1. Clinique Duval
  2. »
  3. Hip Surgery

HIP REPLACEMENT SURGERY

The Duval Clinic has been specializing in hip joint replacement for the last 15 years.

The super-specialist surgeons at Duval Clinic are experts at the types of surgeries used to repair the hip joint. Total hip replacement can be performed with ceramic on ceramic bearing, or dual mobility bearing. Your surgeon will make an assessment of the method that is most appropriate for your specific condition.

Below you will find many answers to your questions and how we can give you back your quality of life. Please consult the following tabs where we offer you brief answers. Our surgeons are happy to elaborate in detail with you during your consultation.

WHAT IS HIP JOINT DEGENERATION?

When the protective joint surfaces (cartilage) are damaged, they are rough and do not slide well together. The result is pain, stiffness, and inflammation. This is called joint degeneration or osteoarthritis. It can be secondary to a fracture, a bone defect, aging, normal wear and tear and rheumatoid arthritis.

HOW DOES IT MANIFEST ITSELF?

Presence of pain

  • at rest; increases with walking; inconvenient to sleep;
  • in the groin, buttock and thigh;
  • can be accompanied by stiffness and lameness.

Restriction of movements 

  • difficulty squatting, going up and down stairs, putting on socks.

You certainly have many questions on the subject, you will find brief answers below. Our surgeons will be happy to discuss these points with you in more detail during a consultation.

WHO SHOULD HAVE THE SURGERY?

Hip joint replacement is a solution to consider when the condition has not satisfactorily improved with non-surgical treatments and:
• Your activities are compromised;
• You have difficulty working or you can no longer work;
• Your quality of life is reduced;
• You have frequent pain;

The purpose of hip joint replacement is to improve your quality of life, relieve your pain, and allow you to return to an active life.

HIP REPLACEMENT SURGERY

Total hip replacement involves replacing both parts of the joint by inserting a metal stem into the thigh bone and a cup into the acetabulum (pelvic cavity). Surgery can be performed with different types of prostheses. In combination with our unique enhanced recovery protocol, our surgeons use specific implants with a bearing diameter close to that of your natural anatomy (> 36mm) to maximize your potential recovery. With these prostheses, there is little chance of dislocation and therefore there is no restriction of movement after surgery, contrary to what is seen after a standard hip replacement. Please see this scientific paper describing our philosophy.

TYPES OF PROTHESIS

The articular surfaces of the prosthesis can be made of metal, ceramic, or polyethylene. Each prosthesis has its own advantages and disadvantages; your expert surgeon will choose with you, based on your condition, the prosthesis most likely to give you the best result.

The Dual Mobility Prothesis

Years ago, our surgeons were the first to implant a dual mobility hip in Canada. Since then, we gained great experience using these prostheses. The bearing is made of cross-linked polyethylene and metal.  It has a large diameter allowing unrestricted range of motion after surgery and a very stable joint.  This prosthesis is generally proposed to patients over 65 years of age.

Please read this paper for more info.

Total hip prosthesis with large diameter ceramic surfaces

In 2011, we were the first surgeons in North America to implant this modern prosthesis. Since then, we did more than 4000 surgeries in young and active patients. Our clinical results are outstanding. This prosthesis will offer its advantages to young (usually less than 65y), and active patients looking to resume demanding work and sport activities. See the results of our first 250 patients in this scientific publication.

Below you will find many answers to your questions about how we can give you back your quality of life. Please consult the following tabs where we offer you brief answers. Our surgeons will be happy to elaborate in detail with you during a consultation.

AM I TOO YOUNG FOR A TOTAL HIP REPLACEMENT?

There is no minimum age for hip joint replacement. Your degree of pain and disability is the best indicator. In general, hip replacement is performed in people over 65 years of age for whom conservative treatments are no longer effective. However, if you are younger and severely affected by hip wear, improvements in prosthesis materials and surgical techniques allow most patients to lead a normal life and possibly keep their prosthesis for the rest of their lives.

For young and active patients, at the Duval Clinic, we use prostheses with ceramic surfaces. After more than 21 years, 97% of our patients have not required re-operation (see scientific article). We will be pleased to evaluate your condition and advise you on the best treatment options for your condition.

ANTERIOR OR POSTERIOR APPROACH, IS IT THE RIGHT QUESTION?
Total hip replacement was named the surgery of the century by the renowned scientific journal Lancet in 2007. Despite this success, no consensus exists on the best surgical approach (anterior, lateral, or posterior). The posterior approach is the most used worldwide. However, in recent years, orthopedic implant manufacturers and some surgeons have marketed the anterior approach intensively, giving the impression that this technique is superior. Choosing a surgeon over a surgical technique is crucial to success.
Anterior Posterior However, recent scientific literature does not confirm the superiority of the anterior approach over other approaches. On the contrary, several studies have reported that the anterior approach is associated with a higher risk of complications1: more significant blood loss, fractures, nerve damage, infections, wound healing problems, and longer surgery time. Above all, some studies have reported inferior clinical results compared to the posterior approach.1 The popularity of the anterior approach in recent years is, therefore, beginning to wane.
In an era when it’s easy to find information but challenging to validate, it’s vital to have an experienced professional who can provide the scientific information appropriate to your condition. Unfortunately, a trendy new technique is no guarantee of success. Whatever the surgical approach, the surgeon’s and his or her team’s experience and excellence remain essential in achieving safer surgery with the best possible results. Over the years and after thousands of procedures, your expert surgeon at Clinique Duval has modified and improved their technique to deliver exceptional care. It is possible not to cut muscles with both posterior and anterior approaches.

Clinique Duval surgeons use the posterior approach to enable their patients to regain a usual, pain-free quality of life. The distinguishing features of their practice are:

  • A subspecialized practice in hip replacement and years of experience as a teacher and researcher in the field.
  • An optimized care protocol that minimizes postoperative pain and maximizes recovery speed. Most of our patients do not take any opioids after surgery. This protocol’s recovery speed is very rapid, whatever the surgical approach.
  • Expertise in the use of large-diameter joint implants, offering maximum joint mobility while limiting the risk of instability. No movement restrictions are imposed after surgery.
  • A short skin incision and careful closure, without staples but rather with skin glue.

Clinique Duval surgeons have demonstrated in award-winning scientific studies2,3,4 that a modern (minimally invasive) posterior approach combined with the elements described above is the solution of choice for patients wishing to maximize their recovery after surgery and minimize the risk of complications such as dislocation (1 in 1000 chance). Choosing Clinique Duval is a guarantee of quality.

You can rely on our team.

References
1- Awad ME, Farley BJ, Mostafa G, Darwiche HF, Saleh KJ. The risk of hospital readmission, revision, and intra- and postoperative complications between direct anterior versus posterior approaches in primary total hip arthroplasty: a stratified meta-analysis and a probability based cost projection. HIP International. 2023;33(3):442-462. doi:10.1177/11207000211066454
2- Lavigne M, Therrien M, Nantel J, Roy A, Prince F, Vendittoli PA. The John Charnley Award: The functional outcome of hip resurfacing and large-head THA is the same: a randomized, double-blind study. Clin Orthop Relat Res. 2010 Feb;468(2):326-36. doi: 10.1007/s11999-009-0938-z. Epub 2009 Jun 20. PMID: 19543863; PMCID: PMC2807020.
3- Vendittoli PA, Martinov S, Morcos MW, Sivaloganathan S, Blakeney WG. Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts. J Clin Med. 2022 Mar 30;11(7):1918. doi: 10.3390/jcm11071918. PMID: 35407525; PMCID: PMC9000212.
4- Sivaloganathan S, Blakeney WG, Vendittoli PA. Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol. J Clin Med. 2022 Jun 8;11(12):3293. doi: 10.3390/jcm11123293. PMID: 35743363; PMCID: PMC9224899.

CAN I HAVE A TOTAL HIP REPLACEMENT IF I AM OBESE?

There is no maximum weight, but all complications associated with hip replacement surgery are increased: wound healing problems, infection, joint dislocation, etc. Therefore it is best to lose weight before surgery. However, the Clinic’s surgeons regularly perform joint replacements on overweight patients. With their experience, expertise, minimally invasive instruments, and special implants, we can optimize obese patient’s care.

IS THERE A MAXIMUM AGE FOR A TOTAL HIP REPLACEMENT?

There is no age limit for hip replacement surgery.

However, your overall health must be good enough for the surgery to proceed without major medical problems. Before surgery, a medical evaluation is performed by our qualified medical team at Duval clinic. Patients over the age of 80 are regularly operated at the Duval Clinic. Importantly, the Duval clinic is the only private orthopaedic clinic in Canada to offer hospitalization for more than 24 hours after surgery, providing a safe environment for recovery. There is no need to be transferred to a hotel after surgery! Our expert surgeons use special implants with a dual mobility bearing. Such prosthetic allows unrestricted activity after surgery.

WHAT IS PERSONALIZED SURGERY?

Hip arthroplasty is a highly effective procedure.  Unsatisfactory clinical outcomes may be due to the neglect of each individual’s unique joint anatomy and kinematics. The Clinic’s surgeons are international leaders in the application of the personalized anatomical biomechanical reconstruction philosophy. This technique aims to reproduce the patient’s native anatomy, thus improving functional results (see this text on the subject). One of our surgeons, Dr. Pascal-André Vendittoli, is the president and founder of the Personalized Arthroplasty Society

WHAT RESULTS CAN BE EXPECTED FROM THE SURGERY?

Hip replacement is a very effective surgery with a high satisfaction rate. Most patients experience a significant reduction in pain and can resume many of the activities they had neglected since the onset of their disease. However, it should be noted that the full benefit of the surgery is often not achieved until 4-6 months after the operation.  With our optimized recovery program, the evening of the surgery, you will be able to stand and start walking. You will resume your normal activity of daily living in the weeks after surgery. Sport activity and physical work are usually resumed after 2 to 3 months.

WHAT WILL HAPPEN AFTER SURGERY

Thanks to our enhanced recovery protocol, post-operative pain should be well controlled and acceptable. Back to your private room, you can eat a full meal and drink whenever you feel like. You will get up for the first time 2-4 hours after the surgery with the assistance of the nurse and physiotherapist. The physiotherapist will help to improve the range of motion of your hip, start muscle strengthening exercises, and start walking.

Once the surgery is over, your prosthesis is firmly anchored to your body. Until you are stable and safe to walk, the use of a walker or cane is recommended (usually 1-4 weeks). Follow the recommendations given by your physiotherapist.

From day one, you will need to follow the exercise program that you will learn before your surgery. You will then do these exercises at home to walk properly and resume your household and sports activities.

We use skin glue to close the incision. This will help reduce discharge from the wound after surgery. You can take a shower starting from the first day after surgery, since the dressing is well adhered to your skin.

Your stay at the Clinic will last 1 to 2 days. When you leave, an appointment will be made for you to see your surgeon approximately 4 to 8 weeks after the surgery. You will be given the required prescriptions for your medications, necessary equipment, as well as a requisition for x-rays.

HOW LONG WILL I STAY IN THE CLINIC?

The Duval Clinic is the only private clinic in Canada that specializes in hip and knee replacements and offers patients private rooms during their short stay. The length of stay varies from one patient to another between 1 and 2 days. Your orthopaedic surgeon and a physician specialized in pre- and post-operative orthopaedic care will provide a safe environment for your recovery.  However, the advancement of operative techniques, optimization of postoperative pain control, better organization of home care, as well as effective multidisciplinary collaboration have made it possible to offer you the possibility to spend less than 24 hours in the clinic after your surgery and have an organized and safe discharge. Your surgeon and attending team will inform you if you are eligible for this accelerated recovery protocol (day surgery).

CAN I PLAY SPORTS WITH A TOTAL HIP REPLACEMENT?
  • 1-2 weeks after your surgery you will be able to start using a stationary bike.
  • 3 to 4 weeks after surgery, you can return to the pool for some water walking or gentle swimming. It is important that the wound is well sealed;
  • During the first 3 months, you should avoid regular and intense sports but can resume social dancing, gardening, bowling, and golf.
  • After 3 months, depending on your condition and the prosthesis used, your surgeon will allow or advise against activities with repeated impacts and pivots such as: jumping, jogging, volleyball, soccer, basketball, aerobic dance, hockey, racquet sports, karate, etc.

    To learn more, please read this article.

    Talk to your surgeon at the clinic for recommendations specific to your condition.

    Sir John Charnley

    British orthopedic surgeon Sir John Charnley is the “father” of the total hip replacement. In 1962, he successfully implanted the first modern total hip replacement. A very prestigious scientific award was created in his name by the American Hip and Knee Society. 

    This distinction was awarded in 2009 to Dr. Martin Lavigne and Dr. Pascal-André Vendittoli, two surgeons practicing at the Duval Clinic. Read the scientific article that earned them this award and the associated press release.

    Another pioneer in orthopaedics

    Montreal orthopaedic surgeon, Dr. J. Edouard Samson is a founding member of the Canadian Orthopaedic Society. In his honour, the university training program at the Université de Montréal is named after him. The Canadian Orthopaedic Foundation annually awards the J. Édouard Samson Prize to an orthopaedic surgeon for the quality of his/her research program. In 2016, Dr. Pascal-André Vendittoli, a surgeon at the Duval Clinic, won this award for his work on optimizing the care of patients requiring joint replacement(s).

    Contact the clinic
    By Telephone: 514-500-7432
    By Fax: 450-663-0776

    Opening hours

    • Monday to Friday from 9:00 a.m. to 4:00 p.m.
    • The hospitalization unit is open 24 hours a day.

    Address:  1487 des Laurentides Blvd, Laval (Quebec) H7M 2Y3