Total hip arthroplasty (THA) continues to be one of the most successful and cost-effective procedures in medicine. THA can relieve pain, restore function, and improve quality of life for patients experiencing hip pain from a multitude of conditions. More than 400,000 total hip procedures are performed annually in the United States. The incidence of THA will continue to increase due to the number of individuals wishing to remain active while they age as well as the increased number of obese individuals. Both THA and TKA (total knee arthroplasty) are commonly performed by Coastal Orthopaedics at Norwalk Hospital’s Center for Joint Care.
A THA surgery replaces the diseased hip joint surfaces with synthetic materials to alleviate pain and improve function. Surgery is usually considered as an option once all non-operative methods of pain control have been exhausted. A THA can be life-changing with improvements in pain, function, and life quality for patients with severe hip disease. Conventional THA surgery has shown excellent long-term survival of the implants.
ignificant effort continues to be spent in research to improve THA. Improvements in materials over the past 10 years have yielded a bearing surface, highly cross-linked high molecular weight polyethylene (CL-HMWPE), which wears 90% less than previous versions. This one change may extend the functional lifespan of a THA by decades. The improvements of the femoral components, with the introduction of newer and tougher ceramics, along with CL-HMWPE, have provided a very durable and long-lasting implant combination for most patients. The use of CL-HMWPE and ceramics together maximizes the benefits of both materials while minimizing the drawbacks of ceramic-only implants (size options, fracture risk, joint squeaking), or metal-on-metal components (pseudotumor formation, pain, high revision rate from wear debris).
The approach to pain management has been revolutionized over the past five years. Pre-emptive use of non-narcotic medications, along with spinal anesthesia, can minimize the generation of pain from surgery even before the procedure begins. After surgery, a combination of traditional and newer non-narcotic medications are used along with a minimal amount of oral narcotic medication. This multimodal pain control method allows the patient excellent pain control while avoid side effects caused by injections of narcotic medications. The side effects of narcotic medications (nausea, vomiting, itching, dizziness, constipation) are typically the reason that patients need to stay in bed and prolong recovery from surgery. Multimodal pain control methods, along with less invasive surgical techniques and aggressive physical therapy protocols, have significantly lessened the hospital stay for all total joint replacement patients. These combined improvements have even made it possible for some patients to go home the day after, and even the day of, surgery. At the Norwalk Hospital joint replacement center, the average hospital stay after joint replacement — for all patients — is only two days.
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