Ask-a-Doc:
Do I Need Total Hip Replacement Surgery?

Hello, I’m Dr. Adolph V. Lombardi, Jr.

We’re here today to talk about total hip replacement and why patients would come and ask for a total hip replacement. 

Total hip replacement is done for the treatment of end-stage degenerative joint disease of the hip, meaning a painful hip that has severe restriction of the range of motion—the inability to bring your leg up and tie a shoe or even put on your sock, to begin with, difficulty getting out of a car, or difficulty going up and down stairs. 

Patients come to us and present with these types of complaints. And let me show you a picture of what we’re talking about because they always say a picture is worth a thousand words. 

So, if we look here, the normal hip has lining cartilage, both on what we call the socket side or your pelvis and on the femoral head or ball side of the hip joint. 

When you develop end-stage disease, mostly secondary to hip osteoarthritis, you lose this cartilage layer on both sides. And in this artist’s rendering, what you see is that the cartilage is lost, and these spurs have formed. We call them osteophytes. 

These bone spurs are what cripple your motion. That’s why you can’t take your knee, flex it, turn it around, and tie your shoe, for example. That’s why you have difficulty getting in or out of your automobile or even rising from a chair at your kitchen table. 

So what we do at the time of the operation is we implant metal, plastic, and ceramic to rebuild your hip joint. Let me show you a picture of what that is.

That is taking a metal rod—usually titanium, this metal rod—and we put it into your thigh bone. The whole purpose of that metal rod is to support the ball. And then on the socket side, we put a metal shell and a plastic liner. 

In the next picture, I’m going to show you those pieces and parts so you understand what’s going to be implanted into your body. 

So, a titanium implant or metal rod that goes down into your thigh bone allows the bone to grow in and around and become intimately attached to it. The metal shell has the same surface type, allowing the bone to grow in and interlock around that implant and secure it in place. 

Now, sometimes we add screws to help hold that socket in place, but not all the time. And then you have a pink ball—that’s a ceramic ball and a plastic liner. And that is what gives you that freedom of motion that you’re looking for. 

And because we replace those bony, painful surfaces, 99% of the time, we get what is called the forgotten hip. That means you don’t realize you even have a hip replacement. 

Now, the question that you raise many times, and what you hear in the lay literature if you will, is, “I had my hip done from the front,” or “I had an anterior approach,” or some patients say they had a posterior approach. 

I would tell you that historically, the posterior approach is the most common approach that has been utilized to put in a hip implant. I will also tell you that here at JIS Orthopedics, we have not used that approach. 

We have always done a laterally-based approach, and the reason we picked that was for hip stability. No one wants the ball coming out of the socket. Unfortunately, the posterior approach is associated with a higher ball-out-of-sock or dislocation than the lateral approach or certainly the anterior approach. 

And the beauty of the anterior approach is that we don’t cut into any muscle. We cut between muscle planes. We get direct access to the hip joint. We work on the socket like I showed you to put in that metal shell, that plastic liner. We work on the thigh bone to put the metal rod in, and then we’re able to make those two pieces together. We’re able to use X-ray fluoroscopic imaging to make sure that we get the leg length correct, the position, and the orientation of the components correct. 

And the healing is what is remarkable. It’s rapid. We actually do not have any precautions. Our basics for you are to go home, sit, stand, and walk. You will advance quicker if you participate in physical therapy, but there are no precautions. 

So if you have friends that tell you that after the operation, you have to lie flat for six weeks—not here, not anymore, or you can’t drive a car for 5 or 6 weeks. Not here. Not anymore. 

We all tell the patients that as soon as they are off their narcotics, as soon as they’re able to raise that leg and move it from break to gas and with confidence, they can resume driving.

And I think that for most patients, that’s typically at about 3 weeks, maybe 4. But most patients, it’s 3 weeks. I have a lot of patients who go back to, I would say, non-labor, intense employment at about three weeks once they can resume driving. 

Now, they may not go back for the full day that initial week, but certainly, they’re getting back into the swing of things and resuming their normal activities. 

So, the advantage of the anterior approach is the rapid recovery and no restrictions on your activities post-op, because we’re put in a good stable hip and we’ve got your leg lengths correct and your stability correct. 

So, that’s why we elect to do most of the patients with an anterior-based or this direct anterior approach. 

Some of my patients may get the lateral approach. That may be the more difficult reconstruction, complex patient. Maybe the patient who’s had a congenital defect, meaning something that was awry since birth and in their hip. But that’s very few. 

Talk to your doctor when you arrive for your office visit. Talk about the anterior approach, the lateral approach, or whatever you’d like to discuss. We’re here to explain what we do in as easy a terminology as possible so that you understand. And no question is a bad question. Every question is welcome. Thank you!If you want to know more about total hip replacement surgeries, contact us at JIS Orthopedics. Our specialists in New Albany and St. Clairsville, Ohio, can give you the answers you are looking for. Schedule a visit with us today!