Is a bad hip preventing you for participating in things you love to do? Do you experience frequent hip or groin pain, stiffness, and difficulty walking regular distances? These may be signs that you need a hip replacement surgery to get back to the things that you enjoy doing the most.
Houston hip replacement surgeon Dr. Larry Likover performs advanced total hip replacement surgery designed to last your lifetime and enable you to walk without limp, pain or a supportive device as quickly as possible. Dr. Likover accomplishes this by performing an “anatomical” hip replacement surgery. Anatomical means placing an implant that closely mimics the size and position of the patient’s arthritic hip that has to be removed.
Please see the video of weightlifter R.H. to show the type of result that can be obtained with a hip replacement performed optimally. R.H. won the Texas weight lifting championship in his age class (50-59) lifting 512 pounds one year after surgery.
Advances in Total Hip Replacement Surgery
The primary concern of the patient who requires a total hip replacement surgery should be how well it will work, meaning will the patient walk normally with his or her new hip? The goal of a hip replacement surgeon is to have their patient walk without a limp and without pain. The secondary consideration should be how long a great result will last without the implant getting loose, wearing out or causing problems in the body.
A total hip implant consists of two components: an acetabular cup (placed in the pelvis) and a femoral stem which has a ball on the top which is placed inside the femur bone. When total hip replacement surgery was first developed, the implants were cemented on both the pelvis side and the femoral side (the cup and the stem). Cement has been shown to last about 10 to 15 years. For this reason, boney-ingrowth hip replacement was developed.
Boney-ingrowth hip replacements have a titanium porous metal surface to allow the patient’s own bone to grow in to the prostheses of implants and hold it in place without cement. This type of metal fixation to bone without cement has the potential to last a lifetime. A boney in-growth hip has living fixation that does not fatigue or wear out like cement does. Dr. Likover performs almost exclusively boney-ingrowth total hip replacement surgery for this reason on both femoral side and cup side.
Once you understand there is a stem and a socket, the question becomes what is the best socket and what is the best ball that goes on the stem making the optimal interface.
Types of Hip Replacement Surgery: Ceramic, Metal on Metal
The other issue, which is the factor in the length of survival of the implant, is the junction between the ball and the socket known as the “interface”. Originally, total hip replacement surgery was developed with a metal ball and a polyethylene (plastic) socket. It has been shown over time that polyethylene without a metal backing deforms and wears out. Metal-backed polyethylene sockets have been used in America for many years and are still the standard of care. Metal on first and second generation polyethylene has caused problems with particulate wear debris causing loosening of the stem or cup over time. Dr. Likover is now using third generation E1 polyethylene which is much more durable. Metal on metal has caused increased metal ions in the blood of uncertain seriousness. Metal on metal hip replacement or resurfacing of the hip are not in favor in the United States for this reason.
The newest interface now available is ceramic on vitamin E1 enhanced polyethylene inside the cup. The stem and cup in all cases is titanium bony in-growth porous metal. Ceramic on E1 polyethylene has the potential to last a lifetime based on wear studies of ceramic on this type of highly cross-linked polyethylene.
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Total Hip Replacement Recovery & Restrictions
People ask about an anterior approach versus a posterior approach. Dr. Stefan Kreuzer was one of the first Houston hip replacement surgeons to perform an anterior minimally invasive approach. Dr. Likover learned that approach from Dr. Kreuzer. Dr. Likover and Dr. Kreuzer now perform the same operation in the same hospital. Dr. Likover’s patients average one night in the hospital following a total hip replacement surgery. If you would like a posterior approach, Dr. Likover does that too.
Occasionally there are technical reasons to do a posterior approach. Anterior approach has been shown to have less overall complications than posterior approach. The most common complication of posterior approach is dislocation. This problem is extremely rare with anterior approach.
Patients spend one night in the hospital. Patients are full weight bearing and allowed to discontinue crutches as soon as possible and switch to a single crutch or cane at the patient’s own pace. Usually by three to four weeks following the hip replacement surgery, the patient is walking quite nicely without support. There are no activity restrictions with an anterior approach hip such as not crossing your legs or sitting in a low sofa.
Total hip replacement surgery patients usually improve their gait pattern for several months, and by two months it is difficult in many cases to detect that the person had any surgery, let alone hip arthritis. Most patients walk normally without the slightest limp.
Anterior Minimally Invasive Hip Replacement Surgery
Dr. Likover performs a total hip replacement procedure with as small an incision as possible from an anterior approach in most cases. Dr. Likover uses Intellijoint Navigation to make sure the implant is positioned properly and correct leg length is obtained. If you have any further questions about a hip replacement surgery in Houston, please contact Dr. Likover and he will be happy to answer them. Send Dr. Likover a message now.