Surgical treatment options for hip replacement

Man golfing

Hip replacement surgery may be an option when pain limits your everyday activities such as walking and bending or when pain continues while resting or stiffness in your hip limits your ability to lift your leg. At Adventist Health Simi Valley, we take a multi-faceted approach to treating hip pain and injuries with the least invasive and simplest solutions. We start with conservative treatment options such as medication and lifestyle changes. However, if all conservative treatment options have been exhausted, then hip surgery may be a great next step. We offer several options:

Total hip replacement

Total hip replacement is a surgical approach that replaces a damaged hip joint with a prosthetic implant, commonly made of plastic, metal or ceramic materials. To perform a total hip replacement, the surgeon removes diseased or damaged bone and cartilage in the hip and replaces the damaged socket (acetabulum) with the prosthetic socket. The surgeon will fit a prosthetic ball on the top of the femur (thighbone) and join the ball and socket together. It requires a 4- to 6-inch incision just behind the hip, along the buttocks area and is performed in 60 to 70 minutes with the patient positioned on his or her side during surgery.

There are two methods of attaching the artificial joint to the existing bones: cemented and uncemented. In a cemented procedure, the artificial joint components are glued to the healthy bones of the pelvis and femur using special cement. An uncemented procedure uses artificial joint components made of porous material. Over time, the patient’s bone grows into the pores of the components, holding the new part in place.

Total Hip Replacement
Total Hip Replacement Post Surgery

MAKOplasty® total hip arthroplasty

MAKOplasty is a robotic arm assisted total hip replacement procedure designed for those suffering with degenerative hip joint disease. Prior to surgery, a CT scan of your hip joint is taken in order to generate a 3D virtual model of your unique anatomy. The 3D model helps your doctor see things he or she can’t typically see with an x-ray alone. This additional information helps your doctor determine the optimal size, placement and positioning of your implant.

Throughout your procedure, Mako provides real-time data to your surgeon. This allows them to continuously assess the movement and tension of your new joint and adjust your surgical plan if desired. Your surgeon guides Mako’s robotic arm to remove the arthritic bone and cartilage from the hip. A virtual boundary provides tactile resistance to help the surgeon stay within the boundaries defined in your surgical plan.

Inclination And Anteversion Feedback[1]

As the surgeon prepares to place the implant into its final position, the robotic arm guides the implant at the desired angle based on the surgical plan. This helps ensure the placement and alignment of the implant are performed according to the plan.

Minimally invasive total hip replacement – direct anterior approach

A minimally invasive or muscle-sparing approach means the doctor performs the surgery through smaller incisions. Incision size varies between three and five inches. Using minimally invasive techniques allows the patients to potentially have better function and it reduces rehabilitation time.

Direct Anterior Approach

Direct anterior approach (DAA) minimally invasive hip replacement surgery

The direct anterior minimally invasive approach is performed through a single incision on the front of the hip with the patient position on his or her back on a special surgical table so the surgeon can manipulate the leg during surgery. With this approach, your surgeon uses a 4- to 6-inch incision but will not have to detach any muscles or tendons. The procedure takes approximately 90-100 minutes. Most patients can return to normal function quicker and with less post-surgical pain. Other benefits include:

  • Does not require detaching or splitting the muscles
  • Allows for the use of both cemented or cement-less implants
  • Less risk of weakness in the nearby thigh (abductor) muscles
  • More accurate restoration of the limb length, less limb length discrepancies
  • No significant motion restrictions after surgery
  • A very low hip dislocation rate of approximately 0-2%
  • Patients quickly return to full function and normal gait (walking stride)
  • Significantly less pain than other hip replacement methods
  • No strengthening limits
  • No abductor (thigh muscle) pillows are necessary to restrict hip motion

Direct Superior Approach

Minimally invasive total hip replacement – direct superior approach

The direct superior minimally invasive approach is performed through a small incision at the upper side of the hip which helps the surgeon avoid cutting (and then reattaching) the key muscle group that enables you to walk and bend. That muscle group includes the IT band (or Iliotibial band) and the external rotators that connect your pelvis to your knee. Avoiding injury to that group of muscles and ligaments may potentially mean better hip stability and recovery.

With this approach, your surgeon uses a 3- to 6-inch incision1 at the side of the hip. The procedure takes approximately 90-100 minutes. Most patients can walk on it the same day of surgery. Other benefits include:

  • Avoids cutting the IT band1
  • Allows for the use of both cemented or cement-less implants
  • Minimizes impact on muscle and tendons
  • Patients are typically walking the same day of surgery under a doctor’s supervision
  • Patients benefit from enhanced hip stability and recovery after surgery1,2,3

1 Roger DJ, Hill D. Minimally Invasive Total Hip Arthroplasty Technique. Clin Orthop Relat Res (2012) 470:2227-34
2 Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: Description of a new technique. J Arthroplasty. 2006;21:1038-1046.
3 Penenberg BL, Bolling WS, Riley M. Percutaneously assisted total hip arthroplasty (PATH): a preliminary report. J Bone Joint Surg Am. 2008;90(suppl 4):209–220.

Virtual visits with orthopedics

Select patients can see our providers online from their home or office by using our Virtual Visit platform. This service allows you a fast, secure and easy way to receive care from the healthcare team in a live virtual visit using your phone or computer. The benefits of choosing a virtual visit include no travel or parking, less waiting, significant time savings and the convenience of seeing your physician from wherever you choose. Learn more

Want to learn more about the various types of hip replacements?

If you want to learn more about the types of hip replacements available, call our nurse navigator Kathryn Harada today. Kathryn brings a passion for helping patients learn about the options available. To speak with Kathryn, call (805) 955-6233 or fill out the form below.


Kathryn Harada, BSN, BA, RN, PHN, CNOR

To speak with our nurse navigator, fill out the form below:

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