Hip Operative Treatments

When are Patients a Candidate for Surgery?

When it comes to the treatment options for your hip arthritis, there are a few key factors used to determine whether you are a candidate for joint replacement surgery. Below are the main factors that are evaluated:

Pain, pain, pain…
The impact of the pain on the activities you would like to do and your own quality of life.
Near end stage (very thin cartilage remaining between bones) to end stage (no cartilage left, bone on bone) levels of degeneration as seen in X-rays.

When is it Time for Surgery?

Joint replacement surgery is an elective surgery. It is up to you when you want to have surgery! There is no right or wrong time. As long as you can maintain motion in your joint, there is no amount of joint wear that we cannot fix. If you choose to wait to have surgery, additional wear your joint has will not impact your surgical outcomes. The decision to have surgery is an individual decision based on how much pain you are having and how that pain is impacting your daily activities.

Other Factors to Consider

During surgery we are not just treating your joint, your general health is important. While we operate on patients with the health concerns below, we first try and maximize the treatment of the concerns before surgery. That way, after surgery, complications related to these concerns can be reduced.

High Blood Pressure
Heart and Lung Disease (we maximize treatments of co-morbidities prior to surgery to minimize risk of complications post surgery)
Weight/BMI
Smoking - we recommend patients stop smoking 4 weeks before surgery. However, it is best to give smoking up completely!
Strength & Conditioning - whatever you do before surgery will significantly help with recovery.

Click below to learn more:

Managing Co-Morbidites

Dig Deeper on these Topics with Dr. DiGioia

Surgical Treatments

There is a spectrum of surgical interventions for joints. The options are different for hips and knees. Some of these treatments have fallen out of favor as modern treatments have proven to provide better outcomes.

Total Hip Replacement (Hip Arthroplasty)

Total hip replacement surgery is the tried and true treatment for patients with near end, or end stage arthritis. A total hip replacement completely replaces the worn surfaces of the joint and cures patients of arthritis and is similar to a “retread” for tires when they are worn. During the procedure, we create a new ball and socket joint by removing the worn femoral head (the ball) and prepare the acetabulum (the socket) and replace them with metal, ceramic and plastic components. We leave all the good bone that supports the implants intact.

After the surgery, you will be “cured” of your arthritis. The worn cartilage and bone rubbing on bone, the source of pain and inflammation that patients experience, is completely removed and can no longer cause pain. A joint replacement can last a lifetime and can be a truly life changing procedure.

Check out this video to learn what happens during the surgery:

In-depth Video on the steps of a Total Hip Replacement Procedure

The Different Surgical Approaches to Hip Replacement

There are three different approaches and incision types for a total hip replacement:

Posterolateral – from the back
Direct Lateral – from the side
Anterior – from the front

While there are pluses and minuses to each approach, studies show that all these approaches work well and have the same, positive outcomes. The most important factor is that your surgeon performs a procedure they have experience with. Each approach has its own nuances that require practice to master.

At the Bone and Joint Center, our surgeons have collectively mastered all three approaches. If the surgeon you meet with does not perform a specific approach, they can refer you within the Bone and Joint Center to a surgeon who does. Our goal is to provide you with all the great benefits the bone and joint center has to offer while still making sure you have a surgeon who is an expert in the required approach.

Other Procedures for Hip Arthritis

Hip Resurfacing: This procedure involves "capping” the femoral head with metal and inserting a corresponding socket in the acetabulum. This is less frequently performed now and is typically performed on younger, more active patients that perform a lot of heavy manual labor.
Arthroscopy: A joint “wash out” procedure. Not a common procedure anymore as studies show only 50% of patients improved and only in the short term. The procedure can also make the hip feel worse because the scope can cause inflammation in hip. NOT RECOMMENDED!

Learn More about Hip Operative Procedures with Dr. DiGioia

Possible Adverse Events

While joint replacements are some of the most successful procedures in modern medicine, it is important be informed on the potential adverse effects of surgery.

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Possible Adverse Events

Success after Joint Replacement

Joint replacement surgery is one of the most successful surgical procedures in modern medicine.
Over 90+ % of joint replacements are still functioning well after 20 years.
Joint replacements do wear or loosen, but this happens slowly over the years and are user dependent based on weight, activity level and general health. However, this is the reason that we always recommend that you have X-rays of a replaced joint every three years, even if you are feeling well.

Your Role in Surgery

You and your family have an important role in your treatment. There are factors that you can help with to improve your outcomes.

Your "Coach", typically a family member, will be your second set of ears and eyes throughout the education and operative processes. Importantly, your Coach will be a part of the care team at home. Having a Coach is clinically proven to improve your surgical outcomes.
Education: Your knowledge, skills, ability, and willingness to learn about and manage your own health and care is also very important.

Remember: The best prepared patients have the best outcomes!

Additional Resources

The Bone and Joint Center’s Hip Surgical Experience Education Video:

Total Hip Replacement Education from Dr. Tony DiGioia's Neighborhood on Vimeo.