According to the Centers for Disease Control and Prevention (CDC), hip replacements are among the most common surgical procedures in the United States; and with osteoarthritis and obesity on the rise, demand for the procedure is expected to grow.
From 1996 to 2006, the number of hip replacement surgeries performed nationally increased by 30 percent, partial hip replacements increased by 60 percent; and the number of the surgeries performed on those aged 65 years and older is more than three times that of their younger counterparts (source: CDC). At NewYork-Presbyterian Hospital/Columbia University Medical Center, the number of hip replacements has increased two-fold since 1999.
"When it hurts to get around in daily life or you can't participate in your favorite sports or hobbies and your medication and physical therapy aren't working anymore, it's time to talk to your doctor. Hip replacement surgery may be right for you," says Dr. Jeffrey A. Geller, director of minimally invasive joint replacement surgery at the Center for Hip and Knee Replacement at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of orthopedic surgery at Columbia University College of Physicians and Surgeons. "After a hip replacement, most patients are in the hospital for two or three days and can get around with a walker about a week later. From there, they transition to a cane, and often return to walking on their own within two to three weeks."
Surgical Innovations
Hip replacement has seen significant advances in minimally invasive surgical techniques. For one surgical option, Dr. Geller and his colleagues use a method that reduces trauma and leads to a much quicker recovery. Traditional approaches require surgeons to split and detach large portions of the musculature; however, Dr. Geller is able to use a small front or rear incision in some cases.
Dr. Geller and his colleagues are also using robotics to improve outcomes in orthopedic surgery. "In the near future, robotic surgery may give us improved accuracy when placing the hip socket, which if it isn't in the correct position could lead to dislocation or the artificial joint wearing out earlier than it should," says Dr. Geller.
Another improvement has been seen with the replacement joints themselves. The first generation of joints had a shelf-life of about 15 years. "Today patients can get as many as 20 years out of their new hips, and with the newest generation of implants, replacement hips may last as long as 30 years," adds Dr. Geller.
Research Update
Dr. Jeffrey A. Geller and his colleagues recently published a study in the Journal of Bone and Joint Surgery addressing a rare complication of hip replacement. Even with a successful initial surgery, it is possible for patients to experience pain and weakness if the gluteus medius muscle -- one of the main supporting muscles of the hip -- is damaged or underperforming. Traditionally there was no satisfactory way to repair the muscle, as any grafts or sutures proved too weak to withstand the force exerted on the muscle.
The new research reports on an innovative surgical approach that reinforces the muscle graft with a piece of the Achilles tendon. "From 2003 to 2006, seven patients received the novel treatment at NewYork-Presbyterian Hospital/Columbia and the results have been very encouraging with all patients experiencing greater strength and decreased or even absent pain," says Dr. Geller.
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