Hip replacement surgery is in an exciting time of innovation and evolution. Multiple competing techniques and advances offer easier, less-invasive procedures with lower risk and fewer complications like postoperative pain or dislocations.
Navigating the sea of new information in search of inspiration and instruction can present a daunting chore. This article provides a brief overview of the state of modern hip replacement surgery, along with 31 instructional hip replacement videos to illustrate the various techniques. The videos cover the lateral, posterior, anterior, and anterolateral approaches, plus minimally invasive methods and cemented vs non-cemented components. (Article updated 6/25/17.)
What is Hip Replacement?
Hip replacement is the most common orthopedic surgical procedure. Used primarily to treat arthritis pain and certain fractures, it can involve total hip joint replacement or partial (or hemi) replacement. With total hip replacement, both the acetabulum and the femoral head are replaced with implants. With hemiarthroplasty, only the femoral head is affected.
As the 31 videos below demonstrate, the procedure is involved and technical, but can be minimally invasive. Patient satisfaction for this procedure varies widely. The average cost in the U.S. is about $40,000, while in Europe it runs a much cheaper $8,000.
Techniques
There are several common hip replacement techniques in use today, with the most common being the posterior approach and the modified anterolateral approach. We’ve included several examples of each technique in the Hip Replacement Videos section below.
- Lateral. In the lateral approach to hip replacement surgery, the surgeon must elevate the hip abductors to access the joint. This approach carries a lower risk of dislocation than the posterior approach, but some critics say poor healing of the abductor muscles can lead to weakness and chronic pain. See a lateral hip replacement video here, with several more in the sections below.
- Posterior. The posterior approach provides excellent access to the femur and acetabulum. It results in less risk of postoperative abductor dysfunction. Some critics point to a high rate of dislocation, though repair of the piriformis, capsule, and short external rotators decreases the risk. There’s a good video of using the posterior technique here, and several more in the sections below.
- Anterolateral. This approach enters between the gluteus medius and the tensor fasciae latae. The surgeon detaches the gluteus minimus, gluteus medius, and hip capsule, then repairs them with a heavy suture. See a demonstration of the anterolateral technique in this video, with several more below.
- Minimally invasive. This hip replacement technique (see videos below) attempts to decrease the damage of soft tissue with a smaller incision size. Decreased visibility can cause excess soft tissue injury and fractures. See an animated example of the minimally invasive technique here.
- Anterior. This approach enters between the tensor fasciae latae and the sartorius muscle. It was originally used for the repair of pelvic fractures. It helped decrease dislocation rates with older, small-diameter hip implants. It also provides quicker recovery time with less pain. There’s a 4-minute animated video of the anterior approach here, and more below.
Implants
There are three parts to any hip replacement system. To view them in action, see this video demonstration of installing the parts in a skeletal model.
Femoral Component. This component fits into the femur. They can be fixed with either a cemented or uncemented stem.
Acetabular Cup. This fits into the acetabulum or hip socket. It’s attached with either cement or friction and can be modular or one-piece (monoblock).
Articular Interface. The articular interface fits between the femoral component and the acetabular cup. It consists of a ball and socket joint.
Risks
As with any invasive surgical procedure, hip replacement comes with its own set of risks. These include death, deep vein thrombosis, fracture, dislocation, postoperative loosening, osteolysis, metal toxicity, and several others. Hip implant failure, nerve palsy, chronic pain, and leg length inequality can also result. See a short patient education video here about the risks of hip implant surgery and some techniques to diminish them.
Alternatives to Hip Replacement
Alternatives to hip replacement surgery include conservative management, hip resurfacing, hemiarthroplasty, and viscosupplementation. Conservative management uses a mix of medication, physical therapy, and activity modification to delay or even prevent the need for hip replacement. Hip resurfacing has become common in Europe over the past 15+ years. It returns greatly improved metrics for patient satisfaction and quality of life.
There’s a surgical demo video here of a hip resurfacing procedure.
31 Useful Hip Replacement Videos
The list of videos below includes hip replacement surgical videos that demonstrate the lateral, posterior, anterolateral, minimally invasive, and anterior techniques. The list also includes short animation demos, patient orientation videos, and a very clear visual example of installing a hip implant in a skeletal model. All videos are grouped by technique.
Lateral
Total Hip Replacement Surgery. 2011, 1.5 hours. Excellent and very informative SD video with full views of OR and closeups of incision. Very informative and engaging narration. By Dr. Pasquale Petrera, MD at PRMC, Salisbury, Maryland.
Live Surgery – Total Hip Replacement. A 20 minute, 2014 video from Dr. Laude with excellent visuals and narration, demonstrating the entire procedure.
https://www.youtube.com/watch?v=fN10ycgxw_c
Total Hip Replacment by Lateral (Hardinge) Approach. 2016, 3 minutes. Excellent, short, very well edited HD video with almost no narration but great use of cutaways and titles to get the points across.
Total Hip Arthroplasty, Direct Lateral Approach. 2014, 10 minutes by Taninnit Leerapun, MD, Chiang Mai University, Thailand. Good English subtitles, excellent HD visuals, good editing. No narration or OR sound. Audio is piano music.
Bipolar Hip Arthroplasty Technique, Monoblock. 2014, 10 minutes by Dr. B. Dudani. Good quality standard definition video with good editing and titles. Narration is good and thorough but somewhat accented. Interesting sitar soundtrack.
How to – Total Hip Replacement Arthroplasty- A Guide. 2015, 16 minutes. Excellent full HD video though the introduction doesn’t look it. Patient sustained femur fracture five years before the operation. Hybrid implant with cemented acetabular cup but non-cemented stem.
Lateral Approach to the Hip Joint. 2014, 14 minutes. Standard definition video of lateral approach hip replacement on cadaver. Informative but somewhat stiff narration.
Direct Lateral Approach. 2012. Taninnit Leerapun, MD, Chiang Mai University, Thailand. Good visuals in HD quality with OR sound and Thai language discussion.
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Posterior
Hip Replacement for Bent Femur. 2017, 9 minutes. Excellent HD quality video with closeups and great angles into the incision. Procedures uses a cemented Marathon cup and Corail HA coated stem. Some OR sound, no narration.
Surgical Video – Posterior Total Hip Replacement. 12 minutes, 2016 from Dr. T. J. Panek at Twin Cities Orthopedics. Good standard definition video with no OR sound but excellent narration. Somewhat oblique views into incision.
Posterior Approach to Hip for Total Hip Arthroplasty. 2017, 7 minutes. Standard definition video shows acetabulum fracture fixation, femoral head fixation. Good narration and instruction. Operation is performed on cadaver.
https://www.youtube.com/watch?v=SNpDPOQYN0w
Minimal Incision Posterolateral Hip Replacement. 2013, 14 minutes. Standard definition video. No OR sound, no narration, but good titles explaining the procedure. Occasionally occluded views.
Hip Replacement Surgery (Hip Arthroplasty). 2010, 6 minutes. Good quality standard definition video with excellent, engaging narration and instruction by Dr. Al Muderis of Australia.
Anterolateral
Anterolateral Approach to Hip, Modified Hardinge. 2016, 6 minutes. Excellent video with very instructional narration and superb visual overlays and annotation. Beautiful HD footage. Very clear with good angles.
Anterolateral Approach to Hip Joint (Watson Jones) for Fracture. 2017, 7 minutes. Excellent, standard definition instructional video of hip replacement on a cadaver.
https://www.youtube.com/watch?v=rFW9FFULbF0
Anterolateral MIS (ALMIS) Total Hip Arthroplasty. 2014, 15 minutes. Dr. N. Roidis of KAT Hospital, Athens, Greece performs hip replacement in this video. Somewhat jerky, no narration but good editing and subtitling.
Total Hip Replacement Surgery. 2012, 15 minutes. Slightly poor quality SD video narrated expertly by Dr. Frank Ebert MD, Chief of the Total Joint Service at Medstar Union Memorial Hospital.
Minimally Invasive
Kepley Total Hip Replacement. This 20 minute video demonstrates a minimally invasive, direct lateral approach, claiming improved safety over the anterior approach, and a lower risk of complications like dislocation or fractures. 2013, High Definition.
Total Hip Replacement Anterior Approach, Minimally Invasive. 2015, 13 minutes. Excellent video from Akram Kasmi with informative narration, great visuals, inset views. Editing is a little jumpy, but that’s why the video can be so short. View into incision is somewhat oblique.
Minimally Invasive Hip Replacement Surgery. 2012, 52 minutes. Good video by Dr. Barry Waldman showing minimally invasive technique. Metal-on-metal. Good standard definition example with mostly good views of the procedure and good narration.
Anterior
Direct Anterior Hip Replacement by William Kurtz MD. 2014, 50 minutes. Full HD, excellent quality, close up with extremely steady image. Fantastic, engaging, very instructional narration with lots of insight into the procedure. Cutaways to some X-Ray views.
Direct Anterior Total Hip Replacement Surgical Procedure Video. 15 minutes. This excellent 2013 standard definition video posted by Firas Haddad shows a good, clear view of the procedure, with operating room sound and good narration and explanation. Occasional screen captures from diagnostic equipment.
Animated Hip Replacement Surgery Demo. 4 minutes. Good, standard definition animation with competent if not engaging narration from 2011. Shows anterior method. Narrated by Dr. Paul Gallogly.
PBS “The Latest Procedure” Special on Anterior Approach Total Hip Replacement Surgery. A one hour, highly produced video from 2014 that demonstrates the anterior approach, including interviews with doctors and patients and full OR views, with excellent doctor narration.
Direct Anterior Approach Total Hip Replacement: Muscle Sparing Technique. 2016, 9 minutes by Van Den Eeden Hip Clinic. Excellent, steady HD visuals with good views into the incision and very educational narration.
Hemiarthroplasty Hip Through Direct Anterior Approach. 2017, 5 minutes. Decent standard definition video by Dr. C.P. Das in Cuttack, India. Good views into the incision, very close up. Good narration with some OR sound. Watch out for the loud test tone at the beginning.
Direct Anterior Hip Replacement Surgery Explanation. 2016, 4 minutes. In this video, Dr. Rodriguez-Elizalde at Humber River Hospital in Canada describes the procedure’s benefits with the Hana table.
Uncemented
Uncemented Total Hip Replacement. 2016, 25 minutes. Superb quality HD video with very informative, somewhat accented narration. Visuals are slightly jerky and very close up.
Additional Video Topics
Hip Replacement Surgery Techniques by Dr. Scott Devinney. 20 minutes. 2015. Here’s an excellent, highly engaging lecture video delivered to a conference room crowd, complete with a very well developed PowerPoint deck and animated examples.
Hip Replacement Surgery – PreOp Patient Education. 5 minutes. This 2013, HD animated video preps patients on the meaning, methods, and expectations surrounding the hip replacement procedure.
Total Hip Replacement Educational Video. 3 minutes. Here’s an animated instructional video from 2015 that shows a skeletal view of hip replacement surgery. Good quality, if a bit academic.
Total Hip Replacement – Day 1. A 6-minute video that shows a patient taking his first steps 18 hours after surgery. 2016.
How To Recover From Hip Replacement Surgery. A 2012 HD patient instructional video from Jonathan Nissanoff about how to rehab most effectively after a hip replacement. Excellent quality with patient interviews and case studies, very well put together.
Total Hip Replacement System- Cemented. 2015, 10 minutes. This video shows the installation of a cemented hip implant on a skeletal model.
Direct Anterior Approach Hip Replacement for Patient Instruction. 2012. 5-minute HD animated video to prepare patient expectations before a hip replacement procedure.
https://www.youtube.com/watch?v=rg2X5UuLImo
Fractured Hip Replacement Video. 2012, 7 minutes. From an award-winning presentation at the American Academy of Orthopaedic Surgeons. Shows partial hip replacement that restores normal function.
Minimally Invasive Hip Replacement. 2016. 7-minute video detailing the reason for hip replacement surgery, mostly for patient instruction and orientation.
Conclusion
The constantly and rapidly evolving world of hip replacement surgery presents new, attractive opportunities for both surgeons and their patients. The videos above showcase the numerous approaches to hip replacement, displaying techniques and variations from across the U.S. and all over the world.
Do you have a comment or would you like us to add your video to the list? Just post a comment below! While you’re at it, look into saving real money on your biohazard waste disposal needs with MedPro. See our nifty savings calculator to see how much money your practice can recoup over the outmoded, rapidly rising price systems of the past.
