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Wednesday, Sept. 21, 2022

Hip Pain and Anterior Total Hip Replacement

Various methods exist to eliminate pain

If you or a loved one has hip pain, you will quickly learn how debilitating this can be. Hip pain and hip arthritis can start to affect a person’s quality of life quickly and dramatically. One may begin to notice decreased range of motion in their hip and deep-seated groin pain that can radiate deep into their buttock or down their thigh. Unfortunately, this hip and groin pain is most likely due to hip arthritis.

Arthritis is the wearing away of cartilage from the hip socket. Cartilage is the cushion in your hip joint. Imagine the tread on a tire or the shiny white substance on the end of a chicken bone: This is cartilage, and in hip arthritis, this surface wears away. The hip socket becomes eroded and rough as the cartilage gives way. The bone rubbing on bone causes deep, aching groin pain, which limits your activity and quality of life.

Initial treatment options include anti-inflammatory medications such as Advil, Celebrex or Tylenol, physical therapy, and even a steroid injection. You may find yourself driving around the grocery store parking lot, looking for the front-row parking spot to minimize your hip pain. Before you know it, you might be sitting at the back of the church because it’s too far to walk to the front. Unfortunately, as time goes on, these workarounds will no longer work. The only lifelong, permanent solution for hip arthritis is a hip replacement.

There are various hip replacement methods, but my preferred approach is the anterior hip approach. It uses a small incision on the front of your thigh to access the hip joint. The anterior approach is muscle sparing – i.e., it does not cut any muscle, unlike the posterior approach, which goes through the big gluteus muscle in your bottom. Once your hip joint is accessed, the surgeon will use tools such as a saw to remove the arthritis in your hip and put in metal parts to give you a new, well-functioning hip. These parts include a metal shell, a plastic liner, a titanium stem and a ceramic head ball. This will eliminate your groin pain and get you back to your active lifestyle.

The anterior hip approach is a relatively novel approach to total hip replacement. It allows for a much better patient experience than in years past. Study after study consistently shows the benefits of the anterior approach. Patients with hip replacements performed this way experience quicker recovery and returned to their high functional status faster. These patients return to walking without a walker sooner and have less pain and more mobility. Moreover, they have shorter hospital stays compared to the posterior approach patients.

In addition to the new approaches to the hip joint, there are several recent advances in the world of hip replacement. The most significant change for patients is how we put them to sleep and control pain. Patients undergoing hip replacement now have spinal anesthesia. Similar to when having a baby, an anesthesiologist will inject medicine near the patient’s spinal cord before surgery. This will numb your legs entirely and help with pain control. This method also decreases surgical risks such as blood clots and bleeding. We can now do the surgery without the tube and anesthesia gas, which means patients wake up feeling more refreshed and less groggy.

We have also changed the way we control pain after surgery. Pain protocols have been developed to minimize the number of opioid pain pills patients need after surgery. The surgeon now injects a mixture of medicine into the muscles surrounding the hip during surgery which helps significantly with pain and swelling in the postoperative period. The combination of the anterior hip approach, spinal anesthesia and our multimodal pain regimen means most patients need very little narcotic pain medication after surgery. We also give a special medication developed for blood loss which makes blood transfusions after surgery virtually a thing of the past. There have been so many advances in this field that this is not your mother’s hip replacement anymore.

If you have questions or would like to further evaluate your own hip pain, I would love to meet and discuss more in person.

Dr. Jeffrey Pearson is a fellowship-trained orthopedic surgeon specializing in anterior total hip replacement and robotic knee replacement. To schedule an appointment, visit https://orthopedicspecialistsla.com/ or call 318-635-3052.


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