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Total Hip Replacement

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For those who have arthritis in the hips, as well as hip fractures or other injuries, normal activities like walking or sitting in a chair can become incredibly painful. There are medications and lifestyle changes that can aid in solving these issues but if these treatments don’t work, total hip replacement might be an option. Hip replacement surgery is one of the most successful operations available today and can markedly improve your quality of life.

Causes of Hip Pain

The most common reason why someone would need a hip replacement is because of chronic hip pain or arthritis like osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Some of the most common causes of chronic hip pain and disability include: Osteoarthritis (OA) is the most common type and is a progressive degenerative disease that causes the joint cartilage to break down. This type of arthritis is most commonly found in older adults and is due to wear and tear as the cartilage cushioning wears away. Rheumatoid arthritis (RA) is a long term, autoimmune disease that causes inflammation in the joints and the surrounding tissue and can destroy the cartilage in the joint. RA and occur at any age and normally affects most of the joints in the body. Post-traumatic arthritis usually develops after an injury and is very similar to osteoarthritis in how it damages the body. Post-traumatic arthritis can present symptoms years after a fracture, ligament injury, or meniscus tear. Avascular/Osteo-necrosis results from a hip injury such as a fracture or dislocation in which the blood supply to the femoral head is limited, making the surface of the bone collapse and causing arthritis. Childhood hip disease can lead to arthritis later in life if the hip does not grow normally or the joint surfaces are affected.

Am I a Good Candidate for Hip Replacement?

If you have significant hip damage from an injury, fracture or arthritis, hip placement surgery may effectively relieve pain and increase your mobility and function. The decision to have surgery will be discussed with you during your initial evaluation while determining if you stand to benefit from surgery. Recommendations to proceed with hip replacement surgery are not based on the patient’s age, and there are no restrictions on body weight. Patients of all ages may benefit from hip replacement, when indicated, but most patients are between the ages of 50 to 80 years old. Other, nonsurgical options will also be addressed, such as medications or physical therapy. In deciding whether or not to proceed, your doctor will weigh the pros and cons with you and help you decide whether the expected benefits outweigh the associated risks. If you don’t understand all the necessary steps of hip replacement from evaluation through recovery, make sure to ask your orthopedist. One of the deciding factors in choosing to go through with hip replacement is checking your expectations. If you want to go through with hip surgery, you should understand what the procedure can and cannot do for you. Most patients will experience significant improvement in mobility and quality of life, but too much physical activity can loosen the prosthesis. Overweight patients are also at risk for creating more wear on the implant. Patients should focus on the fact that hip replacement can allow them to become reasonably active and live a better quality of life. Surgery is often recommended for the following patients:

  • Hip pain limits mobility and impinges daily activities, even simple ones such as bending over or walking a short distance.
  • Hip pain is present even while resting.
  • The hip area is stiff and limits the range of motion in the leg.
  • Difficulty getting into and out of a chair.
  • Conservative care such as anti-inflammatory drugs, physical therapy or mobility aids (walker, crutches, wheelchair) have failed to be adequate relief.

Evaluation

An orthopedic surgeon will determine whether or not you may benefit from hip replacement based on the following factors:

  • Medical history information can paint the full picture of your general health and the extent of your hip pain.
  • Physical examination can assess hip mobility, strength and alignment.
  • X-rays show the extent of deformity or hip damage.
  • MRI scans may be used to assess the condition of the soft tissues of the area.

Before going through with surgery, you doctor will evaluate your skin condition, as well, to look for any infections or irritations that would bar you from proceeding. You may also be advised to donate your own blood prior to the procedure, which will be stored in the event that you would need a transfusion. Patients who are overweight or obese are advised to lose weight to minimize potential stress on the hip prosthesis and decrease the risk of infection. Patients must also plan to have assistance at home during the beginning of their recovery period. Tasks such as preparing food, shopping, and ordinary hygiene will be more difficult as you are less mobile during the healing process. If you live alone and don’t have a family member or friend available to assist you, a social worker or discharge plainer will be able to make arrangements for home care, or you may choose to stay at an extended care facility for rehabilitation.

Treatment

Patients are admitted a day before the procedure so they can be evaluated. Before the surgery, patients are placed under general anesthesia which makes them sleep, or spinal anesthesia, which allows patients to breathe on their own but won’t let them feel anything from the waist down. During the surgery, doctors will remove the damaged cartilage and bone and then replace them with new metal, plastic, or ceramic joint surfaces to restore alignments and function to the hip. The surgery itself takes several hours to complete, and you will stay at the hospital for a few days during your early recovery. The procedure includes:

  • An incision is made over the front or side of the hip through layers of tissue.
  • Diseased and damaged bone and cartilage are taken out, which leaves the remaining healthy bone intact.
  • Prosthesis is implanted into the pelvic bone to replace the damaged socket.
  • The round part of the femur is replaced with a prosthetic ball and is attached to a stem that fits in the thighbone.

There are many different types of designs and materials used for artificial hip joints but all of them consist of two basic components, the ball which is made from either a highly polished strong metal or a ceramic material. The prosthetic implant is designed to be compatible with the existing structures of the hip and mimic the gliding motion of a healthy hip joint. The other component is the socket which is made from plastic, metal, or ceramic. The prosthesis may be coated with a textured metal or a special bone-like substance that allows bone to grow into the prosthesis. There is also minimally invasive hip replacement surgery which allows doctors to replace the hip though two small incisions. With this surgery patients usually have less pain than with traditional hip replacement surgery and the rehabilitation is faster as well. No matter what surgery is performed, patients will need to stay in the hospital for a few days so that they can be monitored. Most patients are able to stand and walk with the help of a physical therapist and a walking device.

Risks and Complications

Like with any surgery there are risks involved. These risks include:

  • Wound infection. The incision site, or deeper tissues, may become infected. If severe, additional surgery may be necessary to remove and replace the prosthesis. Most infections are treatable through antibiotics.
  • Fracture. During surgery, a fracture may be found, which can be corrected through wires, cables or bone grafts.
  • Loosening. If the prosthesis is not solidly fixed in place, it may loosen over time and require additional surgery.
  • Joint stiffening. Sometimes the soft tissues surrounding the joint harden, called ossification, which may be preventable if your doctor gives you medications or radiation therapy in advance.
  • Blood clots. Clots may form in the legs due to immobility during or after surgery, which can become serious if they break off and travel to the lungs. Your orthopedist will prescribe blood thinners after surgery to prevent clots, and compression stockings can increase blood flow in the leg veins. Recognizing the symptoms of a blood clot can help you get medical care if you experience one, such as pain in the legs unrelated to your incision, tenderness in the calf muscle, and swelling in the lower extremities.
  • Shortening or lengthening of the leg: occasionally, a hip implant may make one leg a different length from the other, which can be caused by weakness in the hip muscles.
  • Persistent pain

Recovery

Nurses will monitor you in a recovery room and position you with a splint, such as a foam pillow between the legs, to facilitate recovery. During your hospital stay, the main focus will be on recovery and pain management. Light activity will begin soon after surgery with the help of a physical therapist who can help you learn to use the new hip properly while regaining strength. Your incision wound will be monitored and redressed frequently to prevent infection, and stitches or staples are removed after about two weeks following surgery. In order to have a smoother transition as you leave the hospital, you should arrange to have a caregiver help you for the first few weeks. This includes help preparing meals, placing items you intend to use at waist level so you don’t have to bend over, and making some modifications to your home to ease recovery. Some of the home modifications you may pursue include:

  • Raising the toilet seat.
  • Installing safety bars or handrails around the shower or bath.
  • Make sure handrails on stairways are secured.
  • Use a shower bench or chair for bathing.
  • Use a “reacher” to be able to grab objects that are on high shelves.
  • Remove loose carpet or electrical cords from areas where you walk at home.
  • Place frequently used objects near you, like a phone, reading material, remote or medications, so you don’t have to walk around and look for them.

Following surgery, patients are advised to stop certain activities like jogging and high impact sports for the rest of their life. Doctors may also recommend avoiding specific positions because the joint could become dislocated. However, you will be advised to exercise to regain strength in the hip joint, both at the hospital after surgery and at home. These physical therapy exercises are designed to help speed up the recovery process. These activities should be a regular part of everyday life as you recover so you can regain strength of the joint and muscles. As therapy continues, you’ll be eventually be able to put more weight on the affected leg, and with time, you’ll be able to walk without assistance. After surgery, you will have to take precautions to extend the life of your implant and keep your joints healthy. Take care to avoid falls, especially in the first few weeks after surgery. Stairs are particularly risky, so either have a friend help you as you climb stairs, or avoid stairs until you improve your balance, flexibility and strength. Certain body positions should be avoided as you recover, as well, such as crossing your legs or bending over at more than 90 degrees. Do not turn your feet outwards or inwards at odd angles, as this can pull on the hip. Use a pillow between your legs as you lie down to keep your hips level, as recommended by your orthopedist, until you are advised you don’t need it anymore. Another important consideration is that you will have to protect your hip replacement implant. You can keep your hip replacement in good condition with the following measures:

  • Follow the instructions of your orthopedist and physical therapist regarding exercises to maintain strength and mobility.
  • Try to avoid falls or injuries. A fractured leg may necessitate more surgery.
  • Before any dental work, you will need to take an antibiotic to prevent infection.
  • Be diligent in attending follow-up appointments for x-rays, even if you are doing well in the recovery process.

A hip replacement can make a HUGE difference in your day-to-day life. Are you sick of constantly suffering from a damaged hip? West Medical can provide you with the best possible option for treatment and recovery for a total hip replacement. We ensure effective treatment that will have you back on your feet in no time! If you are interested in learning more about total hip replacement options in Los Angeles, please call West Medical at (855) 690-0565 and one of our representatives will be happy to address any of your questions, comments, or concerns.

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