If you’ve exhausted all ­nonsurgical options to ease the pain of an arthritic hip, it might be time for you to explore hip-replacement surgery. More than a half million such procedures are done in the US each year.

A new hip joint will help get you back to the activities you love. Advances in surgical techniques and the implants themselves—along with being in the best possible health before the operation—make the surgery itself less risky and lead to shorter hip-replacement recovery time and greater hip longevity, says Omar A. Behery, MD, MPH, board-certified orthopedic surgeon. Doctors today also have a much better understanding of what can cause complications and how to minimize them, too. Here’s what’s new in hip replacement…

More emphasis on getting in shape before surgery. The better you prepare physically before a hip-replacement procedure, the more you minimize any inherent risks, such as bleeding or infection, and maximize your recovery.

Presurgical testing. Laboratory testing should include a hemoglobin test and checking your blood oxygenation saturation to make sure your levels are in the normal range. This will help you handle surgery better and lower the risk that you’ll need a blood transfusion. Your nutritional status also should be checked to rule out any deficiencies, especially vitamin D, which is important for bone health and healing. Being undernourished can make you more susceptible to infection, impair wound healing and possibly increase the length of your hospital stay.

Have a dental checkup to rule out or address any gum disease before ­surgery—bacteria associated with gum disease can spread throughout the body and infect a new joint.

Chronic conditions should be well-controlled, including diabetes, high blood pressure and anemia.

Lose weight if you’re overweight. This is one of the best things you can do for your new joint.

If you smoke, quit, and get help if you’re misusing any drugs such as opioids.

Exercise. Ask your medical team for exercises to strengthen your core and leg muscles—these muscles will need to support the new joint. For some useful exercises, go to HipKnee.aahks.org (click on the “Physical Therapy Guides” button in the middle of the page…then under “Hip Replacement Home Therapy Exercises,” click on “Download and print the guide”).

Pre-op imaging studies will be done to determine the right size implant as well as the positioning and alignment to best match your anatomy. These data are now combined with templating software that allows surgeons to create 2-D, or with some programs 3-D, images to assist with the planning process.

Advances in surgery. In the past, hip-replacement surgery was associated with a higher rate of blood transfusion than other surgeries, but the introduction of the medication tranexamic acid (TXA), which minimizes bleeding, has—along with good initial levels of hemoglobin and blood oxygenation—drastically reduced the number of ­people needing transfusions.

New instruments that allow minimally invasive surgery have reduced the amount of soft tissue affected by the surgery and in general result in less pain and a quicker return to function.

Technology in the operating room includes robotics as well as computer navigation and the use of interoperative fluoroscopy, a form of low-dose X-ray done during the surgery itself. It enables surgeons to place the replacement parts with even greater accuracy, leading to better stability and resistance to wear.

Better materials for implants. A replacement hip joint is a ball-in-socket implant made up of four parts—the ­acetabular cup (which inserts into the hip socket of the pelvic bone)…cup liner or bearing surface…femoral stem (inserted into the femur/thigh bone)…and femoral head or ball that articulates within the liner placed into the cup. Newer materials have improved hip-replacement longevity. The cobalt chrome alloys previously used frequently for the metal parts (especially the femoral stems) have been replaced with more frequently used titanium alloy implants, which improves load-bearing and bone remodeling. And the components of the implant have an outer porous layer that allows bone to grow onto them. This improves fixation, or how well the implant stays in place and feels like a natural part of your anatomy.

The implant’s liner materials have also improved significantly and now are mostly made of highly cross-linked polyethylene, which can handle wear much better than earlier types of polyethylene. Technology has allowed the more frequent use of larger diameter ceramic femoral heads—studies have shown a direct link between a larger head and better hip stability and range of motion as well as lower risk for dislocation.

Another improvement: Dual mobility bearing surface—a large polyethylene plastic head that fits inside a metal hip socket, and an additional smaller metal or ceramic head that goes within the polyethylene head. This is an option for people at higher risk for dislocation.

Previous hip implants were very commonly cemented into the bone. Surgeons now can select cementless implants for patients with healthy bone, which allows the implant’s surfaces to accommodate bone-implant integration and encourage better bone remodeling. When the bone surrounding the implant is compromised by a condition such as osteoporosis, cemented implants still may be a better option.

Though personalized 3D implants have received a lot of attention, they’re not that common and are mostly used for people who have a very unique anatomy and for whom a conventional implant may not fit very well. But there’s a wide range of implants available to fit all sorts of variations in human anatomy. We know how long they should last based on published studies, information we don’t yet have on 3D implants.

Individually tailored recovery plan. Just as we now devise preoperative plans, we also tailor hip-replacement recovery time to the individual and avoid recovery setbacks from, for instance, doing too much too soon, which could negatively affect the life of the new joint. Your surgeon will follow up closely with you, especially early on, to make sure you’re progressing appropriately. In general, younger patients—40 to 50 years old—will need assistive devices for maybe two weeks, whereas older patients who needed a walker before the surgery will rely on assistive devices for maybe four weeks.

Physical therapy (PT) can be helpful in recovery. This entails at least six weeks of rehab on a progressive plan starting with stationary biking and strengthening exercises. After the PT work, a sample timeline for a golf enthusiast, for example, to resume play would be starting at the driving range with putting, chipping and half swings and then gradually progressing to a full round of golf about two to three months post-op—that’s when the majority of hip-replacement patients return to their favorite activities without any restrictions.

If you compare today’s hip replacement recovery time to 25 years ago, there’s been a big change. Back then, patients were admitted to the hospital for several days and were given large doses of opioid pain medications. Today, as a result of safer, less invasive surgical approaches and techniques and more effective options for pain control, many people can have a hip replacement as an outpatient. We use different types of medications that act on different receptors yet work synergistically to minimize pain and the need for opioids. We’ve also migrated to using more s­pinal anesthesia and nerve blocks that help with pain control early on and mitigate the side effects of general anesthesia, such as nausea and disorientation.

The results may outlive you. With the right implant and technique for the patient’s anatomy, many people can expect their hip replacement to last the rest of their natural life. There used to be a greater need for revision surgery due to the implant loosening or wear of the bearing surfaces of the new joint, but revisions today are more likely needed after an injury that may cause dislocation, fracture or infection.

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