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Hip Replacement

Hip Replacement

Who Needs a Hip Replacement?

Hip replacement is an operation in which a damaged hip joint is removed and replaced with an artificial joint. There are many medical conditions that can damage the hip joint.

Reasons for Hip Replacement

The most common reason for hip replacement is osteoarthritis. Osteoarthritis occurs when the cartilage covering the ends of the bones where they meet to form joints breaks down. This causes the bones of the joint to rub together. Growths of bone, called spurs may form around the joint. These changes lead to pain and stiffness.

Other possible causes of hip damage include injuries, fractures, bone tumors, rheumatoid arthritis, and osteonecrosis.

Rheumatoid arthritis is a condition in which the body’s immune system attacks the membrane that lines the joint. This can lead to pain, inflammation, and destruction of the joint. Osteonecrosis is a condition in which the blood supply to the bone is cut off, causing the bone to die.

Doctors often recommend hip replacement if pain and stiffness interfere with your ability to do everyday activities – particularly if other treatments have not helped.

Before Choosing Hip Replacement

Treatments your doctor will likely recommend first include exercises to strengthen the muscles around the hip, walking aids such as canes to reduce stress on the joint, and medicines to relieve pain.

Medicines for Hip Pain

Several different medicines can be useful for hip pain. For pain without inflammation, doctors usually recommend the analgesic acetaminophen (Tylenol)

For pain with inflammation, your doctor may prescribe a nonsteroidal anti-inflammatory drug such as ibuprofen or naproxen. For additional pain relief, your doctor may recommend acetaminophen and an NSAID, but you shouldn’t combine the two without first speaking with your doctor.

In some cases, stronger medicines may be needed. These include the analgesic tramadol or a product containing both acetaminophen and a narcotic codeine to control pain. For inflammation, doctors may prescribe corticosteroids; however, they should not be used any longer than necessary because of their harmful side effects.

Hip Replacement Isn’t for Everyone

For example, people with Parkinson’s disease or conditions causing severe muscle weakness are more likely to damage or dislocate an artificial hip. People who are in poor health or at high risk for infection are less likely to recover successfully.

If You Are Considering Surgery

The decision to have hip replacement surgery is one you must make with your doctor and your family. If you would like to consider hip replacement, ask your doctor to refer you for an evaluation to an orthopedic surgeon, a doctor specially trained to treat problems with the bones and joints.

The surgeon must consider many factors before recommending hip replacement. Although most people who have hip replacement are between 60 and 80 years old, age is less of an issue than factors such as pain, disability, and general health. In fact, more and more people under the age of 60 are turning to hip replacement as a way to maintain function and quality of life.

People who are generally healthy are the best candidates for the surgery. Recent studies also suggest that people who choose to have surgery before advanced joint damage occurs tend to recover more easily and have better outcomes.

Types of Surgeries

There are two major types of hip replacement surgery: traditional and minimally invasive, also called mini-incision hip replacement.

Traditional Surgery

In a traditional surgery, the surgeon makes a 10-12 inch incision through some of the muscles around the hip to expose the joint. Then the surgeon removes the damaged bone and cartilage and replaces them with an artificial joint, or prosthesis.

Minimally Invasive Surgery

In minimally invasive surgery, the surgeon makes one or two much small incisions between the muscles. These incisions may be in the back, side, or front of the hip. The recovery time for the mini-incision is shorter than for traditional surgery.

Doctors tend to recommend minimally invasive surgery for younger patients and those who are of normal weight and healthier than those who are candidates for traditional hip replacement surgery.

The Artificial Joint

Regardless of which type of surgery you have, the artificial joint will consist of two basic parts: a ball made of highly polished strong metal or ceramic material and a socket made of plastic, ceramic, or metal. The ball attaches to the top of the thigh bone, or femur; the new socket attaches to your pelvis.

Cemented and Uncemented Parts

These components come in two basic varieties: cemented and uncemented, which refers to the way the parts are attached to your existing bone.

Surgeons fasten cemented parts to existing, healthy bone with a special glue or cement. Uncemented parts rely on a process called biologic fixation to hold them in place. This means that the parts are made with a porous surface. Over time, your own bone grown into the holes in the joint surface to secure them.

Sometimes surgeons use an uncemented part for the socket and a cemented part for the femur. This combination is called a hybrid replacement.

Studies show that cemented and uncemented joints are similarly successful; however, doctors usually use cemented joints for older, less active people and people with weak bones.

Uncemented joints are often reserved for younger, more active people. The main disadvantage of uncemented joints is a longer recovery time because it takes time for bone to grow into the surface of the replacement part(s). Also, recovery may be more painful as bone grows into the prosthesis.

Preparing for Surgery

Have a Medical Evaluation

Preparing for surgery will likely begin with a medical evaluation. During the evaluation, your doctor will assess your general health, looking for any problems that could complicate surgery or your recovery.

During the evaluation, your doctor may order tests on blood and urine samples as well as tests like an electrocardiogram or chest x-rays.

If you are taking any medications, it’s important to tell your doctor the specific medications and doses you are taking. You may need to stop taking some of your medicines for a while before surgery, while you can continue others. Be certain you report all over-the-counter and herbal supplements you are taking. You may be asked to stop taking some of these before the surgery.

What Your Doctor May Recommend

If you are overweight, your doctor may recommend that you lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery. Your doctor may also recommend exercise to strengthen your muscles and improve your general health and recovery.

In case you need blood during surgery, your doctor may recommend autologous blood donation. This means you have your own blood drawn several weeks before surgery and stored in case you need it.

Because dental procedures can allow bacteria to enter the body and these bacteria can potentially lodge in the joint, your doctor may recommend that you have any needed dental work before your surgery.

Before any future procedures, tell the healthcare provider about your artificial joint. You may need to take antibiotics for some dental, eye, and certain other procedures to prevent the possibility of infection in and around the artificial joint.

Learn about the Procedure

It’s also important to know as much as you can about the procedure and what to expect before you have it. Your doctor should be able to give you written information or recommend other sources.

Many people find it helpful to speak with someone who has already had the surgery. If you think you might like to speak with someone, ask your doctor to recommend someone.

Also, some hospitals have classes for prospective hip replacement patients. Ask if the hospital where you will be having your surgery has one and sign up to learn more about the surgery itself and recovery afterwards.

Having Surgery

Having hip replacement usually requires a hospital stay of 3 to 5 days. During that time you will have the surgery and begin recovery and rehabilitation. You will also learn about possible complications, including how to prevent them and recognize them if they occur.

Before Surgery

You will most likely be admitted to the hospital on the day of your surgery. Before you are admitted, however, you will see an anesthesiologist, who will evaluate your general health and talk with you about the types of anesthesia, or pain relief, during surgery.

Two common types of anesthesia for hip replacement are general anesthesia and spinal or epidural anesthesia. With general anesthesia, you are asleep during surgery and a machine helps you breathe. With spinal or epidural anesthesia, you are numbed from the waist down during the operation. Regardless of the method used, the surgery itself will not be painful.

After Surgery

Hip replacement surgery usually takes 1to 2 hours. After surgery, you will be taken to the recovery room where you will be monitored for an hour or two. Once you are fully awake and alert, you will be moved to a hospital room for the rest of your stay.

In the first hours after your surgery, you will be allowed to move very little. Your hospital bed will have special pillows or devices to hold your hip in the correct position.

You may have an IV tub inserted to replace any fluids you lost during surgery. You may also have a tube near the incision to drain fluid and a tube called a catheter to drain urine until you are able to go to the bathroom. You will also receive medicine to relieve pain.

The surgery site will be closed with staples or stitches, which will be removed about two weeks after surgery. In the meantime, it will be important to avoid getting the wound wet until it heals. A bandage can help prevent clothing or stockings from irritating the wound.

Shortly after surgery, a respiratory therapist may visit you and ask you to breathe deeply, cough, or blow into a device to increase your lung capacity. Doing these things will help reduce the risk of infection in your lungs.

Physical Therapy

Later in the day after your surgery or the following day, physical therapists will begin to teach you exercises to help your recovery. A day or two after surgery, you will be allowed to sit on the edge of the bed and stand and walk with help.

A physical therapist will teach you exercises to strengthen the hip muscles and help you safely do daily activities. Because your new hip’s range of motion is more limited than that of a natural hip, it is important to use proper techniques for activities such as sitting and bending, to avoid injuring your new hip.

Possible Complications

While new technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements, there are still some risks you should be aware of. Two of the most common possible problems that might occur in the short term (just after surgery or up to 3 months after) are dislocation and blood clots.

Dislocation

Because the artificial ball and socket are smaller than natural ones, the ball can come out of the socket if you put the hip in certain positions. Positions to avoid include pulling your knees up to your chest, crossing your legs, or bending your hips farther than a right angle.

Blood Clots

Blood clots can occur in the veins of your legs or pelvis after hip replacement surgery. To reduce the risk of clots your doctor will prescribe some combination of special exercises, support hose, and/or blood thinners.

Other Complications

Other complications such as new or ongoing pain, stiffness, fracture, bleeding, or injury to the blood vessels can occur. Sometimes infections elsewhere in the body can travel to your prosthesis, but this is not common. Serious medical complications, such as heart attack or stroke, are even rarer, and if they happened, would most likely occur just after the surgery.

Reducing Your Risk for Complications

To minimize the risk of complications, it’s important to know how to prevent problems and to recognize the signs of potential problems early and contact your doctor. For example, tenderness, redness and swelling of your calf, or swelling of your thigh, ankle, or foot, could be warning signs of a possible blood clot. Warning signs of infection include fever, chills, tenderness and swelling, or drainage from the wound. You should call your doctor if you experience any of these symptoms.

It is important to get instructions from your doctor before leaving the hospital and follow them carefully once you get home. Doing so will give you the greatest chance of a successful surgery.

What to Expect in Recovery

To prepare for recovery, you should learn what to expect in the days and weeks following surgery, including what you will and won’t be able to do. It also means arranging for social support and arranging your house to make everyday tasks easier and help speed your recovery.

Before leaving the hospital, talk with your doctor about activities you should avoid as well as any other special instructions for your recovery. By preparing for surgery and recovery and following your doctor’s advice, you can achieve the greatest benefits from your new hip with the least risk of complications.

You Will Need Help

Because you will not be able to drive for several weeks after surgery, you will need someone to take you home from the hospital and be on hand to run errands or take you to appointments until you can drive yourself.

In your first week or two home from the hospital you will likely need someone to stay with you or at least be close by and available in case you need help. If you don’t live with a family member who can stay home with you, you should plan to stay with someone or have someone come and stay with you.

If you do not have a family member close by, a friend or neighbor may be able to help. Other options include staying in an extended-care facility during your recovery or hiring someone to come to your home and help you. Your hospital social worker should be able to help you make arrangements.

Prepare Your Home Beforehand

To prepare your home for your recovery, stock up on needed items before you leave for the hospital. Make sure you have plenty of nonperishable foods on hand. Prepare meals and freeze them to put in the microwave when you need an easy meal.

In the first weeks after surgery you should avoid going up and down stairs. If you bedroom is on the second floor of your home, consider moving to a downstairs bedroom temporarily or sleeping on the sofa.

Set up a “recovery station” at home. Place the television remote control, radio, telephone, medicine, tissues, wastebasket, and pitcher and glass next to the spot where you will spend the most time while you recover.

Place items you use every day at arm’s level to avoid reaching up or bending down. Ask your doctor or physical therapist about devices and tip that may make daily activities easier once you get home.

Devices you may find helpful include long-handled reachers to retrieve items placed on high shelves or dropped on the floor, aprons with pockets that allow you to carry items while leaving your hands free for crutches, shower benches that let you sit while you shower, and dressing sticks to help you get dressed without bending your new hip excessively.

Make Your Home Fall Proof

Because a fall can damage your new hip, making your home a safe place is crucial. Before your surgery, look for and correct hazards, including cluttered floors, loose electrical cords, unsecured rugs, and dark hallways.

Bathrooms are likely places to fall, so particular attention is needed there. A raised toilet seat can make it easier to get up and down. Grab bars in the tub can keep you steady. Textured shapes on the shower floor can minimize slipping.

Exercise Appropriately

It is also important to exercise to get stronger while avoiding any activities that can damage or dislocate your new joint. Talk to your doctor or physical therapist about developing an appropriate exercise program. Proper exercise can reduce stiffness and increase flexibility and muscle strength.

Most programs begin with safe range-of-motion activities and muscle-strengthening exercises. Activity should include a walking program that gradually increases in time and distance and specific exercises several times a day to restore movement and strengthen your hip joint. Other recommended exercises are stationary bicycling, swimming, and cross-country skiing. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip. 

The doctor or therapist will decide when you can do more demanding activities. Many doctors recommend avoiding high-impact activities such as basketball, jogging, and tennis. These activities can damage the new hip or cause loosening of its parts.