Currently, several causes requiring hip replacement surgery have been discovered. The most common cause in Thailand is hip joint necrosis due to blood supply deficiency, which occurs when the blood vessels supplying the head of the femur are blocked or severed. This is commonly found in the elderly, whose bone density decreases with age, causing joint surfaces to wear down or in patients with rheumatoid arthritis. In middle-aged people, it is often found among alcohol drinkers and those who have been taking steroids for a long time, leading to blood thickening and vessel blockage that cannot nourish the head of the femur, or due to injuries causing fractured hips, making the hip bone soften and collapse like a dilapidated house.
Prevention is better than cure, it might be too late to fix when it’s worsened
The symptoms of this disease include chronic hip pain, both during movement and at rest, feeling tightness in the hip when getting up or sitting down, feeling pain under weight bearing, and difficulty going up and down stairs. Treatment varies at each stage, starting from medication, physical therapy, to surgery.
Currently, the number of patients with hip joint diseases in Thailand has increased. The statistics of osteoarthritis and arthritis are approximately 3.5% of the total population. At the age of 25, the prevalence of degeneration is 4.9%, at age 45 it is 19.2%, and at age 60 the likelihood of degeneration rises to 37.4%. Furthermore, there are more than 25,000 cases of hip replacement surgery annually.
If surgery is necessary, the new method of hip replacement surgery without cutting muscles is another option worth considering.
Traditional Surgery VS New Approach Surgery
Traditional surgery that requires cutting through the back (Posterior Approach) or sometimes through the side of the hip (Lateral Approach), and involves cutting a significant amount of muscle, compared with the new approach, which is a surgery from the front side by splitting two muscle groups. This results in a faster recovery time.
Traditional surgery requires cutting through the back and sometimes the side, where the patient has to lie on one side with a leg rotation, cutting the muscles behind the hip, which are very thick, for hip replacement. After the surgery is completed, the muscle is then sutured closed. This traditional method results in a longer and painful recovery time and also requires caution to prevent hip dislocation because when operated from the back, excessive leg rotation or bending can easily cause the hip to dislocate. Patients are thus instructed to avoid many activities, have to sit on a high chair for a long duration of 6 weeks, sleep with legs apart, and are not allowed to bend their knees. Patients have many pre-cautions.
Compared to the new approach surgery, which may take a similar time but the recovery is much faster. The surgery is performed from the front of the hip (Direct Anterior Approach) where the patient lies on their back, reducing anatomical disruptions. Then, the instruments are used to separate muscles between Tensor fascia lata and Sartorius without cutting any muscle. During the surgery, the surgeon uses a C-ARM fluoroscope to ensure accurate placement of the hip prosthesis and to assess the length of the hips, eliminating concerns about leg length discrepancy after surgery.
In addition, the incision is only 3 – 4 inches long (results may vary among individuals) and very shallow. For women who care about aesthetics, the incision can also be hidden under a bikini line (Bikini Incision). The new approach locks the newly inserted prosthetic hip naturally with the hip muscle, eliminating worries about hip dislocation. With less blood loss, patients recover quickly, experience less post-surgical pain, and can walk normally without limping. They can return to their daily life, work, and sports within 2 – 8 weeks. Many patients are also able to walk immediately without having to worry about placing weight on the hip.
The Hip and Knee Center at Bangkok International Hospital also offers a pre-surgical digital templating called Digital Template Surgical Planning. This technique uses a 1-inch size ball marker during the X-ray for templating. Then it calculates the required size and degrees of angles. This software selects the appropriate size of the hip prosthesis that can be used and is fully adjustable, unlike the previous method of roughly placing a diagram over the X-ray sheet, which had a high chance of error. This software allows for rotating and examining the angle of inclination for more accurate results.
According to global studies, surgeries via the front approach have a low percentage of dislocation of the hip prosthesis, between 0 – 0.5%, while surgeries through the back approach have a dislocation chance of 2 – 4%. The side approach surgeries have a dislocation risk between 1 – 2%.
There are several types of materials for the hip prosthesis to choose from, depending on the doctor’s diagnosis. These include ceramic, plastic, and metal options. For younger patients, ceramics might be recommended due to their longer lifespan compared to other materials. However, lifestyle factors are also considered because if someone enjoys running, a combination of ceramic and plastic might be chosen for durability. Therefore, this new approach of surgery brings great comfort to patients.
