Check Lists

Hip Replacement Check Lists

Choosing a surgeon

• Take your time, be picky.  An interview does not make an obligation.
• Experience matters, frequency matters (you want a minimum of 200 post residency operations and 50 a year)
• Ask about infection rates (>1% is too high)
• Ask about functional complications like leg length discrepancy. Listen to their attitude.
• Ask about post-op prognosis for your desired activity level. Think of activities but also things like sitting cross legged or kneeling.
• Ask about the incision, shorter is better to a point, 4 inches is good enough.
• Ask about the closure – do they sew the joint capsule, how do they close the suture.
• Ask about the team, assistants and anesthesiologists.

Choosing the approach:

Posterior hip replacement

• The most common approach so more people are good at it.  It may be all you can get in your area.
• Can be used for any level of disintegration and all morphologies.
• Large muscles get cut and have to knit together, complete athletic recovery is more difficult.
• Range of motion restrictions, especially in the recovery period, are necessary to avoid the risk of dislocation. Many surgeons eliminate some activities forever.
• Easier to correct mistakes on the fly and respond to the unexpected during the operation.
• Less incidence of nerve damage, though  in rare cases it can be severe.
• More difficult to do bilateral, they have to turn you and place you on to the first hip’s sutures.

Anterior hip replacement

• New approach so relatively few people are good at it.  You don’t want to be part of someone’s learning curve.
• By definition is minimally invasive, typically a 4 inch incision.
• Not available for all morphologies, but almost all.
• Muscles are stretched and fascia torn which is not trivial, still you’d think this is way better than severed.
• No range of motion restrictions, faster recovery, almost no chance of dislocation.
• Less room for the surgeon to maneuver, takes a higher skill level to deal with surprises.
• Higher incidence of nerve damage, generally minor, just some numbness on the outside of the thigh.
• Easier bilateral operation, the patient is in position to have both hips done without moving.

Bilateral hip replacement

• Just one trip to the hospital!
• Not many surgeons have the intestinal fortitude and stamina.
• Likely need for a blood transfusion (make sure it is your own)
• Much longer time under anesthesia.
• Easier for surgeon to match leg length.
• Only one recovery period, with both legs regaining function simultaneously.
• Less mobility early in the recovery period.
• Possibly longer hospital stay.

Choosing Prosthesis

• No Joint will last forever but the really good ones can last 20-30 years of life affirming activity.
• Resurfacing may just have been a fad.  It sounds good, leaving more bone but it isn’t as strong and who wants a second operation anyway.
• Metal on metal can deposit particles and ions in the joint that can travel around the body.  Some people really suffer from this, others don’t feel a thing.
• Ceramic parts are slicker than metal so they might last longer. Downside is they can shatter from enough force. I decided to go for the added safety of metal.
• Metal on plastic, especially plastic that can be removed when worn out seems state of the art.
• Who knows what kind of reactions people will have to scraps of plastic coming off and floating inside of your body so state of the art does not mean risk free.
• Glue is also passé, best practice is to lay the pieces in there and let the body do the integration.
• Mini hip, a smaller spike in the femur is less strong than a full.  The theory is to save tissue for a second operation.  Work on getting someone who gets it right the first time.
• Pick a ball socket size that fits your activity level.