 |
 |
In
a healthy hip, smooth cartilage covers the
ends of your hip bones, allowing the ball to
glide easily in the socket. Smooth weight-bearing
surfaces allow for painless movement. |
In
a problem hip, the cartilage "cushion" wears
away, and the bones rub together, becoming
rough and pitted. The ball grinds in
the socket when you walk, causing pain and
stiffness. |
Replacing Your
Problem Hip
A painful, stiff hip can keep you
from doing the simple things in life, even walking
without pain. Today, physicians can replace your
problem hip, thanks to improved surgical techniques
and materials. Total hip replacement is a safe,
reliable procedure that can relieve your pain and stiffness
and return you to most of the activities you enjoy. Nearly
600,000 primary hip and knee arthroplasties are performed
in the United States each year. Total hip arthroplasty
is the replacement of a worn out hip with an implant
that is designed to function like the patients own
joint prior to the onset of the disease process.
When Walking Hurts
As hip pain and stiffness increase,
you may find more and more things you cannot do. Simply
walking or getting up from a bench can hurt. Hip
pain and stiffness often result from osteoarthritis
(the breakdown of cartilage in your joints), which
makes your hip bones grate painfully together. Osteoarthritis
(OA) is the most common cause of musculoskeletal pain
and disability. Generalized susceptibility is
reflected by the age association, positive family history,
diabetes, and hypertension. Patients who have
had childhood hip disorders such as congenital dislocation,
Perthes disease, and slipped capital femoral epiphysis
are at an increased risk of developing OA at an earlier
age. This is because these childhood afflictions
alter the mechanics of the hip joint leading to increased
pressure and subsequently, early loss of articular
cartilage. Other causes of OA include trauma
or infection, both of which can lead to loss of joint
cartilage or altered joint mechanics.
All hip pain is not OA. There
are many disorders of muscle and soft tissue around
the hip that can mimic the pain caused from arthritis. Pain
from disorders in the spine such as spinal stenosis
or slipped disk can also be referred to the hip region. Other
hip problems include rheumatoid arthritis, injury,
and loss of blood supply to the bones of your hip.
Your Hip Anatomy
Your hip is a simple ball-and-socket
joint where your thigh bone joins with your pelvis. Surrounded
by cartilage, muscles, and ligaments, your hip is the
largest weight-bearing joint in your body. Smooth
cartilage and bone help you walk easily and without
pain. In the normal situation both the femoral
head and the acetabulum are covered with a thick layer
of articular cartilage. It is this thick layer
of cartilage that protects the underlying bone and
acts as a gliding surface (with less friction than
water on ice) during pain free joint motion.
|
|
In
a healthy hip, smooth cartilage covers
the ends of your hip bones, allowing the
ball to glide easily in the socket. Smooth
weight-bearing surfaces allow for painless
movement. |
In
a problem hip, the cartilage "cushion" wears
away, and the bones rub together, becoming
rough and pitted. The ball grinds
in the socket when you walk, causing pain
and stiffness. |
You New Hip
Technical advances have given us
new materials to replace your problem hip with a prosthesis
(artificial hip joint). Like your own hip, your
prosthesis is made up of a ball and socket that fit
together to form a joint. Our team chooses the
best prosthetic design for you after carefully diagnosing
your particular hip problem. In fact, 90% of
the hip replacements will still be in place at 15 to
20 years. Activities such as walking, swimming,
golf, and bicycle riding are all encouraged. Activities
involving impact loading of the hip joint such as basketball
and jogging are discouraged because they can accelerate
the wear of the plastic liner.
Your Orthopedic Evaluation
Our team specializes in bone and
joint surgery. Your surgery is recommended only
after diagnosis of your hip problem, including your
degree of pain and lack of mobility.
Your history includes questions
about your hip pain, medications you may be taking,
prior injuries, and other bone and joint problems you
may have, such as rheumatoid arthritis.
Your physical examination includes
assessing the range of motion in your hip and other
mechanical medical factors.
X-rays provide our team with a
picture of your hip bones and joints. X-rays
also help in the precise fitting of your new
hip.
Joint aspiration (removing a small
amount of fluid from the affected hip joint) to check
for infection may also be performed.
Before Surgery
In addition to following our team's
instructions, there are several things you can do to
prepare yourself for surgery. You may be asked
to lose extra weight, since extra weight puts extra
stress on your new hip. You will be asked to
AVOID ASPIRIN, BLOOD THINNERS, OR ANTI-ARTHRITIS MEDICATIONS
FOR TWO WEEKS PRIOR TO SURGERY to help decrease the
chance of post-operative lung complications.
Understanding the Risks
Total joint replacement is only
undertaken after all non-operative measures are exhausted. Because
hip replacement is an elective surgical procedure with
inherent medical risk, optimal medical status is assured
prior to surgery. Risks include infection, blood
clots, pneumonia, stroke, heart attack, loosening of
the hip, dislocation, fracture of bone or implant,
injury to nerve or blood vessels, leg length discrepancy,
persistent pain, and other post-operative complications. Infection
in your hip joint is the most devastating complication
of total joint replacement. Infection occurs
in .5% of all patients. Patient awareness of
this complication may prevent the need for removal
of the implants. It is important to seek medical
advice from your orthopedic surgeon as soon as possible
if your previously painless hip implant becomes painful. Diagnosis
of infection in the hip joint can be difficult. Your
doctor will discuss these with you before surgery. Make
sure you understand the risks and alternatives prior
to surgery.
Alternatives
Osteoarthritis is characterized
by joint pain and stiffness. The pain tends to
be aggravated by activity and is usually worse at the
end of the day. The pain can be felt in the groin,
buttock, or lateral thigh. Conservative treatment
entails gentle activity to maintain joint motion and
muscles strength. Non-steroidal anti-inflammatory
medication is helpful in reducing joint discomfort
associated with OA. However, over zealous use
of these medicines can be harmful in some situations,
and have been associated with side effects such as
GI bleeding, and liver dysfunction. Reduction
in the stress that the hip joint receives can be quite
helpful in reducing pain. This can be accomplished
with either weight loss or by use of a cane held in
the hand opposite the affected hip. Other alternatives
may also include alternate surgeries.
Your Surgery
You may be admitted to the hospital
one or two days prior to surgery. You cannot
eat or drink anything after midnight the evening prior
to surgery. The day of surgery, you may also
be given an injection to help you relax. You
can also expect an IV (intravenous) line for medications
and for blood transfusions, which are usually needed. Most
patients donate their own blood prior to surgery for
blood transfusions.
In the Recovery Room
After surgery, you may wake up
feeling a bit groggy. Specially trained nurses
will be with you to make you comfortable and give you
pain medication for any discomfort. A pillow
between your legs may be used to keep your new hip
in position. An IV provides antibiotics and fluids
if needed, and a small tube drains your incision. Your
nurses can help you with coughing and deep breathing
exercises, to help prevent lung complications and start
you on the road to a safe recovery.
Your Hospital Recovery
The key to your successful hospital
recovery is keeping your hip in position as it heals. After
a short period of initial healing, you will be started
on easy physical therapy exercises to promote healing
and get you walking again before you go home. While
you are in the hospital your surgeon and physical therapist
will teach you about the care of your new hip.
Initial Healing
After a total hip replacement,
you can expect to mobilize quite quickly. To
keep your new hip in position, you may have a special
bed that keeps your hip from bending beyond 90 degrees. An
abduction pillow keeps your legs shoulder-width apart
and prevents them from rotating inward. Support
stockings may be used to help prevent circulation problems. It
is important to remember that extreme positions, especially
in the early post-operative period, can cause hip dislocation. Do
not be afraid to use pain medicine liberally as post-op
discomfort can slow your rehabilitation.
Physical Therapy
Gentle physical therapy exercises
help strengthen the muscles around your new hip and
regain your hip's range of motion. As soon as
possible, your physical therapist helps you start walking,
a few steps at a time, to promote healing. As
you progress from a walker, to crutches, and then a
cane, you may feel somewhat off balance at first. Gait
training helps you regain confidence and your normal
walking motion before going home. The lengths
of both your legs will be measured. Sometimes
there will be a mild difference, because you now have
a new hip on one side and possibly a worn hip on your
other side. Occasionally, a shoe lift is used
to correct this.
Going Home
Once your hospital recovery is
complete, our team discharges you, and your nurses
can help you pack and make arrangements for going home
or to a rehabilitation center for a short time. Your
sutures and bandages are usually removed before going
home, and you may be given pain or other medications
to take with you. Before you leave the hospital,
you are given any necessary instructions for your safe
home recovery. Be sure to ask any questions you
may have.
Your Home Recovery
At home again, you will still need
to limit your hip bending; otherwise, your new hip
can slide out of position. Your family and friends
can help you follow our team's home recovery instructions,
especially important during the first few months of
healing.
Back at Work
Work can be resumed as soon as
you have greater than 90% of the strength back in your
leg, and can perform activities while in therapy that
mimic the range and flexibility required for your occupation.
Limit Hip Bending
With your new hip, your safe maximum
hip bend is 90 degrees. Four rules of thumb is
remember to keep your hip in position:
-
When sitting, keep your knees
below your hips (sitting on a small pillow helps).
-
Avoid crossing your legs while
lying down or sitting.
-
Avoid bending over at the waist.
-
Sit with your legs 3-6 inches
apart.
Some Helpful Hints
Follow tour doctor's advice on
using crutches or a cane to keep weight off your hip
as it heals.
To limit bending, you may want
to buy a raised toilet seat, a bath bench, long-handled
grippers to reach things on the floor, or other self-help
devices.
Playing golf with a cart, swimming,
upper-body exercises, and other moderate activities
are fine; more active sports such as tennis and skiing
are not recommended.
Since your balance may be off,
use hand rails and wear low shoes for your safety.
Before minor surgery or dental
work, remind your doctor that you have a prosthesis;
antibiotics are usually needed to prevent infection.
It is recommended that all total
joint patients have antibiotic prophylaxis for dental,
GI, and GU procedures that can cause transient bacterium,
which could possibly seed a normal implant. Instructions
regarding the right antibiotic and proper dose will
be given to you after your surgery.
Because people live longer now,
you may outlive your hip. Your prosthetic hip
can be replaced if necessary.
Caring for your Hip
Your hip prosthesis is the result
of years of research. But like any other device,
your new hip's lifespan depends on how you care for
it. In your follow-up visits after surgery,
your doctor will follow your progress and answer any
questions you may have about caring for your new hip.
Back in the Swing of Things
Replacing your problem hip with
an artificial hip can relieve your pain and stiffness
and return you to most of the activities you enjoy. A
problem hip can be safely replaced at any age, and,
with proper care, can last for many active years. With
your new hip, you can look forward to getting back
in the swing of things.
N.B. Post-operatively at home,
REPORT TO EMERGENCY IMMEDIATELY IF YOU NOTICE REDNESS
OF YOUR WOUND, DRAINAGE, CALF PAIN, SHORTNESS OF BREATH,
OR ANY CONCERNS.
| 
