By Hari P. Bezwada, M.D. Princeton HealthCare System
The hip is normally one of the more reliable and stable joints in the body. However, sports injuries, trauma, falls and conditions such as arthritis or osteoporosis can injure the hip to a point where simply walking is difficult and painful.
In order to restore mobility, relieve pain and improve quality of life, hip replacement surgery is often necessary.
Until recently, doctors often reserved hip replacements for patients over age 60, assuming that older people are less active and place less of a burden on the artificial hip. But now, thanks to improved materials and new, minimally invasive operating techniques, patients of all ages are benefiting from hip replacement.
At University Medical Center at Princeton, board- certified orthopedic surgeons are performing an increasingly popular operative procedure called anterior hip replacement surgery, which minimizes pain and speeds recovery, enabling busy patients to get back to their daily routines faster.
The hip joint is located where the femur or thigh bone meets the pelvis or hip bone. The joint is lubricated by fluid, and the ends of the bone are covered with hyaline cartilage. When damaged by trauma, wear and tear, disease, or other conditions, such as hip dysplasia during childhood, the cartilage is lost and does not heal, resulting in degenerative joint disease.
Signs and symptoms of degenerative joint disease include:
• Pain, especially at rest. Pain is usually located in the groin and may feel like a groin pull. It may radiate from the front of the groin to the front of the kneecap, and may also be present in the buttock.
• Limited function. Inability to do daily activities; walk five to 10 blocks; put on shoes and socks; stand for prolonged periods of time; stiffness and loss of muscle function.
• Severe limp and/or a leg length discrepancy often developed as the joint wears out over time and as the body works to compensate for the damaged joint.
Degenerative joint disease is often easy to diagnose. Your family physician or orthopedist will take a complete medical history and perform a thorough physical exam. If degenerative joint disease is suspected, X-rays will likely be ordered to confirm the diagnosis. Almost all patients suffering from degenerative joint disease are candidates for anterior hip replacement surgery.
Unlike traditional hip replacement surgery, in which surgeons are required to detach muscle in order to reach the joint from the back or the side, the anterior approach enables doctors to perform the procedure from the front of the hip without cutting any muscles.
For most patients anterior hip replacement surgery results in:
• A shorter hospital stay (two days).
• Faster recovery (two to six weeks).
• Smaller incisions (three to four inches).
• Reduced pain.
• Fewer requirements for assistive devices (walkers, crutches).
• Quicker return to normal activities, including work and sports.
Years ago, hip replacements had a limited lifespan of approximately 10 years, due to surface material wear. Today, bearing surfaces are made of alternative, wear-resistant materials and are designed to last between 15 and 20 years and perhaps beyond.
In general, patients who undergo anterior hip replacement surgery are almost immediately able to bend their hip freely and put their full weight on it as soon as they are comfortable. Quite often patients are up and walking with the help of a physical therapist the same day as the surgery, which typically takes about an hour. Moreover, patients are often able to go up and down stairs with assistance prior to going home.
While there are several factors that may affect the longevity of joint replacements, advanced technologies have revolutionized hip replacement surgery, allowing more patients to consider treatments at an earlier age. The decision to have a hip replacement is a highly personal choice that should be made between you and your doctor.
Anterior hip replacement surgery is an alternative for people of all ages who are facing a sedentary life with chronic medication and decreased dependence due to degenerative joint disease.
For more information about UMCP’s Orthopedics Program or to find an orthopedic surgeon on staff at Princeton HealthCare System, call 888-742-7496 or visit www.princetonhcs.org.
Hari P. Bezwada, M.D., is board-certified in orthopedic surgery and is a member of the medical staff at University Medical Center at Princeton.

