Total Hip Replacement | Total Hip Arthroplasty (THA) – Direct Anterior

What is a total hip replacement or total hip arthroplasty (THA) surgery?

The hip joint connects the upper part of the leg to the lower torso. It is surrounded by 20 17 muscles that attach to the knee, pelvis, and spine. The femur (thigh bone) and the pelvis (hip bone) are the two bones that make up the joint. Often referred to as the ball and socket, the ball-shaped surface of the femoral head fits into a cup-like depression of the pelvic bone. Smooth cartilage connects the bones, stabilizing the joint and making it easy to move.

If you suffer from osteoarthritis or rheumatoid arthritis of the hip, the breakdown of cartilage and inflammation of the synovium (lining of the joint) leads to irreversible damage to the joint, causing pain and inflammationdisability. The definitive surgical treatment for end-stage hip arthritis – both osteoarthritis and any inflammatory arthritis – is a total hip replacement, also known as total hip arthroplasty. Total hip arthroplasty can also be the definitive surgical treatment for certain types of hip fractures.

A total hip replacement is a surgical procedure where the ball and socket of the hip joint are removed and replaced with an implant system (titanium stem, ceramic or metal head, plastic bearing, titanium alloy socket) to eliminate pain and restore function. Dr. Prem Ramkumar is trained to perform many different types of total hip replacements, but he exclusively uses the MAKO robotic arm. The data surrounding the use of this technology indicates that it potentially offers a more accurate operation and faster recovery (which has been consistent with Dr. Ramkumar’s experience), but this has not been yet universally accepted in large part due to the current void of high-quality research. It is important to understand that not all robotic joint replacements are the same, but that the MAKO is best-in-class and the most time-tested. Dr. Prem Ramkumar, total hip replacement surgeon, is located in Long Beach and serves patients in Los Angeles, Orange County, and surrounding Southern California areas.

What is MAKO robotic hip replacement surgery?

MAKO refers to the MAKO robotic-arm-assisted surgery system by industry leader Stryker. It assists Dr. Ramkumar with pre-planning the total hip replacement using a 3-D model of the patient’s hip by way of a preoperative CT scan. During surgery, Dr. Ramkumar uses the MAKO robotic arm to remove the diseased parts of the hip while preserving healthy bone and tissue. The MAKO then helps Dr. Ramkumar find the ideal position and size of the hip implant down to half a millimeter and half a degree with respect to your specific anatomy. Dr. Ramkumar uses the MAKO system because his experience is consistent with early data that it offers patients the fastest, most predictable, and safest recovery.

Who is a candidate for total hip replacement?

Most Total hip replacement surgeries are performed onis reserved for patients with advanced arthritis whose pain and function are interfering with their quality of life. Age does not dictate one’s surgical candidacy, although we prefer reserving this operation on older patients to decrease the lifetime risk of future reoperation between the ages of 50 and 80, with advanced stages of arthritis. Deciding when to have a total hip replacement is a deeply personal decision, and only you know when it’s time! Dr. Ramkumar only has the privilege of seeing you for a small window of your life, and only you know when your daily activities are replaced by pain and limited movement. Dr. Ramkumar can tell you when you’re a candidate for a total hip replacement after evaluating you, but he can never tell you if you “need” one. (Patients over 55, see “Dr. Ramkumar’s Practice Philosophy on Hip and Knee Replacement.”)

Does Dr. Ramkumar use the superior, transgluteal or anterior approach for total hip replacement?

Dr. Ramkumar has expertise in all approaches for total hip replacement. He prefers to use the direct anterior approach. However, also offers the direct superior approach (modified from a posterior-based approach) or a transgluteal approach. If there was a perfect, risk-free approach to do a total hip replacement, everyone would be doing it. There are advantages and disadvantages to all approaches. Dr. Ramkumar prefers the anterior approach because he feels they recover faster and there may be a lower complication rate – although the evidence is not definitive.

What is the recovery process after MAKO robotic hip replacement surgery?

Typically, you go home the next day following a total hip replacement. In some cases, you can go home the same day. Once home, you will use either a walker or crutches to get around and work with a physical therapist to do some light exercises and stair climbing.  Full recovery is variable and often dependent on the patient’s health status, working status, and recreational activities. Patients feel they can return to light duty work by by 2-3 weeks whereas some may benefit from 6 weeks.

How long does a total hip replacement last and what are the restrictions?

Thanks to advanced technology, a total hip replacement can last 20 to 30 years or even longer.

From an activity standpoint, Dr. Ramkumar does not have any restrictions on what you can or cannot do physically. Allow pain to be your guide. It is important you follow-up for maintenance checks at one year, five years, and ten years even if you have no issues! Assessment of the implants is important with follow-up to detect a problem before you may even realize it, although this is rare.

When you need to go to a dentist or undergo a colonoscopy, Dr. Ramkumar insists you take antibiotics beforehand. For dental visits, you should take Amoxicillin 500mg x 4 one hour prior to procedure; if you have a penicillin allergy, you should take Erythromycin 500mg x 2 one hour prior to procedure; and if cannot take Amoxicillin or Erythromycin then you should take Clindamycin 300mg x 2 one hour prior. For colonoscopies, you should take Metronidazole 500mg x 2 one hour prior to procedure.

What can I expect before and after the total hip arthroplasty surgery?

Dr. Ramkumar emphasizes the importance of establishing clear expectations and providing comprehensive pre- and post-surgery education. This proactive approach not only alleviates anxiety but also leads to an enhanced overall surgical outcome.

What does the process look like leading up to THA surgery?

We follow a detailed process and checklist to ensure your safety prior to undergoing total hip replacement. Although total hip replacement is a common operation, it is a very important life event, and we want to minimize as many preventable risks as possible.

Learn more >> Preoperative Assessment for Joint Replacement/Resurfacing Surgery

What happens after THA surgery?

Our post operative guidelines offer an overview of what you can expect after your surgery, such as:

• How do you address pain management and nausea after surgery?
• Between all the medications and physical therapy, what do the first few days look like after surgery?
• What do the first few days look like after surgery?
• What activities can I do right after surgery?
• Is swelling and bruising after surgery normal?
• Is it normal to have sleep issues after hip replacement and what can I do about it?
• When can I bathe after surgery?
• When can I drive after surgery?

Learn more >> Postoperative Guidelines for Joint Replacement/Resurfacing Surgery

Selecting an orthopedic hip surgeon with experience performing total hip arthroplasty is crucial to a positive outcome. Dr. Prem Ramkumar is located in Long Beach and serves patients in Los Angeles, Orange County, and surrounding Southern California areas.