Total Hip Replacement in New York

More than 300,000 people undergo total hip replacement each year in the U.S. Most often it is a result of degenerative changes due to arthritis, but sometimes the procedure is used to correct other injuries or issues as well.

For years, total hip replacement surgery used two primary techniques which involved accessing the joint from the back (or posterior) or from the side (lateral). Both techniques, while effective, involve cutting major muscle groups, therefore making recovery longer and more uncomfortable.

Anterior hip replacement surgery is a minimally-invasive technique that accesses the hip from the front, sparing the major muscles. Thus, minimizing tissue damage and recovery occurs more quickly and with much less discomfort.

What is Anterior Total Hip Replacement?

Anterior hip replacement uses a specially-designed operating table that allows the hip joint to be carefully positioned so, it can be accessed from the front. The procedure can be performed using general anesthesia or regional anesthesia with sedation, depending on each patient’s specific needs.

Fluoroscopy is a special imaging technique to properly position the joint replacement and ensure that the fitting is accurate.

The technique uses one incision about four inches long in the front of the hip so, the muscles located on top of the joint can be carefully moved to one side without the need to cut through them.Then gently separate the thigh bone or femur from the cup-shaped socket portion of the joint, called the acetabulum.

The socket portion of the artificial joint needs to fit firmly and securely, so, it is necessary to clean the socket and smooth its surface. Once the socket portion is in place, it is time to insert a durable liner to help facilitate joint movement.

They will then prepare the end of the femur after the acetabulum portion of the joint is in place. The femur portion of the artificial joint comprises a stem which they will insert into the femur and a head component, which makes contact with the hip socket.

After a careful evaluation of the placement of all the components comes closing the incision then putting a sterile dressing. They will give you complete instructions for post-op care, including information about physical therapy before the discharge. That will help you learn to use your new joint as well as helpful guidelines to ensure optimal joint function.

Potential benefits of anterior hip replacement compared to the traditional hip replacement surgery, may include the following:

  • total hip replacement XraySmaller incision
  • Minimal soft tissue trauma
  • Reduced post-op pain
  • Less blood loss
  • Shorter surgical time
  • Faster healing time
  • Less scarring
  • Earlier mobilization
  • Less post-operative restrictions
  • Reduced hip dislocations
  • Decreased hospital stay

Normally, after a posterior total hip replacement, your surgeon would give you instructions on hip precautions to prevent dislocating the new joint.  Hip precautions are very restrictive and usually include the following:

  • Avoid the combined movement of bending your hip and turning in your foot.
  • You should sleep with a pillow between your legs for 6 weeks.
  • Avoid crossing your legs and bending your hip past a right angle.
  • Use an elevated toilet seat.
  • Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes.
  •  Avoid low chairs

Recurrent Hip Replacement

Joanne needed a new hip. Doctors replaced her old joint with a titanium stem-and ball and socket, but she continued to have dislocations.
Dr. Karkare, was able to resolve the problem, and she was up and walking around in just a few short days, with no more recurrent hip dislocations, and the story made it onto the local news.

Hip Replacement FAQ’s

What is a total hip replacement?

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components.

How long is the hospital stay?

In recent years, the average length of a hospital stay for hip replacement surgery has decreased significantly. The average hospital stay is around 3 to 4 days after a hip replacement.

How long will it take to recover from a hip replacement?

Recovery from a total hip replacement generally occurs within six weeks. In most cases, however, you will be restricted to using a walker for few weeks after the surgery. You will gradually return to normal activities with no assistive devices at six weeks.

What Are Possible Complications of Hip Replacement Surgery?

Hip replacement surgery is generally a safe procedure. But as with any major surgery, there are potential risks involved. Complications can be general (medical) or specific to hip replacement. Certain medical conditions may increase the risks of surgery. Before the surgery, ask your surgeon the potential risks and complications associated with the hip replacement surgery.

What are the benefits of hip replacement?

The benefits of hip replacement include:

  • Relief from pain
  • Improved movement and strength
  • Restore function
  • Give a better quality of life
How long does a hip replacement last?

Longevity of Hip Replacements varies from patient to patient. Hip implants generally last more than 20 years.

What is the future of hip replacement surgery?

It is likely that we will see further development of resurfacing the joint biologically rather than replacing.

How does hip replacement surgery works?

When hip implants are inserted, new bone will grow onto the components to achieve fixation.

What is anterior hip replacement?

In anterior hip replacement we go from the front, absolutely no muscles are cut at all. We go between the muscles and do the hip replacement.

After getting anterior hip replacement, a major risk factor is the wound issues, which can happen especially in the proximal part of the wound. I do not do hip replacements on patients who have skin fold, which can interfere with the wound healing in the upper part of the wound, and on clinical examination I’m able to mind that.

The procedure itself takes a little longer than the classic posterior approach. In patients who have significant cardiac problems or significant medical problems in which expeditious surgery is very important, I do not use the anterior approach, because it takes more time to do.

What is direct anterior approach hip replacement surgery?

Direct Anterior Hip Replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles or tendons.

Traditional hip replacement involves cutting major muscles to access the hip joint.

Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions such as not bending over or crossing your legs to allow the cut muscles to heal.

However, for Anterior Hip Replacement patients, hip precautions are not necessary as no muscles are cut to gain access to the joint.

What are the advantages of anterior hip replacement?

The main advantage of the anterior hip replacement is the initial rehabilitation is much faster. Patients can let go of their assistive devices very, very quickly and they rehab pretty fast.

However, anterior hip replacement is not a panacea. It is not for all patients. You have to realize that there are certain risks that are associated with anterior hip replacement that are not associated with a posterior hip replacement. Patients with anterior hip replacements sometimes can get numbness on the outside of the thigh. That can sometimes be permanent. Most of the time patients do not notice this.

What are the advantages of anterior hip replacement?

The main advantage of the anterior hip replacement is the initial rehabilitation is much faster. Patients can let go of their assistive devices very, very quickly and they rehab pretty fast.

However, anterior hip replacement is not a panacea. It is not for all patients. You have to realize that there are certain risks that are associated with anterior hip replacement that are not associated with a posterior hip replacement. Patients with anterior hip replacements sometimes can get numbness on the outside of the thigh. That can sometimes be permanent. Most of the time patients do not notice this.

Are there any dislocation precautions after hip replacement, especially after anterior hip replacement?

After anterior hip replacement, there are really no dislocation precautions. But it is important that you do not arrange your hip through extreme motion. What we really don’t want is hyper-extension of the hip. Apart form that, there are really no dislocation precautions after a hip replacement, using the anterior approach.

What is Posterior Hip Replacement?

Posterior approach is an approach that has been used for many years. It is something which is familiar to most surgeons. I use it mainly if there are significant medical problems in which expeditious surgery is necessary.

I use it if there is posterior hardware in the hip, which means if the patient has had earlier surgery and there is hardware in the hip which has been placed through a posterior approach.

However, in the long term, after three months the results are similar for both anterior and posterior hip replacements. Posterior hip replacement is something that is still not thrown out of the window. There are very, very selective criteria that I use for patients who get anterior hip replacement from me.

What precautions should I take after a posterior hip replacement?

After getting a posterior hip done, after doing artificial hip replacement, using a posterior approach, the patient has to follow something called posterior hip dislocation precautions. What does this exactly mean?

After getting posterior hip replacement, the patient should not be crossing their legs. The patient should not be bending their hips beyond 90 degrees. The patient mainly should not be crossing their knees. It’s okay to cross the ankles, but not the knees.

What I tell my patients is that after the surgery, you should keep your knees separated. If you keep your knees separated, the possibility of dislocation is very, very low.

Labral Tear

What does a labral tear in the hip feel like?

A labral tear will manifest as pain in the groin. It will present as sharp pain, worse with activity.

Can hip labral tear heal on its own?

A labral tear of the hip does not heal on its own, just like the meniscus tear in the knee joint. However, with some therapy, some anti-inflammatory medication a labral tear can become asymptomatic. Not all labral tears are indications for surgery. As I always say, I treat patients not MRIs or x-rays. Labral tears seen on the MRIs and therefore is not asymptomatic and does not need to be treated.

Are hip labral tears common?

Hip labral tears are part of hip degradation. They are a precursor for hip arthritis. Hip labral tears are especially common where patients are predisposed to hip arthritis like patients who have hips dysplasia.

Can a labral tear in the hip cause back pain?

By itself, a labral tear in the hip will not cause back pain. It will present as pain in the groin; however, if the patient is walking with a tilt it can cause secondary back pain. Once the hip pain from the labral tear is resolved, the back pain should go away.

How do you fix a torn hip labrum?

A torn hip labrum is fixed using arthroscopy techniques. It’s very minimally invasive procedure; however, it’s particularly important to carefully select patients who are candidates for labral tear versus patients who are candidates for hip replacement surgery. With significant arthritis in the hip joint, patients are not candidates for labral repair.

Hip Dysplasia

What are the symptoms of hip dysplasia?

Hip dysplasia by itself is asymptomatic; however, there’s increased stress on the cartilage because of the shallow cup. That is a precursor for arthritis, so ultimately with hip dysplasia patients can develop hip arthritis.

To prevent hip arthritis in the early stages of hip dysplasia, there are certain osteotomies that can be done by highly specialized surgeons and those can avoid the need for hip replacement surgery. The other advantage of these osteotomies is that when the hip replacement is needed there is better coverage of the bone on the cup side.

Is hip dysplasia permanent?

Yes, hip dysplasia is something that presents in a child and it is a permanent condition. It means that the hip cup is shallow and there is concentration of stresses on the cartilage or the hip joint. This condition is a precursor for arthritis.

Is hip dysplasia disability?

Hip dysplasia by itself it not a disability; however, when it leads to arthritis the pain from the arthritis can be a disability. What is the cause of hip dysplasia? There are numerous causes of hip dysplasia. Some of them are preventable, most of them are not preventable and there is also a genetic cause for hip dysplasia.

Total Hip Replacement Case Studies

  1. Case Study 1
  2. Case Study 2

Why choose Dr. Kakare?

The anterior approach to total hip replacement surgery is a more recent advancement, and not every orthopedic surgeon has the skills and experience to perform the technique.

As a top joint replacement specialist in New York City, Dr. Karkare has extensive experience in anterior hip replacements, ensuring patients have the broadest array of safe and effective treatment options to relieve hip pain and other symptoms.

Dr. Nakul Karkare - NY Orthopedic SurgeonBefore any procedure is performed, Dr. Karkare performs an in-depth evaluation of each patient to determine if an anterior approach could be a good choice or if another approach might be preferred.

This enables every patient to make an informed, educated decision so they can feel confident in their care every step of the way.

To schedule your evaluation, call (212)951-0182 or use our online contact form to learn more.

Schedule Your Initial Visit

Contact Dr. Karkare

(212) 951-0182

Book Appointment

Send a Message

Dr. Nakul Karkare