When it comes to hip replacement surgery, there are a number of procedure options and only your doctor can tell you which is right for you. Age, activity level, Body Mass Index, etc. are all factors in determining which hip replacement you will be best suited for.
Traditional surgery involves an 8-12 inch incision on the side or back of your leg. The Anterior procedure uses a 3-6 inch incision on the front of your leg. This allows your surgeon to have an optimized view of your hip joint during surgery.
Listen in as Dennis Beck, MD, explains the advantages for the patient when receiving an Anterior Hip Replacement.
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The Advantages of an Anterior Hip Replacement
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Learn more about Dr. Beck
Dennis Beck, MD
Dr. Beck specializes in general orthopaedics and total joint replacement. Dr. Beck is one of the few surgeons in the area performing anterior hip replacement.Learn more about Dr. Beck
Transcription:
The Advantages of an Anterior Hip Replacement
Melanie Cole (Host): Hip replacements are a highly effective and efficient way to treat arthritis of the hip, either from wear or tear or from the effects of trauma in many patients. When it comes to hip replacement surgery, there are a number of procedure options and only your doctor can tell you which one is right for you. My guest today is Dr. Dennis Beck. He’s an orthopaedic surgeon specializing in general orthopaedics and total joint replacement at Orthopaedic Associates. Welcome to the show, Dr. Beck. So, what are some of the most common reasons for hip pain that you see patients for?
Dr. Dennis Beck (Guest): Thanks for having me. Some of the most common reasons for hip pain that we see on a daily basis are arthritis of the hip but also arthritis of the spine as well, causing pain radiating around to the hip.
Melanie: So, when someone comes to you with these pains, what’s the first line of defense?
Dr. Beck: The first line of defense is, obviously, to ascertain what the source of the pain is, whether it’s the hip or the back. We do X-rays. We do clinical examinations and try to get a good thorough history and try to find out if there’s any other mitigating or other factors that may have made things worse going up to that point.
Melanie: When does it come to surgical intervention? When is that required?
Dr. Beck: Surgery is always the last resort. After we’ve tried medical therapies--things like Advil, things like Aleve, anti-inflammatory medicines, Tylenol--the usual medical treatments for these things; and therapy or other factors, then we opt for surgery only when we’ve tried everything else and the patient and physician come to that agreement together.
Melanie: So, tell us the way it was traditionally done to have a total joint replacement of the hip and what you’re doing now more minimally invasively?
Dr. Beck: Traditional hip replacement over the last 20 or 30 years has involved a relatively large incision going to the muscles on the back of the hip, commonly known as the gluteus muscles. The surgery is a bit invasive. There’s a bigger incision, there are muscles are cut to approach the hip from the back side, the hip replacement’s implanted. But, to get to that hip and to get that implant in place, there are ligaments that are cut and there are muscles that protect the hip in its socket that are cut through as well. So, there are relatively more risks of the hip coming out of the joint and what have you in the more traditional hip replacements.
Melanie: So, tell us how the anterior hip replacement is an example of how the medical field is continually evolving. Explain that a little bit for us.
Dr. Beck: The anterior hip replacement, called “direct anterior hip replacement,” is a technique, an approach to the hip, that actually has been around for a long time and used in other ways for trauma surgery and other applications. Only in the last five or ten years has this approach been adjusted to accommodate the placement of hip replacements. It’s done through the front of the hip, it’s done without cutting any muscles, it does not involve cutting any ligaments that stabilize the hip. So, the relative improvement of that is reduced risk of the hip popping out later, there’s reduced pain afterwards, and patients, quite frankly, are able to leave the hospital, if not the same day, the very next day.
Melanie: So, explain a little bit about the hip joint because people hear shoulder replacements and knee replacements, and typically, a hip replacement has seemed like an easier recovery. Am I correct?
Dr. Beck: Typically, that is the perception.
Melanie: So, why is it such, if it is such a big joint, and it has many motions. What is it about the hip that makes this recovery a little bit easier?
Dr. Beck: I think, in general, as compared to a knee or a shoulder replacement, the hip has so much freedom of movement that there’s a large scope of range of motion the hip undergoes that allows for earlier rehabilitation, earlier weight-bearing, better outcomes with therapy, and the muscles – although there’s a significantly larger group of muscles around the hip – they are, by their definition, stronger and bigger and, I think, are able to support the immediate post-surgical rehab a little bit better.
Melanie: And, what would you like patients to know before the surgery about preparing for a total hip replacement?
Dr. Beck: Patients should continue their exercises; they should continue trying to stay mobile and moving; they should really work on maximizing their nutrition, high protein foods. Definitely, if the patient smokes cigarettes, it’s always advisable to stop that prior to any surgeries as that does slow the healing process down as well. But, I always advise the patients to just stay as mobile as they can, try to lose any extra weight you’ve been wanting to lose for a while and get everything else in as good a shape as possible, regarding dental work and other medical problems you might have put off prior to having any hip surgery done or any surgery done. That will really improve the outcome and reduce the risks involved.
Melanie: What about after the surgery, Dr. Beck? Are they still going to set off alarms at the airport? What about the implants themselves? How long do they last? Do they need to be replaced?
Dr. Beck: Great question. That’s probably the most common question, is the airport and metal detection screenings, for sure. The hip replacements, any large metal joint replacements, are going to set off metal detectors, whether it’s in schools, courthouses or airports. We, ironically, don’t give out cards anymore because government agencies don’t recognize that as an authority but just a little strategic planning prior to going to an airport really does help with that. What patients can expect afterwards is they can expect to get up on their feet right away, get going with therapy. The implants don’t typically need to be replaced in a lifetime. The technology, in that sense, has really evolved quite a bit, with different ways to manufacture the polyethylene or plastic liner between the two metal parts, different bearing surfaces. They’re constantly changing and constantly evolving and really increasing the life span much more quickly now than in the past.
Melanie: What about pain management after the recovery? Is this something that can develop pain after you’ve replaced the hip? Is there scar tissue that develops to hold it in place, which could be good, but contribute to pain? What happens there?
Dr. Beck: Great question. Pain after joint replacement – it should be counselled to every patient that our goal is to eliminate your pain but a good result around the world by any registration, by any means, is a reduction of pain, maybe 50, maybe 75, 85% in anybody’s hands. We want zero pain. Unfortunately, that’s not always the case but in 90% of patients with knee or hip replacements at two year follow-up report good or satisfactory results and would say they would have it done again. Pain management can be a helpful assistance adjunct to that. Especially the use of narcotics and the use of anti-inflammatories really should be monitored carefully but it is definitely involved after hip replacement and sometimes for the long-term afterwards.
Melanie: And, how is the new hip different? What is the patient feeling with this new hip?
Dr. Beck: Patients with hip replacements occasionally feel like they can feel changes of temperature when the weather changes, when rain fronts and cold fronts, sort of the old tales you hear about knowing when the weather’s going to change. I think probably some of that’s related to barometric pressure changes and metal implants and such. It feels like it’s not your new hip. I try to tell them, it feels kind of like a crown on your tooth or if you’ve had a root canal or something like that. You don’t hurt, but it’s not quite the same. It works and it’s an improvement over the diseased state that existed prior.
Melanie: And, how soon – and I know this is patient dependent – can they resume activity and maybe even sporting activities? Are there any limitations?
Dr. Beck: With the anterior hip replacement, one of the real good benefits of that is that there are no restrictions in the position of your body. Typically, hip replacement patients are given very specific precautions to minimize the risk of the hip coming out of the joint, as far as bending over, stooping down, sitting in deep seats. Anterior hip replacements have typically very few, or no restrictions on the position or movement. I’ve had patients in the best case scenario who have turned to work on their feet all day, in two to three weeks, or sometimes six weeks, but almost half the time posterior hip replacement, and there are no restrictions. Occasionally, we’ll have a patient on a walker or a cane or some sort of assistance for a couple of weeks afterwards, just as a precaution until the surgical trauma passes and the patients get recovery from their anesthesia and things like that, but not typically. There are no restrictions in the long-term.
Melanie: And, in the last few minutes, Dr. Beck, give us your best advice to patients listening, about when they should consider hip replacement surgery, when it affects the quality of their life. What do you tell them every day?
Dr. Beck: I tell patients, very simply, when this is something you think about from the moment you wake up until the moment you go to bed at night; when it reduces your ability to live life, to enjoy yourself; if you’re not enjoying yourself with your kids, your grandkids; if you’re not able to work; if you’re constantly thinking about this and requiring more and more medications; and your outlook on life is becoming a depressive outlook on life; and you get to this sense of hopelessness and pain that we’ve all had at some times in our lives when we’ve suffered from disease, that’s the time to say, “You know, it’s time to go to surgery.” That’s the time to get your hip replaced, after, of course, you’ve received consultation with your surgeon and primary care doctors. But, really, the answer is that the patient has to know in his or her heart that they’re ready to have this done and has to understand that their life will be different, in many ways for the better, but in some ways just different going forward, once they’ve had the surgery done.
Melanie: Why should they come to Orthopaedic Associates for their care? Tell us about your team.
Dr. Beck: We have a group of, I’m very proud to say, 12 orthopaedic surgeons, we’re all board certified. All of us specialize in various different parts of orthopaedic surgery. I think one of the most unique things of our group in the changing face of healthcare, the industrialization and business aspects of healthcare that we’re all seeing as patients is we’ve maintained a real hometown sense of personal attention. We have really strived, as we’ve changed to electronic records, and the sort of business and the industrialization, the really fast-paced movement, and patients feel like they’re being herded through like cattle. I really am proud of the fact that we’ve maintained a really personal relationship with our patients and have just tried to remain as accessible as possible. And, we all, in our group, are committed to maintaining that, no matter what happens around us because that’s really the essence of why we’re doing what we’re doing, and our whole corporate culture is built around that as well.
Melanie: Thank you so much, Dr. Beck, what great information. You’re listening to Orthopods, with the experts from the Orthopaedic Associates. For more information, you can go to oaevansville.com. That’s oaevansville.com. This is Melanie Cole. Thanks so much for listening.
The Advantages of an Anterior Hip Replacement
Melanie Cole (Host): Hip replacements are a highly effective and efficient way to treat arthritis of the hip, either from wear or tear or from the effects of trauma in many patients. When it comes to hip replacement surgery, there are a number of procedure options and only your doctor can tell you which one is right for you. My guest today is Dr. Dennis Beck. He’s an orthopaedic surgeon specializing in general orthopaedics and total joint replacement at Orthopaedic Associates. Welcome to the show, Dr. Beck. So, what are some of the most common reasons for hip pain that you see patients for?
Dr. Dennis Beck (Guest): Thanks for having me. Some of the most common reasons for hip pain that we see on a daily basis are arthritis of the hip but also arthritis of the spine as well, causing pain radiating around to the hip.
Melanie: So, when someone comes to you with these pains, what’s the first line of defense?
Dr. Beck: The first line of defense is, obviously, to ascertain what the source of the pain is, whether it’s the hip or the back. We do X-rays. We do clinical examinations and try to get a good thorough history and try to find out if there’s any other mitigating or other factors that may have made things worse going up to that point.
Melanie: When does it come to surgical intervention? When is that required?
Dr. Beck: Surgery is always the last resort. After we’ve tried medical therapies--things like Advil, things like Aleve, anti-inflammatory medicines, Tylenol--the usual medical treatments for these things; and therapy or other factors, then we opt for surgery only when we’ve tried everything else and the patient and physician come to that agreement together.
Melanie: So, tell us the way it was traditionally done to have a total joint replacement of the hip and what you’re doing now more minimally invasively?
Dr. Beck: Traditional hip replacement over the last 20 or 30 years has involved a relatively large incision going to the muscles on the back of the hip, commonly known as the gluteus muscles. The surgery is a bit invasive. There’s a bigger incision, there are muscles are cut to approach the hip from the back side, the hip replacement’s implanted. But, to get to that hip and to get that implant in place, there are ligaments that are cut and there are muscles that protect the hip in its socket that are cut through as well. So, there are relatively more risks of the hip coming out of the joint and what have you in the more traditional hip replacements.
Melanie: So, tell us how the anterior hip replacement is an example of how the medical field is continually evolving. Explain that a little bit for us.
Dr. Beck: The anterior hip replacement, called “direct anterior hip replacement,” is a technique, an approach to the hip, that actually has been around for a long time and used in other ways for trauma surgery and other applications. Only in the last five or ten years has this approach been adjusted to accommodate the placement of hip replacements. It’s done through the front of the hip, it’s done without cutting any muscles, it does not involve cutting any ligaments that stabilize the hip. So, the relative improvement of that is reduced risk of the hip popping out later, there’s reduced pain afterwards, and patients, quite frankly, are able to leave the hospital, if not the same day, the very next day.
Melanie: So, explain a little bit about the hip joint because people hear shoulder replacements and knee replacements, and typically, a hip replacement has seemed like an easier recovery. Am I correct?
Dr. Beck: Typically, that is the perception.
Melanie: So, why is it such, if it is such a big joint, and it has many motions. What is it about the hip that makes this recovery a little bit easier?
Dr. Beck: I think, in general, as compared to a knee or a shoulder replacement, the hip has so much freedom of movement that there’s a large scope of range of motion the hip undergoes that allows for earlier rehabilitation, earlier weight-bearing, better outcomes with therapy, and the muscles – although there’s a significantly larger group of muscles around the hip – they are, by their definition, stronger and bigger and, I think, are able to support the immediate post-surgical rehab a little bit better.
Melanie: And, what would you like patients to know before the surgery about preparing for a total hip replacement?
Dr. Beck: Patients should continue their exercises; they should continue trying to stay mobile and moving; they should really work on maximizing their nutrition, high protein foods. Definitely, if the patient smokes cigarettes, it’s always advisable to stop that prior to any surgeries as that does slow the healing process down as well. But, I always advise the patients to just stay as mobile as they can, try to lose any extra weight you’ve been wanting to lose for a while and get everything else in as good a shape as possible, regarding dental work and other medical problems you might have put off prior to having any hip surgery done or any surgery done. That will really improve the outcome and reduce the risks involved.
Melanie: What about after the surgery, Dr. Beck? Are they still going to set off alarms at the airport? What about the implants themselves? How long do they last? Do they need to be replaced?
Dr. Beck: Great question. That’s probably the most common question, is the airport and metal detection screenings, for sure. The hip replacements, any large metal joint replacements, are going to set off metal detectors, whether it’s in schools, courthouses or airports. We, ironically, don’t give out cards anymore because government agencies don’t recognize that as an authority but just a little strategic planning prior to going to an airport really does help with that. What patients can expect afterwards is they can expect to get up on their feet right away, get going with therapy. The implants don’t typically need to be replaced in a lifetime. The technology, in that sense, has really evolved quite a bit, with different ways to manufacture the polyethylene or plastic liner between the two metal parts, different bearing surfaces. They’re constantly changing and constantly evolving and really increasing the life span much more quickly now than in the past.
Melanie: What about pain management after the recovery? Is this something that can develop pain after you’ve replaced the hip? Is there scar tissue that develops to hold it in place, which could be good, but contribute to pain? What happens there?
Dr. Beck: Great question. Pain after joint replacement – it should be counselled to every patient that our goal is to eliminate your pain but a good result around the world by any registration, by any means, is a reduction of pain, maybe 50, maybe 75, 85% in anybody’s hands. We want zero pain. Unfortunately, that’s not always the case but in 90% of patients with knee or hip replacements at two year follow-up report good or satisfactory results and would say they would have it done again. Pain management can be a helpful assistance adjunct to that. Especially the use of narcotics and the use of anti-inflammatories really should be monitored carefully but it is definitely involved after hip replacement and sometimes for the long-term afterwards.
Melanie: And, how is the new hip different? What is the patient feeling with this new hip?
Dr. Beck: Patients with hip replacements occasionally feel like they can feel changes of temperature when the weather changes, when rain fronts and cold fronts, sort of the old tales you hear about knowing when the weather’s going to change. I think probably some of that’s related to barometric pressure changes and metal implants and such. It feels like it’s not your new hip. I try to tell them, it feels kind of like a crown on your tooth or if you’ve had a root canal or something like that. You don’t hurt, but it’s not quite the same. It works and it’s an improvement over the diseased state that existed prior.
Melanie: And, how soon – and I know this is patient dependent – can they resume activity and maybe even sporting activities? Are there any limitations?
Dr. Beck: With the anterior hip replacement, one of the real good benefits of that is that there are no restrictions in the position of your body. Typically, hip replacement patients are given very specific precautions to minimize the risk of the hip coming out of the joint, as far as bending over, stooping down, sitting in deep seats. Anterior hip replacements have typically very few, or no restrictions on the position or movement. I’ve had patients in the best case scenario who have turned to work on their feet all day, in two to three weeks, or sometimes six weeks, but almost half the time posterior hip replacement, and there are no restrictions. Occasionally, we’ll have a patient on a walker or a cane or some sort of assistance for a couple of weeks afterwards, just as a precaution until the surgical trauma passes and the patients get recovery from their anesthesia and things like that, but not typically. There are no restrictions in the long-term.
Melanie: And, in the last few minutes, Dr. Beck, give us your best advice to patients listening, about when they should consider hip replacement surgery, when it affects the quality of their life. What do you tell them every day?
Dr. Beck: I tell patients, very simply, when this is something you think about from the moment you wake up until the moment you go to bed at night; when it reduces your ability to live life, to enjoy yourself; if you’re not enjoying yourself with your kids, your grandkids; if you’re not able to work; if you’re constantly thinking about this and requiring more and more medications; and your outlook on life is becoming a depressive outlook on life; and you get to this sense of hopelessness and pain that we’ve all had at some times in our lives when we’ve suffered from disease, that’s the time to say, “You know, it’s time to go to surgery.” That’s the time to get your hip replaced, after, of course, you’ve received consultation with your surgeon and primary care doctors. But, really, the answer is that the patient has to know in his or her heart that they’re ready to have this done and has to understand that their life will be different, in many ways for the better, but in some ways just different going forward, once they’ve had the surgery done.
Melanie: Why should they come to Orthopaedic Associates for their care? Tell us about your team.
Dr. Beck: We have a group of, I’m very proud to say, 12 orthopaedic surgeons, we’re all board certified. All of us specialize in various different parts of orthopaedic surgery. I think one of the most unique things of our group in the changing face of healthcare, the industrialization and business aspects of healthcare that we’re all seeing as patients is we’ve maintained a real hometown sense of personal attention. We have really strived, as we’ve changed to electronic records, and the sort of business and the industrialization, the really fast-paced movement, and patients feel like they’re being herded through like cattle. I really am proud of the fact that we’ve maintained a really personal relationship with our patients and have just tried to remain as accessible as possible. And, we all, in our group, are committed to maintaining that, no matter what happens around us because that’s really the essence of why we’re doing what we’re doing, and our whole corporate culture is built around that as well.
Melanie: Thank you so much, Dr. Beck, what great information. You’re listening to Orthopods, with the experts from the Orthopaedic Associates. For more information, you can go to oaevansville.com. That’s oaevansville.com. This is Melanie Cole. Thanks so much for listening.