Replacing a hip used to be invasive and painful.
It used to require cutting through muscles and tendons.
It used to require days of pain and recovery in the hospital, physical therapy, and sometimes a stay in a rehabilitation center.
Now you can have a hip replaced and be back home the same day.
The surgery can also be done in a way that reduces pain. Healing time is quicker, and there is a faster return to normal strength and mobility.
How it works
Dr. Roy I. Davidovitch, one of the pioneers of same-day hip replacement surgery, and the first surgeon to do the procedure in New York, has performed more than 100 such operations.
Davidovitch, an orthopedic trauma surgeon with NYU Langone Medical Center in New York City, and director of its Hip Center, uses the minimally invasive anterior approach for total hip replacement.
The goal of hip replacement is to restore range of motion and to help relieve arthritic pain.
The major advantage for patients of same-day replacement is their ability to recover comfortably at home. That allows them to avoid a hospital stay and to take control of their recovery, Davidovitch said.
“My goal is to get patients on the road to rapid recovery,” Davidovitch said in a Healthline interview, “and get them to return to work and their everyday level of function as soon as possible — and forget about their hip replacement.”
With the anterior approach, Davidovitch explained, he makes “a small incision from the front, sparing the muscles and tendons from being cut from the bone as they may be in a posterior approach.”
He removes the patient's worn ball-and-socket joint and replaces it with an artificial socket. Then, he inserts a stem with a ball into the femur bone.
Anterior hip replacement surgery is no more complicated than hip replacements where patients stay overnight or several days.
“The hip replacement itself takes about an hour, depending on the complexity of the case,” Davidovitch said. “For a same-day replacement, a patient can come in at 9 a.m., be up walking with the physical and occupational therapists by 2 or 3 p.m., and leave by 5 or 6.”
A new approach
The anterior approach is a newer technique that minimizes post-surgical pain and helps patients to be relatively functional soon after they get home.
Davidovitch said he believes this helps patients to recover faster, and to experience fewer restrictions on everyday activities.
This approach also has been shown to decrease the risk of complications such as dislocation and leg-length discrepancy, as well as to improve accuracy of new hip positioning.
Hip replacements, first performed in 1960, are one of the most successful operations in all of medicine.
The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHA) reports there are more than 300,000 total hip replacements performed each year in the United States.
Davidovitch said a minimally invasive posterior approach also has its own benefits, and some surgeons throughout the country send their patients home the same day after undergoing this type of replacement.
“At about six months post-surgery, patients are doing about the same regardless of what approach they had done,” he said.
Complications and warning signs
Any surgery comes with the risk of complications, and hip replacements are no exception.
Those risks include medical problems while at home and difficulty dealing with pain, according to the American Association of Hip and Knee Surgeons.
NYU Langone has strict selection criteria for who can undergo same-day hip replacements to reduce those risks.
“Critics of same-day discharges are concerned about rare, catastrophic effects like blood clots or pulmonary embolisms,” Davidovitch said. “But if a patient is at higher risk for these side effects due to underlying conditions, we don’t consider sending them home the same day. We haven’t had any readmissions in our same-day hip patients.”
Many health conditions rule out same-day surgery.
Davidovitch says his patients cannot have cardiac disease, chronic liver disease, uncontrolled diabetes, obesity, or any other medical risk factors that can lead to excessive bleeding and increased risk for infection.
They also must have a strong support network at home and someone who will be home with them as they recover.
“I estimate fewer than 50 percent of my patients will be candidates for a same-day discharge,” he said. “But, they might go home within two days.”
What are the warning signs that you might need to replace a hip?
Patients who come to Davidovitch often describe pain in the groin and the front of the thigh as well as mobility problems, which are brought on by hip joint deterioration.
Deterioration occurs because of osteoarthritis caused by age-related wear and tear that worsens over time, other types of arthritis, fractures, damage to the hip joint, and other conditions, such as hip dysplasia.
Patients often tell Davidovitch that “their world is shrinking,” and they are able to do less and less. If medications, nonsurgical interventions, rehabilitation, and physical therapy do not help to reduce the pain, these patients may be candidates for hip replacements.
More younger patients
Hip replacement patients are increasingly younger.
“The increase in younger patients undergoing total hip replacements is probably due to both a demographic shift caused by people staying more active longer than before, and to the fact that implants have become more durable,” Davidovitch said. “The durability of the new generation of hip implants means that total hip replacements have become an option for active younger people, for whom this surgery may be the best option for eliminating chronic hip joint pain.”
Most patients who undergo hip replacements are in their late 50s and early 60s, but Davidovitch said he is seeing a growing number of patients undergoing these procedures in their late 40s.
Davidovitch said other surgeries, such as knee replacements, could become same-day procedures in the near future.
To accomplish this will require a strong, multidisciplinary, coordinated effort from hospital leadership, orthopedics, anesthesiology, nursing, and physical and occupational therapy.
At NYU Langone, Davidovitch and his colleagues worked with the anesthesiology department to develop a new protocol for anesthesia and pain management.
“Patients are given shorter acting anesthesia that allows them to walk the same day but reduces their pain in the days that follow,” he said. “We needed to work with our nursing, physical therapy, and occupational therapy colleagues to develop ‘prehab’ educational sessions for patients prior to surgery. They learned exactly what to expect after surgery — from getting into bed to using the bathroom — so they could recover safely at home outside of the hospital.”
“It is a big decision to undergo a hip replacement,” Davidovitch said. “But if the pain is so bad that your quality of life is severely affected, a hip replacement may offer benefits. Once the hip replacement goes in, the pain goes away, and people can get back to their daily lives.