Direct Anterior Hip Replacement | Hip Arthroscopy | Hip Osteotomy | Advances in Orthopaedic Anesthesia | Total Joint Replacement
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Hip replacement surgery isn’t just for “old” people anymore. People of all ages, weary of living with constant hip pain, are coming to University of Maryland Medical Center seeking a less invasive option known as direct anterior hip replacement. Most often it is patients with chronic hip pain, including osteoarthritis; dysplasia, or a misalignment of the hip joint; slipped capital femoral epiphysis, a disorder causing the thighbone to slip out of place; or a loss of blood supply to the hip from disease or medication use who seek out a replacement.
The University of Maryland is at the leading edge of advancements in complex hip surgeries, having performed anterior hip surgery for many years and switching nearly entirely to the anterior approach about two years ago.
Direct anterior hip replacement removes the ball and part of the socket of the natural hip – which is diseased or injured – and replaces them with artificial parts by accessing the hip socket from the front of the body, known as the anterior side. Conventional hip replacement surgery, now done on only a minority of hip replacement patients at UMMC, accesses the hip from the back or side, but the anterior method avoids cutting through muscle, leading to less blood loss, pain and scarring. Hospital stays are generally shorter with direct anterior hip replacement because of less trauma to the hip tissues.
Physicians who perform hip replacement: Farshad Adib, MD; Ted Manson, MD
Hip arthroscopy is a more commonly-used, minimally invasive procedure where small cuts are made around the hip and small cameras are inserted to diagnosis, examine and possibly treat the hip joint.
The most common reasons for hip arthroscopy are to:
- Remove small pieces of bone or cartilage that may be loose inside your hip joint and causing pain
- Repair a torn labrum (a tear in the cartilage that is attached to the rim of your hip socket bone)
Less common reasons for hip arthroscopy are:
- Hip impingement syndrome (also called femora-acetabular impingement, or FAI). This procedure is done when other treatment has not helped the condition.
- Hip pain that does not go away and your doctor suspects a problem that hip arthroscopy can fix. Most of the time, your doctor will first inject numbing medicine into the hip to see if the pain goes away.
Physicians who perform hip arthroscopy: Farshad Adib, MD; Craig Bennett, MD
Hip osteotomy is in the most simple terms a surgery to change the shape of the hip joint that preserves a patient’s joint and averts the need for hip replacement surgery.
Practically unheard of even a decade ago, the University of Maryland is among a handful of places offering this procedure. It is increasingly being considered an option to help younger people with congenital hip dysplasia and similar hip malformations — which lead to arthritic changes in the joint — function better with less pain. In the past, these patients might undergo hip replacement surgery in their thirties, forties or fifties. Osteotomy can only be applied to a limited subset of patients, but may delay their need for hip replacement.
While the goals of hip osteotomy surgery are the same for all patients, the procedure itself is slightly different for each patient due to specific anatomical quirks.
Depending on the patient, the hip socket may be too shallow, too large or too small, and the head of the femur may not be properly round. An osteotomy corrects the individual hip deformity by cutting and repositioning the bone of the femur, hip socket or both, changing the way they fit together.
Typically six weeks after surgery patients are fully weight-bearing and have started physical therapy. By three to six months, they notice an improvement and the pre-operative pain they had is almost always gone.
Physicians who perform hip osteotomy: Jason Nascone, MD
The idea of numbing a portion of the body with epidural, spinal or peripheral nerve blocks is far from new, but “regional anesthesia” is assuming increasing prominence at the University of Maryland Medical Center, especially in orthopaedics.
Patients need less general anesthesia, if it's used at all, and sometimes an entire procedure can be done with only a regional anesthetic. Regional techniques require additional training and specialized equipment which is available at the University of Maryland.
An example of the advanced equipment would be high-resolution ultrasound imaging, which allows clinicians to view nerves with unprecedented clarity, promoting greater use of peripheral nerve blocks to numb entire extremities. Over the last 15 years, we have seen a dramatic increase in the use of high definition ultrasound. This has allowed us to easily visualize and target specific nerve structures, opening a world of accessibility and safety in procedures.
When the covering that allows a normal joint to move freely and painlessly is worn or damaged, the friction of bone rubbing on bone results in loss of motion and decreases a joint's weight-bearing capacity. Joint replacement means the bone surfaces within the joint are surgically removed and replaced with synthetic materials, usually a prosthesis made of durable, wear-resistant plastic and/or metal. Different procedures and components may be used, depending on factors such as the nature of the disease or injury, the patient's age, and condition of the bone. Most patients can look forward to resuming an active, fulfilling lifestyle following a successful procedure.
Communication With Patients and Referring Physicians
We are committed to providing ongoing communication to both patients and referring physicians. Before, during and after treatment, patients and their families can expect concern and compassion, education and training, as well as injury prevention information.
After surgery, a schedule of therapy and exercise will be established to teach patients how to get in and out of bed safely, walk with a walker or crutches, and improve muscle strength and joint motion. If necessary, occupational therapists can help patients relearn daily living skills, including bathing, dressing and meal preparation. Case Managers are available to arrange home care, home medical equipment, and other support services for the return home.