When Is It Time for a Hip Replacement?
Arthritis is a condition that occurs when the surface of a joint (cartilage) wears out. Your cartilage is covered by tough, slick, 1/4-inch-thick tissue that allows your bones to glide over each other without causing painful friction. When cartilage thins or wears out completely, the bone ends rub against each other, resulting in pain and stiffness.
According to the Centers for Disease Control, one in four people will develop hip arthritis in their lifetime. Those with a family history of arthritis of the hip have an increased chance of developing it, and the risk increases with age, obesity or an injury that puts stress on the hip cartilage.
First-line therapies generally recommended for pain caused by hip arthritis are anti-inflammatory drugs, exercise and physical therapy. For a time, one or more of these therapies may provide relief so that you can sleep, climb stairs and perform the activities of daily living. But when hip pain becomes so severe that these therapies no longer work,
and it hurts too much to even go for a walk, it may be time to consider a hip replacement.
Types of Hip Replacement
The most common type of hip replacement is the posterior approach. During this surgery, the surgeon makes a 6- to 8-inch incision over the side or back of the hip, cutting through the muscles and detaching tendons and ligaments from the back of the hip. The surgeon then removes the diseased bone and cartilage from the hip joint and replaces the ball and socket with an artificial hip.
The minimally invasive anterior approach hip replacement surgery requires only a small 3-4 inch incision. Surgical entry to the hip joint is through the area between the lower abdomen and the top of the thigh. The surgeon is able to reach the hip without cutting through muscles or detaching tendons, working by way of the natural space between the muscles. In addition, the most important muscles for hip function – the gluteal muscles, which attach to the pelvis and femur – are left undisturbed and therefore do not require a healing process.
Compared to traditional total hip replacement, the anterior approach has been shown to cause considerably less pain and result in a quicker recovery and lower risk of post-operative hip dislocation, where the hip pops out of the joint, one of the most common complications after surgery.
Since no muscles are cut to access the hip joint, the anterior approach, also referred to as “muscle-sparing” surgery, is associated with a quicker return to normal activity. Patients are not required to sleep in a special position, use special instruments to put on their shoes and socks or have an elevated toilet seat. They can return to driving as soon as they are comfortable.
Anterior approach hip replacement is performed on a special surgical table called the hana™ Hip & Knee Arthroplasty Table, the only table designed exclusively for hip and knee replacement. The table allows the surgeon to rotate the hip in ways that are not possible with conventional surgical tables. Additionally, because the table allows for continuous image guidance during the surgery, it is possible to adjust the implant if it is not perfectly aligned, before the patient leaves the operating room.
Orthopedic surgeon Corey F. Burak, MD, brought the minimally invasive anterior approach hip replacement technique to Phelps in 2006. He was the first surgeon in Westchester County, NY, to perform this surgery and has more experience in anterior approach than any other orthopedic surgeon in the Northeast, having performed more than 2,000 such surgeries to date.
Option for a Wider Variety of Patients
“The bulk of my patients are between 40 and 60 years old,” says Dr. Burak. “These are people with arthritis or congenital conditions, or athletes who’ve had sports injuries. They have different expectations for the surgery than an older person. They’re eager to get back to their active lifestyles, which often includes sports and playing with their kids.”
In addition to these benefits for a younger, on-the-go patient, this surgery is an option for a much wider variety of patients than traditional and other minimally invasive hip replacement surgeries. “I’ve operated on patients from 25 to 98 years old and from 100 to 400 pounds,” says Dr. Burak. “The beauty of this operation is that you don’t have to be selective – almost all patients are candidates.”
About five years ago, Cheryl Slaughter, a 45-year-old athlete and personal trainer living in Croton, began having hip pain caused by arthritis and from falling on her hip while skiing. Initially she tried physical therapy to alleviate the pain, which helped for a while, but eventually the bone-on-bone pain became more than she could tolerate. Her pain was seriously restricting her life.
Cheryl conducted extensive research before deciding what kind of hip replacement to have and who should perform the surgery. Because of her occupation, she is in contact with many physical therapists, so she asked them for recommendations. Dr. Corey Burak’s name came up again and again.
Cheryl had anterior approach hip replacement surgery performed by Dr. Burak at Phelps in December of 2012 and left the hospital three days later. One week after surgery, she was walking 1½ miles, and she returned to work full time after just one month. “If I had a desk job I would have gone back weeks earlier,” she says.
In addition to the method used to replace her hip, she attributes her quick recovery to the strengthening exercises she did prior to surgery, and to the fact that she went on an anti-inflammatory diet. Certified as a corrective exercise specialist (a personal trainer for people with injuries), she says she “knows how to rehab.”
The married mother of two teenagers speaks about how wonderful it is to go into New York City with them and to be able to go up and down the steps to the subway. She also is back to boxing twice a week, one of her favorite sports, and works out with weights at the gym.
“Hip replacement is the best thing I ever did,” she says. “My hip was restricting me a lot. Now I have a renewed ‘baby’ joint with lots of range of motion and a renewed life. I can stand up straighter and move without restriction. It’s great to be able to walk without pain.”
Mary Wu of Ossining is one of Dr. Corey Burak’s most impressive patients. A two-time kidney transplant recipient with a number of chronic medical conditions including congenital kidney disease, Mary was diagnosed with mild scoliosis and left hip arthritis at the age of 10. She has been in pain and had limited mobility for much of her 30-year life.
In April of last year, when her hip pain became too much to handle, Mary underwent anterior approach hip replacement surgery. For more than five years, she had not been able to walk for more than 15 minutes at a clip, but after the surgery and several months of intense physical rehabilitation at Phelps, she is learning to “move and groove again.”
In fact, Mary was chosen to be the adult honoree for the first annual 2013 Westchester County Jingle Bell Run/Walk for Arthritis, a national event held by the Arthritis Foundation in 200 cities across the U.S. A dedicated Arthritis Foundation ambassador, Mary has appeared before Congress and local legislators advocating for arthritis issues. “My new normal with my new hip has been invigorating. Life and living have never been more beautiful and extraordinary,” she says.
Marian Weinberg’s hip had been hurting for years. This 94-year-old Sleepy Hollow resident has led a very active life, and continued playing tennis until age 92, in spite of the pain. Finally she realized she had to do something about it.
“When I told my children I was considering getting a new hip, they said that I shouldn’t do it, that I’m too old, that my bones would split, that I would be in a wheelchair for the rest of my life. But I didn’t listen to them, and I’m glad I didn’t!”
Dr. Burak performed anterior approach hip replacement surgery on Mrs. Weinberg in September of 2011, and she left the hospital three days later for a stay in a skilled nursing facility and two weeks of physical therapy. In four weeks, she was walking without a cane, and without any pain.
“Getting my hip replaced is the best thing I ever did,” says Mrs. Weinberg, who was a math teacher at Briarcliff High School and is one of the founders of Corporate Angel Network, a charitable organization that arranges free air travel for cancer patients to and from their treatment locations using empty seats on corporate jets. She hasn’t had any problems with her hip in the last two years and currently swims half a mile twice a week.
“Some people think that once you reach a certain age, it’s not worth undergoing such a major operation,” says Dr. Burak. “But if you’re in generally good health and motivated to recover, it can be safely and successfully done.”
Corey Burak, MD, is board certified in orthopedic surgery by the American Board of Orthopedic Surgery. He earned his medical degree from the SUNY-HSC at Syracuse College of Medicine in NY. He completed a general surgery internship at Saint Vincent’s Hospital and Medical Center, New York, NY, and an orthopedic surgical residency at Tulane University Hospital and Medical Center in New Orleans, LA, where he completed a research fellowship in adult reconstruction under the renowned Dr. Robert L. Barrack. Dr. Burak also completed a fellowship in hip and knee arthroplasty at the Dorr Arthritis Institute, Los Angeles, CA, and received the Rockwood and Green Award in 2002.