5 Things to Know About Hip Replacement Surgery – Medicare Health Plus – Medicare Health Plan Advisors in Central Florida

In early 2024, David Leppla, 71, from Rochester, New York, finally had enough of the piercing pains in his hips that had been plaguing him for at least nine months.

“As the pain got worse, it started to linger. Moving my leg up and down hurt. Even moving my foot from the gas to the brake when I drove the car hurt,” he says. His orthopedist told him that he would likely need a hip replacement to rid him of the pain.

With a family history of osteoarthritis and having already had both knees replaced, Leppla wasn’t surprised at the doctor’s suggestion. And the recommendation put him in good company.

According to the Cleveland Clinic, surgeons perform more than 350,000 hip replacements in the United States each year — up from 138,700 in 2000, federal statistics show — and more than 90 percent of them are done on adults aged 50-plus.

Here are five things you need to know if you are considering the procedure.

1. It’s the hip joint — not the pelvis — that gets replaced

If you’re picturing a hip replacement, or hip arthroplasty, as replacing the large platelike bones you rest your jeans on, stop right there. Yes, that area is part of your hip, but it’s known as the pelvis. The hip in the case of surgical replacement is the ball-and-socket joint where the head of the femur (thigh bone) inserts itself into the pelvis at the acetabulum, basically at the crease created when you sit down. That joint is what gets replaced.

Normally there is cartilage in the hip joint and also on the head of the femur to act as a cushion between the two bones. If the cartilage wears away, you’ll have exposed bone-on-bone friction in your hip joint, which can cause pain and stiffness.

For a hip replacement, a surgeon basically installs a metal socket in the acetabulum and a metal stem inside the tube of the femur. The metal stem is then connected to a ceramic ball forming a new joint.

“Now there’s no bone-on-bone. We’re replacing the joint, the parts, the articulating motion of the hip,” says Spencer Summers, M.D., a hip and knee replacement surgeon with New York’s Hospital for Special Surgery who is based in West Palm Beach, Florida.

You may have heard the terms total or partial hip replacement. The only difference is with a partial hip replacement, the head of the femur is replaced with a prosthetic stem and head. The socket is not replaced. “Partial replacement is a less common procedure, often only performed when a person falls and sustains a hip fracture,” Summers says.

2. Not everyone with joint damage needs a hip replacement

Pain and inflammation caused by osteoarthritis — sometimes called “wear and tear” arthritis — is the most common reason for a hip replacement, followed by rheumatoid arthritis (a chronic autoimmune disease) and a post-traumatic issue, such as a fall, Summers says. A condition known as osteonecrosis, which is when blood supply to the hip bone is cut off, can also lead to a hip replacement.

With osteoarthritis, which affects roughly 33 million U.S. adults, there’s a genetic component and a use component, Summers says. “In some people, their cartilage is less durable and tends to wear out faster. That’s the genetic component.”

As for use, Summers explains that some people are harder on their hips — they accumulate injuries over time, they may be overweight, and the hip may wear out from more stress going across the joint over a longer period of time. “Eventually arthritis develops, but not in everybody,” he says.

The decision to have hip replacement surgery is different for everyone and requires a conversation with your doctor. If you’re not dealing with an accident or a physical ailment like a tumor, for example, going under the knife will likely depend on your lifestyle and your pain level. For instance, if pain is causing you to lose sleep or is making daily tasks more difficult, you may be a candidate.

Sometimes a person’s imaging tests may look like they’re in pain, but their symptoms don’t match, explains Rishi Balkissoon, M.D., an adult reconstruction orthopedic surgeon at the University of Rochester Medical Center (URMC) in Rochester, New York. “It may be surprising that just because you are bone-on-bone, this does not mean that you need surgery.”

If you don’t opt for surgery, Balkissoon says there are evidence-based, non-surgical treatments that may help with symptoms, including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen; cortisone injections; physical therapy; low impact activity and the use of assistive devices such as a cane or walking sticks.

3. Most patients go home the same day as their surgery

Curious what the procedure entails? Here’s a quick snapshot.

There are four main ways surgeons can get to the hip:

Anterior, where they enter through the front of the upper thigh
Anterolateral, where they enter from the side and then around the front
Lateral, where they enter just from the side
Posterior, where they enter behind the side of the hip bone

While there are pros and cons to each, the “best” method is the one that fits your medical needs and the one that your doctor is most comfortable with, says Summers, who performs approximately 400 hip replacements each year.

Before your operation, discuss with your surgeon whether you’ll be going home the same day or spending the night in the hospital. “The vast majority of patients are candidates to go home the same day as the surgery,” Summers says. You might need to stay over if you have a preexisting condition that needs some extra monitoring.

On the day of the surgery, expect to arrive an hour or two beforehand. You’ll have some paperwork to do, and you’ll meet the various people responsible for your care, such as the anesthesiologist. “Usually, these surgeries are done with a spinal anesthetic, which means they give you one injection in your low back, and you’ll be numb from the waist down,” Summers says.

A general anesthetic can be used, too. Leppla, the patient from Rochester, says his hip surgeries — he’s had both replaced — were done under general anesthesia because he had scar tissue from a previous back surgery. But if you can tolerate a spinal, Summers says, “you can avoid the discomfort of having a tube down your throat and you won’t necessarily be as groggy after surgery.”

The procedure takes about an hour and a half to two hours, and you will likely be walking later the same day. Leppla says his surgery took two hours and then he was in recovery for about two hours. Later that day, he was already starting physical therapy.