Total Hip Replacement.

total_hip_replacementThis page provides information on total hip replacement and covers the basics of the anatomy of the hip, causes of hip pain, the process of total hip replacement, and precautions to be taken before and after the surgery.

After reading this article, you should have a better understanding of total hip replacement and how to care for a patient who has undergone this procedure.

Understanding The Anatomy of the Hip

The hip is easily among the largest joints in the body. By type, it is a ball and socket joint with the ball end being the femoral head (the top of the thigh bone, also known as the femur) and the socket being part of the pelvic bone, called the acetabulum.

A smooth tissue called articular cartilage covers the bone surfaces, providing a cushion for the bones so they move easily and smoothly. In addition to this cartilage, the hip joint is covered by a soft tissue called synovial membrane which secrets a small amount of fluid to lubricate the cartilage. When this membrane does its job well, the hip operates with little or no friction.

Generally, the hip joint gains its stability from the ligaments that connect the ball to the socket.

What is total hip replacement?

Total hip replacement is the replacement of the hip joint, the need for which arises from the ball, socket or both having been damaged.

The damaged bone and cartilage are replaced with artificial parts. The procedure would involve the following:

  • The damaged femoral head is replaced with a metal stem that is fixed to the center of the femur. This stem can either be cemented or “press fit” into the bone.
  • The damaged cartilage surface of the acetabulum is removed and replaced with a metal socket. This can be held in place by means of a screw or cement.
  • A spacer–made of plastic, ceramic or metal–is placed between the ball and socket. This is to allow for the smooth movement of the new joint.

What causes hip pain?

Nearly everyone who undergoes total hip replacement surgery does so because of hip pain. One of the most common causes of hip pain is arthritis. Different types include:

Osteoarthritis, which is synonymous with age. Like everything that is exposed to usage, over the years the hip joints experience wear and tear. This results in the cartilage, which normally acts as a cushion for the bones, wearing out. Pain is caused by the bones rubbing against each other. This type of arthritis is usually found in people over the age of 50.

It is also possible that an abnormality in the development of the hip in childhood can cause an early occurrence of osteoarthritis.

Rheumatoid arthritis is an autoimmune disease. By this we mean that the body’s immune system acts against its own the cells, leading to the inflammation of the synovial membrane. If this continues, it can result in damage to the cartilage and consequently cause the bones to rub against each other, bringing about pain and discomfort.

Post-traumatic arthritis is another type that causes pain. It occurs after a serious injury to the hip and can result in damage to the cartilage.

Avascular necrosis is when the hip sustains an injury, such as a fracture or dislocation, resulting in a reduced supply of blood to the femoral head. This can lead to the collapse of the bone surface, which in turn can lead to arthritis.

Children and even infants can also have hip problems. Even after these problems are successfully treated, the joint surfaces may be affected or the hip may not grow normally, resulting in arthritis as they grow older.

Who can get a total hip replacement?

Anyone who has chronic hip pain can get a total hip replacement. It has nothing to do with age or weight.

Symptoms include:

  • Difficulty carrying out normal activities such as walking and bending.
  • Hip pain throughout the day, whether at rest or at work.
  • Difficulty moving or lifting the leg.
  • Lack of success with physical therapy, walking supports or medication for pain relief.

Getting a Hip Replacement – The Process

If, after reading this, you decide you might need total hip replacement surgery, do not hesitate to talk with an orthopedic surgeon.

An orthopedic surgeon specializes in the diagnosis and treatment of bone and skeletal conditions. He or she would conduct a physical examination to determine hip mobility, strength and alignment. A more extensive evaluation would involve X-rays. Should the surgeon feel a need for additional tests, MRI (Magnetic Resonance Imaging) can be done.

After all the tests have been carried out, if the surgeon thinks the best course of action is to get a total hip replacement, the patient would then begin to prepare for the procedure.

How to Prepare for Surgery

There are both medical and non-medical preparations for a hip replacement surgery. The medical aspect would be managed by a medical practitioner while the patient, with the help of the doctor, would take care of the non-medical aspects.

Some of the medical aspects of preparation include:

Medical examination: This would be mainly to ensure a person is healthy enough to go through the surgery. At this stage, any pre-exisiting health condition is looked at carefully to determine whether it can affect the procedure.

Furthermore, the surgeon should be made aware of any medication a patient is taking. Dental work, medication for urinary infection, or any other medical treatment should be completed before going into surgery.

The patient may have to donate some blood in case they require blood after the surgery.

Every medical angle has to be thoroughly covered. The patient may also be advised to lose weight so as not to increase the stress on the new implants after the surgery.

As the medical issues are taken care of, the non-medical issue also need to be addressed:

It should be understood that certain adjustments will have to be made in the living arrangement of the patient. After the surgery, the patient will require reduced stress on the hip joint by walking with crutches or a walker. These support structures would make certain chores impossible or difficult to handle. Some arrangement may have to be made for assistance during this period.

It would also help to make some modification in the home. Generally, place things in a way that allows for easy movement around the house. For example, install handrails and safety bars in the bath or shower, have the same installed along stairways, use a shower chair, always ensure that while sitting the knees are lower than the hips, remove loose carpeting and cords around the house. The idea is to generally remove anything that would place unnecessary stress on the new hip joint during the recovery process.

The Surgery

After being admitted into the hospital for the surgery, and after all the examinations have been concluded, the surgery will start after the anesthesia team has evaluated the patient and decided on what form of anesthesia to administer.

General anesthesia would put the patient into a deep sleep. Localized anesthesia will numb the body from the waste down. Prior to this time, the surgeon will have chosen the form of implant to be used and decided whether to use “press fit” or cemented fastening.

The entire procedure takes several hours. During this time, the damaged cartilage and bone are removed and replaced with the implants.

After Surgery

Following surgery, the initial recovery is in the hospital. During this period, the patient is monitored for infection. The patient is also monitored for atelectasis, which is the rare but possible partial collapse of the lungs arising from shallow breathing caused by anesthesia.

The patient is also monitored and given pain medicine to reduce post-operative pain and discomfort. The wound is dressed and kept as dry as possible, a practice the patient should employ until the wound is fully dried.

To help hasten recovery, the patient’s diet usually includes a good supply of iron and lots of fluids. Physical therapy strengthens the hip and gets the patient back in shape quickly.

Remaining care and recovery continue at home.

Possible Complications

With any surgical procedure, there is always a risk of complications. Statistically, less than 2% of patients have any serious complications after total hip replacement surgery. Having said this, there still is a need to point out the possible complications that could arise.

A person could be infected after the surgery via the suture points or deep inside the hip joint around the implant. The infection could happen in the hospital or after the patient has been discharged. There is even the possibility of an infection occurring after several years.

If the infection is mild, it can be treated with antibiotics. However, if the infection is deep, it may require surgery.

A blood clot can easily arise after this type of surgery. The orthopedic surgeon knows this and will take precautions such as prescribing blood thinners, physical therapy, inflatable legs, etc. If unattended to, complications arising from a blood clot can be fatal.

Occasionally, it happens that one leg feels longer than the other after surgery. This problem can be solved with a shoe lift.

The danger of dislocation occurring is high in the first few months following surgery. This is because the tissues are still healing. Depending on the type and frequency of the dislocation, it would be taken care of either by a closed reduction or another surgery.

Precautions to Take After Surgery

It is important that too much stress is not placed on the new hip. While physical therapy is very important for strengthening the hip, it should not be over done.

As much as is possible, the patient should avoid falling. This can damage the new hip, requiring additional surgery.

Infections are a constant threat. Following the surgeon’s instruction is very important. Medications for blood thinning should be continued until otherwise discontinued by the doctor. Report any unusual feeling immediately to the doctor.

Precautions to take for at least six weeks following hip replacement surgery:

  • Avoid crossing of legs.
  • Ensure that the hip is not bent at more than a right angle.
  • When sleeping, place a pillow between legs.
  • Avoid turning feet too much in or out.

Conclusion

A person can enjoy an improved life style after a successful total hip replacement therapy. However, it is important to note that some discomfort may be felt until the patient gets fully accustomed to the new hip.

It is also important that the right amount of physical exercise is maintained. This will help with strength and mobility, but should not be over done.

Antibiotics should always be taken before any dental procedure. The patient should let the dentist know that they had a hip replacement surgery.

Lastly, it is advised that the patient stay away from high intensity sports or activities. The new implants will last longer if wear and tear is reduced to a minimum. Selecting the right surgeon is the first and most important decision to make regarding hip replacement surgery. Call or visit us in Tampa, Florida, at Tampa Hip and Knee.

Kurt Hirshorn MD of Tampa Hip and Knee guarantees expertise and compassion when caring for his patients, and ensures a good hospital stay. Schedule an appointment today or call us at (813) 377-4445.
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