For many people, joint replacement offers relief from arthritis or other conditions that cause debilitating pain in the hip or knee. If you’re considering hip or knee replacement surgery, Dr. Donald Hohman offers a few key considerations.
First, make sure you’ve tried all the available non-surgical measures.
“Doctors generally don’t recommend any surgery until more conservative treatments have been exhausted,” said Dr. Hohman, a joint replacement specialist on the medical staff at Texas Health Center for Diagnostics & Surgery.
For hip or knee pain due to arthritis, those measures might include over-the-counter pain relievers, such as acetaminophen. If medications don’t provide adequate relief, doctors may advise modifying activities and possibly physical therapy.
“Physical therapy can help address any weaknesses in key muscle groups,” said Dr. Hohman. “The goal of therapy is to help strengthen those weak areas, which might help take some stress off of your joints and provide some relief from arthritis pain.”
Some patients also try injections of pain-relieving medication before choosing surgery.
“The downside is that injections may work for a short period of time, but they are not a cure for the condition,” said Dr. Hohman. “Some people do get fairly long-lasting relief, but for most patients, injections are eventually going to stop providing enough relief.”
Once a patient and their physician have exhausted these conservative measures, the next step is to consider surgical options.
“When you've got end-stage arthritis of your hip or persistent knee pain, joint replacement is a very reliable, very predictable, very successful operation for the management of arthritic hips or knees,” said Dr. Hohman.
Posterior versus anterior hip replacement
Those considering hip replacement surgery will need to make a choice in consultation with a surgeon: posterior versus anterior hip replacement. The difference between a posterior or anterior hip replacement relates to how the surgeon accesses the hip joint, rather than the implant itself.
“Each approach has pluses and minuses, and we discuss those with our patients as we make treatment decisions,” said Dr. Hohman
With posterior hip replacement, the surgeon approaches the hip joint through the back of the hip. That involves moving the sciatic nerve and opening the capsule in the back of the hip. The downside: as a result, the hip that is more prone to instability, and patients must follow precautions to keep the hip in place.
Whenever it’s a safe and viable option, Dr. Hohman prefers minimally invasive muscle-sparing anterior hip replacement. That approach involves moving the femoral nerve out of the way to access the hip. Some patients will experience a sensation, post-operatively, on the front and side of the leg, which almost always disappears in time. The advantage is a more stable hip.
“It’s actually easier to take care of patients after anterior hip replacement,” Dr. Hohman said. “In fact, it almost works too well! Patients do so well that sometimes we have to slow them down, so they don’t push themselves too hard too quickly.”
The anterior approach gained prominence during the second half of the 20th century. Studies suggest that the posterior approach – the more traditional and popular approach -- is associated with a shorter operative time, while the anterior approach has the potential to decrease the length of the hospital stay and provide greater short-term functional restoration.1
Some patients believe it’s important to find a surgeon like Dr. Hohman, who is proficient in both approaches. He continues to perform posterior hip replacement surgery in cases where anterior surgery is not an option. However, he thinks it’s more important for patients to choose a surgeon they’re comfortable with, who frequently performs the procedure they need, and who is backed by an experienced nursing and support team.
“A joint replacement procedure is kind of like a relationship,” he said. “You’re going to have that hip for as long as you're alive. We're going to know each other for as long as you have it.”
Life After Joint Replacement
Many patients want to know what to expect after knee replacement, or what to expect after hip replacement. And many who do go through either procedure are pleasantly surprised.
“Recovery from joint replacement surgery is really becoming really quite rapid,” said Dr. Hohman. “It's not uncommon for people to go home the same day after a hip replacement and to require only Tylenol for pain control. We try to stay away from heavy-duty narcotics because those have negative side effects and just slow down the whole recovery process in general.”
Among patients considering joint replacement surgery, Dr. Hohman often hears this question: “What are the activities that I can and cannot participate in when I have my joint replacement?”2
His response: Likely you’ll be able to enjoy the majority of activities that you want, but patients do need to consider that implants are not designed for high-impact activities. While some patients might be able to run or do other high-intensity, high-impact activities after surgery, likely they won’t get the longevity they desire out of the implant.
Ultimately, the goal for life after knee replacement, or life after hip replacement, is to get patients back to enjoying the activities they love — such as hiking, cycling or swimming — without pain.
“As I tell my patients, joint replacement generally should not be considered as a performance-enhancing operation,” he said. “It's really a quality-of-life enhancing operation. The goal is to get you back out living life without debilitating pain.”
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[1] Fagotti L, Falotico GG, Maranho DA, Ayeni OR, Ejnisman B, Cohen M, Astur DC. POSTERIOR VERSUS ANTERIOR APPROACH TO TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Acta Ortop Bras. 2021 Nov-Dec;29(6):297-303. doi: 10.1590/1413-785220212906244610. PMID: 34849093; PMCID: PMC8601379.
Cohttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601379/
[2] Hohman 2020 video https://www.youtube.com/watch?v=DXpPIhu_wR0