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A surgeon at Baylor University Medical Center in Texas has a new way of doing hip replacement surgery that works better for heavier patients. If you are contemplating hip replacement surgery, especially if you pack a few extra pounds, ask these questions.

Dr. Sanders answered a number of questions about the new procedure during a conversation with the Alternative Health Channel sponsored by Ivanhoe. In paraphrase, here are some of the more frequently asked questions and their answers here.

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Q. Does the front-entry approach for hip replacement surgery result in a shorter or longer surgical scar?

A. The incision is about the same length whether the surgeon cuts from the front, the back, or the side. It is what happens underneath the skin that is different.

Q. What is different about the tissues the surgeon cuts from the front?

A. There are fewer cuts to muscles and tendons that stabilize the hip, so it is less likely to slip or become dislocated during the healing process. 

Q. Is there anyone who can't have this variation of hip replacement surgery?

A. A few patients, Dr. Sanders says, have hip problems that require the incision to be made on the back of the hip, but almost every patient can have the front-entry procedure.

Q. Why haven't doctors been doing the operation this way all along?

A. Before there were artificial hip joints and hip joint bone grafts, orthopedic surgeons did surgeries to repair fractured pelvic bones through the front of the body. About 1960, surgeons started implanting artificial hip joints. A few surgeons, such as my own doctor, recognized the value of the front-entry approach even then, but most surgeons felt it was easier to cut from the back of the hip, that is, easier for the surgeon during the surgery.

Q. Isn't hip replacement surgery intensely painful?

A. Broken hips (and cancer of the hip joint) are intensely painful. Most hip replacement patients, however, experience less pain after the operation, even immediately after the operation, than before, even when swelling and dislocation are taken into account.

Q. Sometimes doctors don't place the artificial joint correctly. Is this more or less likely with the new surgical approach.

A. When the doctor cuts from the side, it is not possible to use an x-ray machine to guide the exact placement of the joint. When the doctor cuts from the front, it is possible to use x-ray to make sure the joint is positioned in exactly the right place in the socket.

Q. What percentage of patients experience dislocations after hip replacement surgery?

A. With the old technique, Dr. Sanders says, about 3 to 4% of patients experience dislocations of the hip socket after surgery. With the new technique, about 0.1% of patients experience hip dislocations.

Q. And what's the advantage for heavier patients?

A. When the surgeon works from the front of the hip, there is less tissue to cut through. Subcutaneous fat falls to side of the surgical field rather than obscuring it. The surgery is faster and easier for the doctor to perform.

Not every orthopedic surgeon does the procedure from the front, and you are unlikely to persuade your surgeon to make an exception for your case. However, if you have time to plan your surgery, you can ask around to find out if there are surgeons available to use this new technique, and if there are not, whether there are ways your surgeon can make your recovery faster. 

  • Alternative Health News, A New Route to a New Hip--In-Depth Doctor's Interview, ivanhoe.com, Accessed 25 August 2013.
  • Berger RA, Sanders SA, Thill ES, Sporer SM, Della Valle C. Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. Clin Orthop Relat Res. 2009 Jun.467(6):1424-30. doi: 10.1007/s11999-009-0741-x. Epub 2009 Feb 28.
  • Photo courtesy of Science Museum London by Flickr : www.flickr.com/photos/sciencemuseum/9672239334/
  • Photo courtesy of Andrea_44 by Flickr : www.flickr.com/photos/8431398@N04/2812258995/