Not Your Parent’s Total Hip Replacement – Reprinted from the NYTImes 1/19/2021

Therapists who work with THRs – this is good marketing material!

By Jane Brody
If I’ve learned anything during nearly six decades of reporting on medical science, it’s that the longer you wait, the better the methods of prevention, diagnosis and treatment are likely to become. That’s true for almost every field of medicine — cardiology, gastroenterology, oncology, etc. And it may be particularly relevant for orthopedic surgery, a specialty facing ever-increasing demands from an aging population with bones, joints, ligaments, tendons and muscles that break down after decades of wear and tear.

Although repairing these body parts is rarely urgent, many people endure painful joints for years, even decades, often out of fear of surgery. The delay can have both obvious risks of ongoing pain and increasing disability, as well as unexpected consequences like injury to previously healthy muscles and joints that are overstressed as a result.

I have good news for people with degenerated hip joints that are in serious need of replacement. The last decade has seen significant incremental improvements in surgical techniques and the ability to fit patients with artificial hips that are highly resistant to mechanical failure or a need for revision.

A close friend recently underwent replacement of a second hip, nine years after the first, and is thrilled with how minimal the pain was and how rapidly she’s recovered function this time thanks to the updated techniques her surgeon used.The essential fact of hip replacement has not changed. Traditionally, the damaged ball-and-socket joint is removed surgically and replaced by one made artificially. But the way this is done, especially the preparation involved, can make a major difference in the immediate and long-term success of hip replacement surgery.As one surgeon, Dr. Patrick A. Meere, told me, “A large part of today’s improved performance — rapid discharge, faster return to function, and diminished need for pain management — is attributable to more refined surgical technique,” especially muscle-sparing approaches that result in faster pain-relief and functional recovery. Instead of cutting through muscles to gain access to the hip bones, the surgeon navigates between muscle fibers of the pelvis to reach the bony parts of the joint.

One major improvement is the use of computer-assisted navigation that enables the surgeon to see precisely how to align the implanted joint. Dr. Meere, an orthopedic surgeon at N.Y.U. Langone Health, said that most surgeons now use some form of the technology, which results in more accurate leg length and minimizes the risk of dislocating the replaced joint.

But perhaps the most exciting aspect of modern hip replacement is the increasing use of robotic surgery. Although robots have been used for many decades to manufacture motor vehicles with greater precision, robotic joint replacement is a relatively new kid on the block. And, Dr. Meere said, it typically takes surgeons 15 to 25 operations to develop proficiency in using the robot.

The extra cost involved in robotic hip replacement is not yet covered by Medicare or most insurers. But after learning about its advantages, my friend chose to pay the extra several thousand dollars out of pocket. It involves creating a three-dimensional model of the patient’s hip joint. A CT scan of the patient’s pelvis is done before surgery, or a 3-D model of the hip joint can be created at the time of surgery. When the scan is done in advance, the surgeon is able to create a more precise operative plan — in effect, a virtual rehearsal of the operation.


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