Hip Fractures

Are you experiencing pain over your outer upper thigh or groin?
Is it painful for you to flex or rotate your hip?

You may have a fracture of the hip. If your thigh bone has been weakened by an injury or a disease such as cancer, you may notice aching in the groin or thigh area for a period of time before the break. If the bone is completely broken, that leg may appear to be shorter than your non-injured leg.

Most hip fractures are caused by a fall or from a direct blow to the side of the hip. There are several medical conditions that can weaken the bone and make the hip more susceptible to breaking. In severe cases, it is even possible for the hip to break with the patient merely standing on the leg and twisting. A hip fracture is a break in the upper quarter of the thigh bone. The extent of the break depends on the forces that are involved.

Certain types of hip fractures may be considered stable enough to be managed with nonsurgical treatment, but surgery is frequently needed. Surgical results are better when performed soon after the fracture occurred. The type of surgery used to treat a hip fracture is primarily based on the bones and soft tissues affected or on the level of the fracture.

Total Hip Replacement

Do you have hip pain that limits everyday activities, such as walking or bending?
Do you experience hip pain that continues while resting or sleeping?
Do you have stiffness in your hip that limits your ability to move or lift your leg?
Does your hip pain continue despite having tried anti-inflammatory drugs, physical therapy, canes or walkers?
Does your hip pain affect your quality of life?

You may be a candidate for a total hip replacement. There are three types of arthritis that are the most common cause of chronic hip pain.

Osteoarthritis – which is typically age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older.
Rheumatoid Arthritis – which is an inflammatory arthritis. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.
Post-Traumatic Arthritis – which can follow a serious knee injury such as a fracture.

Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities. Hip replacement surgery is one of the most successful operations in all of medicine which is why more than 300,000 hip replacements are performed each year in the United States. In a total hip replacement the damaged bone and cartilage is removed and replaced with prosthetic components such as:

Metal Stem – The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone.
Metal or Ceramic Ball – A ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
Metal Socket – The damaged cartilage surface of the socket is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
Spacer – A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

Who Gets Total Hip Replacement Surgery?

There are no specific age or weight restrictions for hip replacements.
Recommendations for surgery are based on a patient’s level of ongoing pain and disability. not age. Most patients who undergo total hip replacement are age 50 to 80, but have been performed successfully from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Good news! Most patients who undergo total hip replacement begin standing and walking with the help of a walking support and a physical therapist the day after surgery. In some cases, patients begin standing and walking on the actual day of surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.

Hip Bursitis

Are you experiencing pain at the point of your hip?
Does the pain extend to the outside of your thigh?
Was your hip pain and intense at first, but now has become more of an ache?
Over time has your pain spread across a larger area of your hip?
Is your hip pain worse at night when lying on the affected hip?
Is your hip pain worse when you get up from a chair after being seated for a while?
Does your hip pain get worse with prolonged walking, stair climbing, or squatting?

You may be experiencing bursitis.Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.

What Is Hip Bursitis?

Bursitis is inflammation of the bursa. Bursae, are small, jelly-like sacs that contain a small amount of fluid, and are positioned between bones and soft tissues. Bursae act as cushions to help reduce friction during hip movement. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone, and another is located on the inside of the hip. When the bursa in the inside of the hip, the condition is still referred to as hip bursitis, even though the pain comes from the groin area.

Good News! There are multiple nonsurgical options to treat hip bursitis including:

Activity modification. Avoid any activities that worsen your symptoms.
Anti-inflammatory drugs such as Ibuprofen, naproxen, piroxicam, and celecoxib.
Assistive devices such as a cane or crutches, typically used for a week or more.
Physical therapy.
Steroid injection. This is a simple and effective treatment that can be done in the doctor’s office. It involves a single injection into the bursa. The injection may provide temporary (months) or permanent relief.

Surgery is rarely needed for hip bursitis. If you have exhausted all the nonsurgical treatments for hip bursitis we may recommend removal of the bursa. Hip bursitis surgery is done on an outpatient basis, and can be quite effective. If you are experiencing significant hip pain call the Orthopaedic Center of Vero Beach at 772-778-2009 to schedule an appointment. We’ll conduct a thorough examination which may include an MRI or CT scan, and discuss the best treatment option for you.

ABLE Anterior approach for hip replacement

ABLE Anterior Approach

If you've been told you are a candidate for hip replacement surgery, you may benefit from a minimally invasive surgical technique called ABLE Anterior hip replacement surgery. Put simply, this technique changes the direction from which a surgeon can access your hip joint.

With the ABLE Anterior approach, your specially trained orthopedic surgeon is able to repair your painful hip through a natural space between the muscles of the anterior (front) portion of the hip, rather than making the incision on the posterior (back) side, which has the potential of damaging the muscles that make up the primary support system for the joint. These are the muscles you spend weeks and months rehabilitating after surgery.

During this procedure the hip joint is exposed between the anterior muscles, without the need to cut tissue or detach tendons. Once access is gained, the portion of the upper thigh bone (the femoral head and neck) and the hip socket (acetabulum) are prepared for the insertion of the hip replacement implant, just as in a traditional procedure.

The hip replacement is comprised of metal and plastic components that replace the ball-and-socket elements of the hip joint. They are secured within the femur (thighbone) and acetabulum (hip socket) either with bone cement or by "press-fit," meaning the implants are shaped to achieve stability without bone cement. Through the use of X-rays, physicians can ensure the implants have the proper fit and alignment to ensure comfort and a natural range-of-motion after surgery.

Smith & Nephew offers a wide range of hip replacement implants and your surgeon will choose the most appropriate one for you. One consideration used in selecting your implant may be its resistance to the scratching and abrasion that can cause an implant to wear out before its time.

Advantages to utilizing the ABLE Anterior approach

This minimally invasive technique allows for preservation of the soft tissue surrounding the joint, allowing for immediate stability following surgery, as well as a possible lower risk of dislocation, as the primary support muscles are left intact.

Patients may have a shorter hospital stay, as there are typically fewer post-operative restrictions and the possibility of a faster healing time associated with this technique.

Important safety notes

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

BIRMINGHAM HIP^◊ Resurfacing

BIRMINGHAM HIP^◊ (BHR^◊) Resurfacing System

An alternative to total hip replacement. bhrsmall Younger active male patients who suffer from hip pain due to non-inflammatory arthritis (degenerative joint disease) such as osteoarthritis, traumatic arthritis, avascular necrosis, or dysplasia/DDH, or inflammatory arthritis such as rheumatoid arthritis, may benefit from the bone-conserving approach of the BIRMINGHAM HIP Resurfacing System (BHR). Unlike total hip replacement, which removes all of the bone within your ball and socket hip joint, the BHR resurfaces just a few centimeters of bone, preserving more of your original joint.

Candidates for hip resurfacing

Hip resurfacing is intended for younger active male patients in need of a hip replacement. The suitability of resurfacing as an appropriate treatment for you should be determined by your surgeon, including by a review of your bone quality and the size of your femoral head. Please discuss your options with your surgeon.

The implant

The BHR was CE marked in January 1997 and has been implanted in hospitals in Europe since then. It was approved for use in the United States by the Food and Drug Administration in 2006.

The BHR has two parts: the femoral head (the ball) and the acetabular component (the socket).

The benefits of the BHR technique and implant for appropriate patients may be significant. The implant's head size, its bearing surfaces and its bone-sparing technique could make it the right choice for active patients. In fact, the implant's rate of survivorship for men under the age of 65 is comparable to - and in many cases, better than - standard total hip replacements after ten years of use¹.

Head size

While the implant closely matches the size of your natural femoral head (hip ball), it is substantially larger than the femoral head of most total hip replacements. This increased size helps to reduce the risk of dislocation of the implant after surgery².

Bone conservation

The BHR implant conserves substantially more bone than a total hip replacement. Since it preserves the natural femoral neck and most of the natural femoral head, a well-placed BHR reduces concerns about post-operative leg length discrepancy. Also, should you need the implant to be replaced at some point in the future, you would be a candidate for a standard hip replacement stem as opposed to needing a longer "revision" stem-type, as is often the case when a traditional total hip replacement needs to be replaced.

The procedure

Total hip replacement requires the removal of the natural femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing, by contrast, preserves both the femoral head and the femoral neck.

During the procedure, your surgeon will only remove a few centimeters of bone around the femoral head, shaping it to fit tightly inside the BHR implant. Your surgeon will also prepare the acetabulum for the metal cup that will form the socket portion of the ball-and-socket joint.

The femoral component is cemented over the top of the prepared femoral head like a tooth cap, and the acetabular component is pressed into place much like a typical hip replacement component would be.

Why BIRMINGHAM HIP Resurfacing?

Long-term successful outcomes around the globe:

The Australian Orthopaedic Association National Joint Replacement Registry Annual Report 20153 showed BHR survivorship of 90.2% at 14 years follow-up, the longest of any resurfacing device.
BHR continues to be the most implanted resurfacing device world-wide and is the only hip resurfacing device with 14 years of registry data.
Great Britain's Oswestry Outcomes Centre's patient registry revealed BHR 10-year survivorship of 95.4%, with 98.6% of patients rating their opinion of the experience as pleased or extremely pleased⁴.

Important safety notes

Any surgery presents some risks for the patient. There are potential risks with hip resurfacing surgery such as fracture, infection, loosening, dislocation and wear that may result in the need for additional surgery. Females should not be implanted with the BHR. You should always follow your surgeon's recommendations as regards what you should and should not be doing after you have been implanted with a BHR. Early device failure, breakage or loosening may occur if you do not follow your surgeon's recommendations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or if you experience impact accidents such as falls. Hip resurfacing surgery is intended to relieve hip pain and improve hip function. Talk to your doctor to determine what treatment may be best for you.

References

Data on file, Smith & Nephew.
S. S. Jameson, D. Lees, P. James, Serrano-Pedraza, P. F. Partington, S. D. Muller, R. M. D. Meek, M. R. Reed. Lower rates of dislocation with increased femoral head size after primary total hip replacement. J Bone Joint Surg 2011;93-B:876-80.
Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2015.
Robinson E, Richardson JB, Khan M. MINIMUM 10 YEAR OUTCOME OF BIRMINGHAM HIP RESURFACING (BHR), A REVIEW OF 518 CASES FROM AN INTERNATIONAL REGISTER. Oswestry Outcome Centre, Oswestry, UK.

Disclaimer

The information presented about the BHR is for educational and informational purposes only. It does not constitute and is not a substitute for medical advice. Only your physician can advise whether the BHR may be suitable for you and your condition. You should consult your physician about whether the BHR constitutes an appropriate treatment option for you, and about the associated risks, benefits, contraindications, warnings and possible outcomes. Not everyone who receives a product or treatment will experience the same or similar results; results may vary depending on a number of factors, including each patient's specific circumstances and condition, and compliance with post-operative recommendations. Smith & Nephew is not responsible for the selection of any treatment by a physician to be used on a particular patient. Smith & Nephew makes no representations, warranties, guarantees or assurances as to the availability, accuracy, currency or completeness of the information presented or its contents. Smith & Nephew shall not be liable for any damages or injury resulting from your reliance on any information provided. Your use of the information is at your own risk.

OXINIUM^◊ Technology for Total Hip Replacement

What is OXINIUM^◊ Technology?

If it is determined that an implant made with OXINIUM^◊ technology is right for you, the femoral head or ball of your implant will be made from OXINIUM^◊ Oxidized Zirconium - a patented ceramicised metal alloy that Smith & Nephew spent more than a decade developing.

During manufacture, OXINIUM^◊ implants undergo a process that transforms the zirconium surface into a hard, ceramicised metal - while still retaining all of the durability of the underlying metal. This means that it won't fracture like a true ceramic, yet its ceramicised surface is more than twice as hard and therefore twice as resistant to the kind of scratching that can cause a cobalt chrome implant to wear out before its time.¹

An OXINIUM^◊ femoral head is typically combined with a liner made of highly crossed-linked plastic (XLPE). The combination of these materials is known as VERILAST^◊ Technology.

Important safety notes

References

Zardiackas, Lyle D., Kraay, Matthew J., Freese, Howard L, editors. Titanium, Niobium, Zirconium, and Tantalum for Medical and Surgical Applications ASTM special technical publication; 1471. Ann Arbor, MI: ASTM, Dec. 2005

What is XLPE?

hipxlpe

What is XLPE or highly cross-linked plastic?

As remarkable as OXINIUM^◊ Oxidized Zirconium is, it is the combination of the OXINIUM material on XLPE that makes provides wear protection on both surfaces of the implant.

XLPE is created by altering chemical bonds in the polyethylene we use to create our plastic inserts. By doing so, we are able to create a tighter weave at the molecular level, thus reducing the amount of wear experienced when the metal component rubs against it. Perhaps the easiest way to think of it is like a fabric with a higher thread count.

Important safety notes

The Polar3^◊ Total Hip Solution

POLARSTEM^◊ + OXINIUM^◊ Technology + R3^◊

Trusted Technology. Trusted Performance.

Chances are, if you've landed on this site it's because you or someone you know is considering total hip replacement. Chances are also pretty good that this means you have questions... lots and lots of questions. We understand and have designed this site to answer as many of these questions as possible. However, we strongly advise that you also talk to your surgeon about these questions and about all of the information you've found on this site. After all, no website can possibly know what's best for you or any other patient. Only by talking with your surgeon about all of your options will you be able to determine the right treatment for you.

Outcomes that outperform

According to the 2017 report of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJREW), with 99.02% implant survivorship, POLARSTEM with R3 is the best performing hip combination at 7 years regardless of fixation method.¹

When compared against the class average of cementless constructs in the NJREW, POLARSTEM has a:

46% reduction in overall femoral revision²
36% reduction in risk of dislocation²
61% reduction in risk of aseptic loosening²

Similarly, the R3 Acetabular System has a:

55% reduction in the overall risk of acetabular revision³
77% reduction in the revision risk from aseptic loosening³
44% reduction in the revision risk from malalignment of the socket³

The POLAR3^◊ Total Hip Solution

One of the most exciting hip replacement options on the market today is the POLAR3 Total Hip Solution. Although we call it a single solution, it is actually made up of three proprietary technologies that, when combined, can deliver extraordinary results that are designed to improve surgical outcomes and maximize patient satisfaction. Of course, you shouldn't just take our word for it. Instead, let's look at what is being reported in one of the largest joint registries around the world.

The POLAR3 System is a total hip solution, meaning that it includes a hip stem, a hip head and an acetabular cup. Together, these three components are designed to replace the ball and socket structure of your natural hip.

Important safety notes

References

National Joint Registry for England, Wales and Northern Ireland: 14th Annual Report. 2017
National Joint Registry for England, Wales and Northern Ireland. Implant Summary Report for POLARSTEM, dated 16 May 2018.
National Joint Registry for England, Wales and Northern Ireland. Implant Summary Report for R3, dated 16 May 2018

Hip Services

Hip Fractures

Total Hip Replacement

Who Gets Total Hip Replacement Surgery?

Hip Bursitis

What Is Hip Bursitis?

ABLE Anterior approach for hip replacement

Advantages to utilizing the ABLE Anterior approach

Important safety notes

BIRMINGHAM HIP◊ Resurfacing

BIRMINGHAM HIP◊ (BHR◊) Resurfacing System

Candidates for hip resurfacing

The implant

Head size

Bone conservation

The procedure

Why BIRMINGHAM HIP Resurfacing?

Important safety notes

References

Disclaimer

OXINIUM◊ Technology for Total Hip Replacement

What is OXINIUM◊ Technology?

Important safety notes

References

What is XLPE?

What is XLPE or highly cross-linked plastic?

Important safety notes

The Polar3◊ Total Hip Solution

POLARSTEM◊ + OXINIUM◊ Technology + R3◊

Outcomes that outperform

The POLAR3◊ Total Hip Solution

Important safety notes

References

BIRMINGHAM HIP^◊ Resurfacing

BIRMINGHAM HIP^◊ (BHR^◊) Resurfacing System

OXINIUM^◊ Technology for Total Hip Replacement

What is OXINIUM^◊ Technology?

The Polar3^◊ Total Hip Solution

POLARSTEM^◊ + OXINIUM^◊ Technology + R3^◊

The POLAR3^◊ Total Hip Solution