Considering a hip replacement in Houston? Hip surgeon Dr. Larry Likover performs advanced total hip replacement surgery designed to last your lifetime and enable you to walk without limp, pain or supportive device as quickly as possible. Dr. Likover accomplishes this by performing an “anatomical” hip replacement. Anatomical means he is placing an implant that closely mimics the size of the patient’s arthritic hip that has to be removed. Another name for “anatomical” is a “magnum” replacement. The full name of what Dr. Likover does is a dual mobility, magnum, ceramic on E1 polyethylene hip which will be explained below.
Please see the video of weightlifter R.H. to show the type of result that can be obtained with a magnum hip replacement. 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 is to have the patient walk without a limp and without pain. The secondary consideration should be how well 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 (pelvis) cup and a femoral stem which has a ball on the top of the stem. When total hip replacement 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 prosthesis 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 ingrowth hip has a living fixation that does not fatigue or wear out like cement does. Dr. Likover performs almost exclusively Boney-ingrowth total hip replacement 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: 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 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 still are in many cases. Metal on first and second generation polyethylene has caused problems with particulate wear debris causing loosening of the stem or cup over time. Metal on metal has caused increased metal ions in the blood of uncertain seriousness.
The newest interfaces now available is ceramic on vitamin E1 enhanced polyethylene. 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.
View Magnum™ in Motion
Greatly Reducing Risk of Hip Dislocation
A “magnum” hip is a hip replacement that uses a ball and socket the same size of the patient’s. It appears that since this type of implant matches the patient’s own hip size the patient has a better chance of having a normal gait and natural feel of the hip internally.
The most common complications of small or standard ball hip replacement is hip dislocation. If the patient inadvertently assumes a squatting position, crosses his or her legs or trips and falls, these abnormal positions might cause the ball to dislocate from the socket after it has been implanted. A dislocation of the ball from the socket usually requires to patient to come to the hospital and be placed under anesthesia to allow the doctor to pull the implant back into place.
By using a big ball and a big socket, the chance of dislocation is greatly reduced because it is very difficult for a large ball to come out from the socket. The original hip replacement had a very small ball (22mm) and dislocation of the ball was a very common problem, especially in the early postoperative period. A big ball implant uses an implant about the same size and the patient’s natural hip. When a dual mobility implant see on the video on this page, the chance of dislocation becomes extremely low.
Total Hip Replacement Recovery & Restrictions
People ask about an anterior approach versus a posterior approach. Anterior approach has been promoted by some hip surgeons as “better”. All studies show the results and rate of recovery are the same for either approach. Dr. Likover’s patients average two nights in the hospital following a total hip replacement surgery.
Dr. Likover allows his patients to discontinue crutches as soon as possible and switch to a single crutch or cane at the patient’s own rate. Usually by three to four weeks following the surgery, the patient is walking quite nicely without support.
Total hip replacement 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. Many patients walk normally without the slightest limp.
Minimally Invasive Hip Replacement
A word about “minimally invasive” hip replacement. Minimally invasive has been promoted by various orthopedic surgeons as a “major breakthrough.” This has turned out to be a lot of “hype”. Basically, with this type a procedure the incision is so small the hip surgeon cannot see what he is doing. This type of hip replacement surgery can result in the implants being placed in a poor position causing all types of problems including instability, dislocation and earlier failure of the implants.
Dr. Likover performs a total hip replacement procedure with as small an incision as possible. It is far more important to get the implant positioned correctly for a successful outcome than to be overly focused on the size of the skin incision.
If you have any further questions about a hip replacement in Houston, please contact Dr. Likover and he will be happy to answer them. Send Dr. Likover a message now.