Hip Replacements: The How, When, and Who (To Go To)
Most of us have heard about the idea that manufacturers intentionally design products poorly so that we consumers are forced to buy replacements, often within just a few years. ‘Planned obsolescence’ is the economic phrase for this phenomenon, which also includes products being made to fall out of fashion so that we are incentivized to buy new items in order to remain current and, therefore, socially acceptable, pressured to keep up with the proverbial Joneses (pun intended), as it were. As Americans we don’t balk much at this since shopping is our national pastime and a day at the mall purchasing a new toaster, make-up, perfume, sweater, or dishware is regarded as exciting, exhilarating even. But what about when planned obsolescence also seems to apply to our bodies? It sometimes seems that our own great Creator’s prior job was serving on the board of Williams-Sonoma. As the years advance, for many of us, our joints and eyesight begin to fail, our memories fade, and general deterioration sets in. Luckily, however, modern day medicine, like Home Depot, has also made replacements available. It seems that the day when replacing new body parts becomes just as common as replacing the blender may not be far off.
Some Surprising Statistics About Hip Replacements
Currently, there are more than seven million Americans living with an artificial knee or hip and this figure is expected to rise as our life spans increase (1). Most people though, like myself, never anticipate that they will become part of this statistic. What comes to mind for many when thinking of a person with a hip replacement is a little, old, frail nursing home patient (since someone must be really old to need a new hip) who uses a walker after her surgery to get around (because of course she’d need a walker since an artificial hip couldn’t possibly be as good as a real hip). So it was with great reluctance that I finally acknowledged that the only solution for the hip and leg pain, which I’d been suffering from for years, was a hip replacement.
When learning though that between 2000 and 2009, hip replacement surgery increased by 123% for patients between 45-64, my resistance to this idea decreased (2). I was just one amongst a growing number of non-elderly folks that was a good candidate for a prosthetic hip. According to health writer Eric Niiler, what was once considered “a last-ditch operation for the elderly... has become a more common option for younger people who suffer pain that limits activity, disrupts sleep, and causes them to miss work” (4).
Like myself, many people today tend to stay more active in their middle years than in the past and continue to engage in athletic pursuits and vigorous workouts, which can result in chronic pain from consistent use. Additionally, doctors who may have recommended putting off hip surgery until 60 or so are no longer reluctant to recommend a replacement due to modern technology’s new and improved hip replacement materials, which are considered far superior to those used as recently as the 1990s. The strength of these new materials gives them greater longevity, making the potential for them to last for a younger patient’s entire lifespan more probable. I like to think of it like this — we’re not elderly, we’re athletic! And that’s why we require this surgery. So with the trend of younger people walking around with hip replacements and with more people than ever before with them generally(over one million Americans have hip or knee replacement surgery per year nowadays and by 2030, researchers expect that number to increase to four million (3)), it’s not so unlikely that a hip replacement will no longer be considered just for the octogenarians among us— they may begin to be considered, well, hip even!
The History of Hip Replacements
Experimentation with hip surgery began back as early as the late 1700s. The first partial hip replacement attempts though occurred back in 1891 when Themistocles Gluck, “invented an implantable hip replacement, a ball-and-socket joint fashioned of ivory and affixed with nickel-plated screws” (5). Like other doctors’ attempts, which followed Gluck’s, his partial hip replacement success with patients’ improved mobility was short-lived. Gluck’s patients eventually suffered from severe infections whereas other doctors’ patients became handicapped after just a few years; some patients even had their prostheses shatter (6, 7). A diverse variety of materials were employed in these initial attempts including acrylic, rubber, ivory, glass, and Vitallium, a trademarked bone replacement designed in the 1930’s, while screws and cement were the options for affixing the prostheses (6).
In 1953, the English surgeon George McKee found success with metal-on-metal hip replacements and soon this became the standard material used by surgeons, a trend which lasted up until the 1970s. The real revolution though occurred in 1962 when Sir John Charnley, considered to be the father of the modern total hip replacement, determined that the size of the femur head was creating friction and ultimate long-term wear and creating even for some a squeaking in the hip while walking. Charnley’s solution involved a device that utilized “a metal femoral stem and a polyethylene component for seating the joint in the acetabulum of the pelvis” and acrylic bone cement, which he borrowed from the dental field. Low friction arthroplasty was the name for his surgery, and indeed Charnley’s experiment did result in reduced friction and wear and thus increased longevity in these new style prostheses.
Since Charnley developed his model, there have been quite a few innovations, some of which have lead to greater prosthesis longevity. However, many of these have actually been “inferior to Charnley’s Hip” (8). The greatest innovation and cause for optimism in the field is the advancement in surgical techniques. It turns out that the anterior rather than conventional posterior approach to hip replacement surgery is a superior approach. With the anterior approach, patients experience a decrease in trauma to the soft tissue “thereby limiting the possibility of dislocation” as well as a quicker recovery time, not to mention a smaller scar since the incision is usually smaller.
The When (To Seek One)
As a proponent of natural healing and remedies, my go-to when I begin to experience any discomfort are natural supplements, and with my hip pain it was no different. When the relief never arrived though, I reasoned that I needed to give it more time and that I could myself attempt to increase the reduced space in my joint. It wasn’t until years later after limiting my activities and experiencing great pain in not just my hip but now my leg as well that I realized it was possible that my thinking on the topic had been too narrow and another modality might be required to address the severity of my issue. The strenuous training, the reduced space in my ball and socket joint, as well as the inevitable arthritis that comes with aging, which had all combined into a formula for pain, also made me a perfect candidate for a total hip replacement. It seems that I had endured a diminished quality of life unnecessarily and if I had only met Dr. Joel Matta sooner, I would have spared myself from not just physical pain but also bouts of depression, decreased engagement in social activities, and diminished confidence as well.
My hope now is that my unnecessary suffering was not all for naught and that through my story I can, at least, convince others to take a look at their own lives and ask themselves whether or not pain is a significant part of it. So how about it? Am I talking about someone you know or maybe you? Consider whether pain is affecting your mood and self-esteem. Other questions to ask when determining whether or not you’re a candidate for a total hip replacement are: is pain limiting your daily activities, are pain medications no longer sufficient for alleviating pain, does pain persist even while resting, are you stiff and sore after sitting, does pain interfere with your ability to sleep (8)? Then ask yourself whether or not you really think that this will get better with time and what you have to lose by seeking a simple consultation with a doctor like Dr. Matta. Like me, you may be decreasing your quality of life unnecessarily, especially since the anterior approach to hip replacements has revolutionized the surgery, making it less invasive and the recovery so expedient. And also like me, you could also be up and walking and doing stairs the day after surgery, feeling better than you have in years and with a new zeal for life!
The How (The Anterior Approach)
So how do surgeons like Dr. Matta perform the anterior approach to hip replacement and how exactly does it work? After my surgery and a speedy recovery, I was so fascinated with the hip replacement process that I asked Dr. Matta if I could watch him perform a hip replacement on another person at the St. John’s Health Center and luckily, with the patient’s permission, I was granted entry into the operating room. I wanted to see in person the same surgery he performed on me to better understand the mechanics of it. For decades,I’ve studied the human body and its physiology and have viewed many other kinds of surgeries in my work. I was especially keen to understand exactly what takes place during the anterior approach hip replacement so that I could more effectively explain this process to others in my lectures, during radio interviews, and when friends and clients are fearful about going through the same surgery. There is really no replacement for the actual viewing of hip replacement surgery, but I’ve done it for you so you don’t have to. Below is what I learned.
The Hip: So let me first just explain the basics about the design of our hips. It’s very simple really. At the top of our thigh bone, the femur, is the femoral head, also known as a ball, which rests in the acetabulum, also known as the socket. A layer of cartilage covering both ball and socket normally protects them from friction, allowing for comfort and an ease of mobility. It is when the cartilage degenerates that friction begins, as the bones hit up against one another causing pain, pain that is often prohibitive of an ease of mobility.
The Table: Let me tell you how impressed I was with the operating table designed by Dr. Matta — state of the art surgical equipment known as a HANA or Profx table. After the patient is fitted into compression boots which help to prevent blood clots that can result from surgery, the carbon fiber spars in which the legs are placed get to work manipulating the leg being operated on. The table is also affixed with a robotic device, which accesses the wound and adjusts the femur to a position conducive for operating on, moving it throughout surgery as different areas require access.
The Surgery: So after receiving anesthesia and being transferred to the operating table, a four to five inch incision is made to target the area of the femoral head and neck to be removed. A device known as a “reamer” refines and shapes the acetabulum so that the titanium prosthetic socket may be introduced. In order to fit the new femoral head, trial heads are inserted. In order to gauge for size, X-ray images of both hips are produced on screens so that the doctor can precisely reproduce the distance between the femur and the pelvis by viewing the opposite hip before the prosthesis is finally inserted. My procedure lasted only just over an hour. But let’s not forget the final step!It’s actually performed by the patient. Once you leave the hospital, the responsibility is with you to follow the regimen given by the doctor and his team as a way to your new life of freedom from pain.
How to Choose Your Doctor
Over my adult life, there have been countless times when I’ve visited doctors and physicians’ assistants for various reasons, and it was obvious to me that he or she was only performing a perfunctory job, focused solely on the issue at hand while attending very little to my overall health and completely indifferent to my state of mind. Oftentimes, if I didn’t ask them about their lives, families, interests, etc., we would have exchanged very few words. Many times I was asked a question only to be asked the same question minutes later, revealing just how little attention the doctor was actually paying to me. In other words, the bedside manner of many left much to be desired.
Now imagine your brother, father, grandfather, and best friend all rolled into one person, who happened to also be the best hip surgeon in the world. Isn’t that the doctor who we’d all choose (if he existed outside the realm of fantasy)? Well, guess what? That’s Dr. Matta and he is not a fantasy but a real and incredible surgeon who has earned my highest recommendation. His skills and talent combined with his compassion and sympathy for his patients make him truly one of a kind! And as a kind and compassionate doctor, he has taken the time to procure a staff who are equally compassionate and kind. With this team, there was never a moment when I was not treated with the utmost respect and dignity; I could tell that they cared most sincerely about my well-being and only wanted the best for me. It made all of my visits to his Hip and Pelvis Institute in Santa Monica, as well as my short time at the St. John’s Health Center for surgery (that's the hospital next door to my doctor’s office), very positive experiences indeed. Dr. Matta’s staff and the orthopedic hospital staff worked hand-in-hand with one another seamlessly. How refreshing it was: everyone could have won a congeniality contest with his or her pleasantness and delightful demeanors. This doctor and his staff really seem to understand the mind-body connection and the importance of a positive mindset in order to facilitate healing and recovery. It was truly amazing and a joy to be taken care of by so many positive people. In fact, if the hospital food had been all organic, I may have even extended my stay there!
Dr. Matta teaches surgeons worldwide how to do his anterior approach. If you can’t see Dr. Matta at the Hip and Pelvis Institute (310-582-7475), the next best thing would be to find an orthopedic surgeon who was taught by Dr. Matta, or at least a doctor who does the anterior approach style hip replacement. You can call Dr. Matta’s office and get a reference for the best hip replacement doctor in your area of the country or world. People travel from all over the world to have Dr. Matta do their hip replacements. How fortunate I am that his office is only minutes from my home.
How Hip Pain and Surgery Affect Emotional Health
For a few years before surgery when the pain was not responding to my natural treatment regimen, I began to realize that it was taking a toll on my emotional health. It wasn’t just that I was depressed from the consistent pain; it was a depression resulting from the exile I felt from the world, my life. I was forced to alter my lifestyle to such a degree that I avoided stairs, long errands, and traveling. Furthermore, exercise had always helped me to feel confident about my body, burn off stress, and get my endorphins going; for someone who has led an active life and is used to engaging in physical fitness regularly, I felt alienated from my body. It wasn’t serving me like it had. My life’s work has been about health and I’d spent my lifetime taking the utmost care of myself only to feel my body betray me; my identity itself suffered. The exile I felt was also a result of the depression that caused me to skip many social engagements and other activities that I would have previously relished. My diminished confidence caused me to become self-conscious in situations that had previously worked to affirm me. This was no way to live. The day I contacted Dr. Matta was the beginning of a new chapter, one in which I began the process of getting my life back!
If any of this resonates with you, I urge you to see your doctor without delay. If it turns out that you are a candidate for hip replacement surgery, schedule it soon. You will be so happy that you did. I’ve resumed my regular activities and feel healthier and more energetic than I have in years. By the afternoon on the same day as my surgery, I was already feeling 80% better. And within just a few days, I was walking and moving better than I had the day before surgery. This was truly transformative, nothing less than a second chance really.
So now that you know that recovery from anterior hip replacement surgery is brief (only one to three months), the prostheses are built to last, and the benefits are beyond measure, what are you waiting for? You replace your TV, your microwave, and your mattress when they wear out or when better, newer models become available. And they’re not half as important as your body! And guess what? There are better, newer models. Technology offers us in the 21st century a lot of options for improving our lives. And although there’s not an app for it yet, technological advances have made hip replacement surgery easier than it’s ever been. The future is now!
So You’re Going to Have Surgery: 10 Tips for a Smooth and Comfortable Recovery
It’s important to remember that once the doctor and his or her staff complete their work and you leave the hospital, you are the one responsible for your care and ultimate healing and recovery. Recovery of the body often starts with the mind and a positive attitude. Therefore, comfort and freedom from stress are essential when recovering at home. Most of us wish we had more time in bed. Well, here’s your opportunity. Why not frame this recovery time as ‘me’ time, something that is often in short supply in our busy lives!? Below is a list that I’ve created, based on my own as well as others’ experiences, that will help you to recover more comfortably from surgery (any kind of surgery at all) while avoiding stress, and quite possibly even enjoying this time for yourself.
1. Complete work and home projects before surgery so that you can focus on recovery and avoid stress. This includes things like gardening, work reports, and housework. Consider hiring a housekeeper before surgery, if you don’t normally use one, so that the house is clean and clutter free when you return home.
2. Put fresh clean linens on the bed right before the surgery so that when you come home from the hospital your bed is as comfortable and cozy as possibly can be.
3. If you need to rearrange the house a bit so that you have easy access to things then consider doing this. For those with stairs, this is especially important since you want to avoid climbing them during this time.
4. People who color their hair should get it done before surgery so you don’t have to worry about it afterwards. I got my hair trimmed the week before surgery. Feeling good about yourself is important—and can help expedite recovery!
5. In the same spirit as number 4 above, consider what other beauty treatments you may not get to for a while and get them done before hand. These may include a mani/pedi and shaving or waxing your legs. Maybe even indulge because it feels good, like getting a massage, facial or other skin treatment. I did all of this before my surgery.
6. Lay out some books and magazines that you’ve wanted to read. Make sure that at least two of them are positive, uplifting and inspiring books to help keep you positive and focused on your healing. I finished eight books during my recovery time.
7. Make some food/meals/dishes to put in your freezer that you or a family member can easily heat up for quick and easy meals.
8. If you live alone, make sure you have some friends lined up to help you out around the house and with errands in order to simplify and support your recovery. If you have pets, arrange for friends or a professional pet care provider to help out with them as well.
9. Visualize healing. Picture yourself engaged in your favorite activities which you’ve been unable to participate in due to your pain. This will motivate and inspire you and keep you positive when you’re feeling like your movement is restricted and when confined to your bed.
10. This final suggestion is another one to do before surgery because it could help you avoid potential infections. It involves any necessary dental work, including a basic cleaning. I got my teeth cleaned the week before surgery. The concern involves the bacteria in our mouths; our mouths are literally teeming with it. There has long been a concern that bacteria might enter the bloodstream during a dental procedure. Simply cleaning your teeth can cause the gums to bleed and we want to avoid bleeding gums. It is feared that bacteria in the blood could travel to the site of a prosthetic device such as a knee or hip implant and cause infection. If the infection erodes the bone around the implant, the patient may need another joint replacement operation. This surgery may be streamlined and easier than it was in the past, but that doesn’t mean you want to go through it again. Also, it is advised to wait at least three months after surgery before having any further dental work and if you do, consider taking an antibiotic just in case. The jury is still out on just how legitimate this concern is but it is certainly better to be safe than sorry and avoid risks. And when we get our teeth cleaned, it helps eliminate stains and tartar, making them whiter and shinier. And that’s going to be important - because once you have this surgery and start feeling like a stronger, younger version of yourself, you’re going to be smiling — a lot!
If you are considering a hip replacement (or you know someone who might need one), I hope this article will build your confidence, strengthen your resolve, and free you from the trepidation I had for a few years before my surgery. There is nothing to be afraid of with this anterior approach hip replacement surgery. For me, it was a very positive experience, actually life-changing every step of the way. I hope you take the opportunity to revitalize and reenergize your life, too. And, like me, you will have a future free of hip pain and many bright tomorrows.
Joel Matta, MD, Director of the Hip and Pelvis Institute in Santa Monica, CA;
Visit: HipandPelvis.com (310-582-7475): Contact his office with any questions.
1. "2.5 Million Americans Living with an Artificial Hip, 4.7 Million with an Artificial Knee." AAOS Online Newsroom | 2.5 Million Americans Living with an Artificial Hip, 4.7 Million with an Artificial Knee. N.p., n.d. Web. 25 Jan. 2017.
2. "Growing Popularity of Hip and Knee Replacement Surgery Places Extra Burden on Critical Care Services." Hospital for Special Surgery. N.p., n.d. Web. 25 Jan. 2017.
3. "As joint replacements grow more popular, younger patients face repeat surgeries." The Washington Post. WP Company, 03 Jan. 2011. Web. 25 Jan. 2017.
4. Knight, Stephen Richard, Randeep Aujla, and Satya Prasad Biswas. "Total Hip Arthroplasty - over 100 years of operative history." Orthopedic Reviews. PAGEPress Publications, 06 Sept. 2011. Web. 25 Jan. 2017.
5. "History of Hip Replacements: First Arthroplasty & Developments." Recall Center . N.p., n.d. Web. 25 Jan. 2017.
6. "The Evolution of Hip Replacements: A Patent History." IPWatchdog.com Patents & Patent Law. N.p., 19 May 2014. Web. 25 Jan. 2017.
7. Matta, J.M: Anterior Approach for Total Hip Replacement: Background and Operative Technique; Chapter 8 p.121-140; MIS Techniques in Orthopaedics (Scuderi, G.R.: Tria, A.J.; Berger,R.A.. editors); copyright Springer Science+Business Media, Inc.
- Matta, J.M.; Ferguson, T.A.: The Anterior Approach for Total Hip Replacement. Orthopaedics, vol 28, no. 9; p. 927-928; September 2005.
- Yerasimdes, J.G; Matta, J.M.: Primary Total Hip Arthroplasty with a Minimally Invasive Anterior Approach. Seminars in Arthroplasty, vol 16, no. 3, p.186-190; September 2005.
- Matta, J.M.; Shahrdar, C; Ferguson, T.A.: Single Incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table. Clin Ortho Rel Res, no. 441, p 115-124, December 2005.
- Siguier, T.; Siguier, M.; Brumpt, B.; Mini-Incision Anterior Approach does not increase dislocation rate. A study of 1037 Total Hip Replacements. Clin Orthop Rel Res, no. 426, p. 164-171, 2004.
- Finerman, G.A.M., Dorey, F.J., Grigoris, P., McKellop, H. A.; Total Hip Arthroplasty Outcomes, Churchill Livingstone Inc.; 1998.
8. How Do I Know If I Need Hip Surgery? N.p., n.d. www.zimmer.com/patients-caregivers/article/hip/who-needs-hip-surgery.html. Accessed 25 Jan. 2017 Web.
If any thing is sacred, the human body is sacred.
~ Walt Whitman
The human body experiences a powerful gravitational pull in the direction of hope. That is why the patient's hopes are the physician's secret weapon. They are the hidden ingredients in any prescription.
~ Norman Cousins
The human body has two ends on it: one to create with and one to sit on. Sometimes people get their ends reversed. When this happens they need a kick in the seat of the pants.
~ Theodore Roosevelt