Hip Replacement: Q&A with Eric Smith, MD
Eric L. Smith, MD, the newest member of our orthopedic surgery team, specializes in hip and knee replacement surgery. We recently sat down with him to learn more about the benefits of hip replacement surgery. To learn more about orthopedic surgery at BMC, please visit their webpage or call 617.638.5633.
When is a patient ready for a hip replacement?
Many of my patients arrive at the clinic with that very question, wanting to know their options, and wanting relief from their pain. We first look at their complete medical history. We learn how that person’s daily life and activities are affected by their pain. We also conduct a thorough physical exam and review their X-rays. As a result of all these things, we come up with the best treatment plan for each person.
Usually, surgery becomes an option after non-surgical treatments - activity modification, pain medications such as Tylenol or non-steroidal anti-inflammatories (NSAIDs), or walking aids such as a cane - are no longer helping.
How does chronic hip pain affect a patient’s quality of life?
I see patients who can’t do their grocery shopping, or get in and out of a car anymore. They can’t take the stairs, or play with their grandkids. Others can no longer play their favorite sport. And for some patients, simply remaining independent is a challenge. Hip replacement is extremely successful in recapturing a great quality of life, and getting a person back to their favorite activities.
What takes place during a hip replacement surgery?
When a patient undergoes a total hip replacement, they are sedated and cared for by an anesthesia team throughout the operation. They are then positioned, prepped, and draped correctly, so that I can perform the procedure. Inside the operating room, there are many things that help us, from state-of-the-art equipment and complex surgical instruments to our infection prevention efforts.
The operation itself consists of removing the damaged joint, and replacing it with an artificial one, which can be made of a number of types of materials including highly cross-linked polyethylene, titanium, cobalt chromium, or ceramic. We talk to each patient and determine what type of replacement material is right for them.
What are the different types of hip replacement surgery?
The most commonly performed replacement is a total hip replacement. That’s when both the femur, or the ball portion, as well as the socket (or acetabulum), are replaced. Then, new bearing surfaces are implanted in those areas which help eliminate the patient’s pain.
Some patients are better candidates for a partial hip replacement, where only the ball portion is replaced with an artificial part. The patient’s cup portion (their acetabulum) is not replaced. The most common reason for a partial replacement is when someone breaks their hip.
A revision hip replacement is performed when some part of the total hip replacement is not functioning correctly. It might be the ball, the stem, or the cup. There are many different reasons why someone has a hip replacement that’s not functioning properly, and needs a revision. The most common reasons are wear and tear, or hip dislocation.
What can patients expect in terms of recovery from hip replacement surgery?
Everyone’s recovery is different, but at BMC, most of our patients are discharged home one day after their hip replacement surgery. This is thanks to a great combination of nursing care, physical therapy that gets the patient up and walking same day or next-day, and our minimally invasive, direct anterior approach to the surgery. With an anterior replacement, patients experience fewer complications, have better strength after the operation, and can participate in more activities sooner than they could with a posterior approach hip replacement.
After their operation, patients use devices like a walker or cane to help them move around. But, they’re encouraged to stop using them as soon as they feel steady enough to walk without them. In terms of going back to work, some of my patients return as little as two weeks after their surgery, but that varies depending on the person and on their profession. The same is true for driving. I encourage my patients to be their own best judge and return to certain activities at their own pace, using their best judgment.
What’s the success rate of hip replacement surgery?
Total hip replacement is the most successful operation performed in the U.S. Ten-year survivorship for total hip replacement is approximately 95%-97%, and patient satisfaction rates are approximately 90%.
Why should someone choose BMC for their hip replacement surgery?
The professionalism and positive energy of the nursing, physical therapy, and occupational therapy staff is really remarkable at BMC. They take extremely good care of our patients. It’s truly a multidisciplinary approach, and it takes a whole team to get a patient well again.