed in combination with a minimally invasive approach, providing the advantages of both: improved accuracy thanks to the robot, and faster recovery with minimally invasive surgery.
With the quantum leaps that have occurred in this field in recent years, the aim is a hip replacement that feels so natural, you’d guess it was your own hip.
Benjamin Domb, M.D., is medical director of the Hip Center for Excellence at Adventist Hinsdale Hospital.
