“It’s the best thing I’ve ever done for myself!”

Michelle Cunningham has a new mantra for those unsure about getting a hip replacement. Just get it done!

“It’s the best thing I’ve ever done for myself,” said Cunningham, 61, of Foxboro, who once again challenges herself with walking, exercising, skiing, running, and a future goal of horseback riding since her right hip replacement in April 2023.

“During the COVID-19 pandemic I did a lot of walking with hand weights and began to notice that my right hip felt a bit off,” said Cunningham. “I had injured my hip a few years earlier and I think I probably developed arthritis. That was confirmed when I had it checked.”

Cunningham did physical therapy for two years, which helped but, in the end, she needed surgery to replace her hip.

“My girlfriend’s sister recommended I see Jonathan Sunkin, MD, an orthopedic surgeon at Falmouth Orthopedic Center locations in Falmouth and Sandwich, because he had replaced one of her hips and surgically repaired another, and she spoke very highly of him,” said Cunningham. “When I saw him, he told me I could try physical therapy again, but eventually, I would not be able to move as I wanted to because my hip was becoming bone-on-bone, and it wouldn’t get any better. That’s when I decided to have the surgery.”

Hip Replacement Surgery

Hip replacement surgery involves replacing the hip joint with artificial implants that include a ceramic ball and a metal cup with an inner plastic lining. Once the old hip is removed, the ceramic ball with a metal stem is placed on the top of the femur as the metal stem is inserted into the top of the thigh bone (femur). The metal cup is placed into the socket part of the hip bone (acetabulum). This allows the new joint to rotate smoothly.

“There are two approaches to doing hip replacements,” said Dr. Sunkin. “There is the direct anterior approach and the posterior approach, that is the traditional way.

While both surgeries use the same orthopedic parts, Dr. Sunkin explained there are differences in the two surgeries:

Direct Anterior Hip Replacement Surgery

• The incision is relatively small and is made in the front of the thigh.
• The surgeon accesses the hip and femur by separating the tensor fascia latae muscle and the sartorius muscle and going in between the two muscles.
• The patient lies on their back on a special table, known as a Hana table that allows positioning the patient in a way that helps the surgeon visualize and access the femur (thigh bone) to remove the ball part of the old joint and insert the stem of the new hip joint into the top of the femur. A ceramic ball with a plastic liner is placed in the hip joint. X-rays are used throughout the surgery to assess the size and exact position of the implants in real time. The leg lengths are measured to make sure they are the same.

Posterior Hip Replacement Surgery

• The posterior approach involves a long incision in the back of the patient’s buttock to access the hip and visualize the femur.
• The surgeon splits the gluteus maximus muscle and cuts the short external rotator muscles to gain access and replace the hip. The muscles are repaired at the end of the surgery.
• The patient lies on their side.
• Measurements are taken to ensure leg lengths are the same.

Dr. Sunkin uses the anterior approach for 95 percent of his hip replacement patients. He will occasionally do a posterior approach when a patient has orthopedic hardware from an old fracture, or they have a rod in their leg. The advantage of a posterior approach in these situations is the ability to make the incision as large as necessary to gain access to the femur.

“Hip replacement surgery, whether it is anterior or posterior, is a major operation and it always impresses me how quickly patients do feel better,” he said. “Hip replacements are typically good for 20-30 years and are designed to wear out like other mechanical parts. The stem and cup are titanium and the ceramic ball contains a plastic liner, which is the most advanced part of it because it is made with highly cross-linked polyethylene.”

Cunnigham offers the following advice for those who may be hesitant to get a hip replacement.

“You will know when it’s time and, once you do, forge ahead and don’t hedge about getting it done,” said Cunningham. “It will only get worse and you’ll no longer enjoy what you used to be able to do without the replacement. Dr. Sunkin is very efficient and will answer all your questions. He will be there as long as you need him to be, and I highly recommend him.”