Having a damaged hip, whether it is through fractures, arthritis, or other conditions, makes a lot of common activities that you need to do throughout your day extremely hard to do without extreme pain. Because of your hip, it may be hard to even put on your shoes and socks, or you could feel extremely uncomfortable while trying to rest.
You may have to consider replacing your hip completely through surgery if changes in your activities, walking aids, and medications do not actually help. Hip surgery can help relieve your body from a lot of pain and stress by replacing the hip joint with an artificial joint. This can get you back to enjoying your usual activities without the pain and stress that you used to endure!
Hip replacement surgery started in 1960 and is considered one of the most important advances in surgery of the century. Improvements in joint replacement have increased the effectiveness of the procedure of total hip replacement. In today’s time, there are more than 193,000 total hip replacements performed each year in the United States only.
ANATOMY
The hip has two main parts to it and is one of the largest weight-bearing joints in the body. There are two main parts: the first is the femoral head which is a ball at the top of your thigh bone and the second is the acetabulum, which is a rounded socket in the pelvis. Ligaments make sure that the joint is stable through the tissue that connects the ball to the socket. The ball and socket bone surfaces have a durable cover of cartilage which cushions the bones so that they can easily move.
There is also the synovial membrane which is a smooth and thin tissue which covers the hip joint surfaces. Usually in a healthy hip, this tissue makes a small quantity of fluid which minimizes friction due to lubrication of your hip joint.
These parts of your hip usually allow you to move easily when they work in harmony.
COMMON CAUSES OF HIP PAIN AND LOSS OF HIP MOBILITY
Arthritis is the usual cause of all chronic hip disability and pain. The most common forms of arthritis in the hip are traumatic arthritis, rheumatoid arthritis and osteoarthritis.
- After a serious hip injury or fracture, you may get traumatic arthritis. This can cause osteonecrosis, which is when the articular cartilage is damaged- which in time causes stiff pain in the hip.
- Rheumatoid arthritis is when the synovial membrane becomes swollen, which damages the articular cartilage, and can produce far too much synovial fluid. This autoimmune disease can lead to pain and stiffness.
- Adults that are 50 years and older, or those with family history of arthritis, can have osteoarthritis. It’s usually caused by slight irregularities of hip development. This disease can wear away the articular cartilage which cushions the bones of the hip. This also causes the bones to rub against each other, which causes the hip to become extremely painful and stiff.
IS TOTAL HIP REPLACEMENT SURGERY FOR YOU?
You should never make the decision of choosing to have hip replacement surgery by yourself. You should definitely discuss this choice with your primary care doctor, your orthopedic surgeon as well as your family. Though usual patients of hip replacement surgery range from sixty to eighty years of age, usually the patients are evaluated individually by their orthopedic surgeons. The surgeon will not solely be looking at your age when trying to evaluate your status as a potential hip replacement patient. The doctors have to look at all possible factors, like your general health, disability and the extent of your pain.
You may benefit from hip replacement if:
- Anti-inflammatory drugs do not genuinely help your pain relief.
- Your hip pain is limiting your daily activities like bending down or even walking.
- You cannot rest because of the hip pain, no matter the time of day.
- Physical therapy or walking aids do not help ease your pain.
- Because of the stiffness of your hip, you cannot lift or move your leg.
THE ORTHOPAEDIC EVALUATION
When an orthopedic surgeon has to evaluate you for hip replacement surgery, they usually try to look for the best method to relieve all and any of your pain as well as make sure your mobility is going to improve. Medications, physical therapy, other types of surgery can be considered as other treatment options besides hip replacement. Your surgeon will make sure to explain all the risks and possible complications before you choose to do the hip replacement surgery, including the possible risks during the surgery itself as well as the after effects of the surgery. Usually an orthopedic evaluation will include:
- X-Rays
- Physical Examination to access your hips’ alignment, strength and mobility
- Medical history overview as well as extent of your hip pain
- At times you may have to get an MRI or bone scan in order to examine the condition of your hip’s bones and soft tissues.
WHAT TO EXPECT FROM HIP REPLACEMENT SURGERY
The first and foremost important thing to consider before making the choice to have the hip replacement surgery is to understand what the surgery can do as well as what it cannot do.
There is a drastic reduction of pain after a patient undergoes hip replacement surgery, which in turn can improve daily functions and activities. However, keep in mind that you will not be able to do things that you could not do before your hip problem occurred.
After surgery, it’s recommended to avoid extremely active functions, like high-impact sports or even jogging, for the rest of your life, since this could lead to any sort of dislocation once more. Dislocation would essentially render the entire surgery useless and a waste of your time and money.
With normal daily activities, there is still the risk that the prosthesis can get wear and tear, which in turn can loosen your prosthesis and the pain can return once more. This risk increases if you are overweight or keep participating in strenuous activity.
YOUR ACTUAL SURGERY
The day that you have your surgery, you will have to be admitted to the hospital. The anesthesia team will have to evaluate you before admission. Usually the most common types of anesthesia used for this procedure is general anesthesia or spinal anesthesia. The team in charge of your anesthesia will make sure to discuss your options with you before the surgery so that you can choose the best method of anesthesia for you.
The actual procedure will take at least a few hours. Once in surgery, your orthopedic surgeon will make sure to remove the damaged bone and cartilage. After this is done, then they will put in the new plastic, ceramic, or metal joint into place to restore proper alignment in your hip to improve the function.
With artificial hip joints there are various different designs that are used. Usually there are two different basic components that are used in all designs: the ball component and the socket component. At times the prosthesis can allow the bone to grow into it through a coated texture.
After one to two hours after the operation, you will be monitored for your recovery from the anesthesia. Once you are fully awake, the hospital staff will transfer you to your hospital room.
MINIMALLY INVASIVE TOTAL HIP REPLACEMENT
Orthopedic surgeons have been able to develop newer techniques for smaller incisions throughout the past years in order to allow for a less painful and quicker recovery. These minimally invasive hip replacements are not for everyone, however. Patients who are heavy or muscular, or have health problems that can be detrimental to the healing process or have a deformity of the joint will have a higher risk of problems.
Make sure to talk to your doctor about the risks and benefits of minimally invasive hip replacement if you’re interested in the option.
YOUR STAY IN THE HOSPITAL
The stay will usually last for a few days. Your hip will definitely feel some pain, however, you will be prescribed pain medication in order to make you comfortable.
After your surgery it’s extremely important to pay attention when asked to breathe deeply and make sure to cough frequently in order to avoid any lung congestion. A positioning splint will be used to protect your hip during recovery, as well.
Your recovery will have some necessities that the hospital staff will be able to help you with, such as walking and some light activity. Usually these activities either begin the day of your surgery, or the day afterwards. There will be a physical therapist to help you, with the aid of walking support, walk and stand the day after your surgery. This physical therapist will also introduce you to exercises post-surgery to do in order to restore movement in your hip for walking and other activities that you do daily.
COMPLICATIONS
The rate of complications during surgery is actually low for hip replacement surgery. Less than 2% of patients have serious complications after surgery, like joint infections. The possibility of heart attacks or strokes or other major medical complications occur even less frequently. It’s important to keep in mind that chronic illnesses could increase the complications rate. When complications do occur, even if they are rare, full recovery can be prolonged or even limited.
The most common complication of hip replacement surgery is blood clots in the pelvis or leg veins. Your surgeon may make sure to take precautionary measures to prevent any blood clots, however, if they do form, they make sure to prevent the blood clots from being problematic. Some of the measures that your surgeon may take is through blood thinners, inflatable leg coverings and even ankle pump exercises.
After a hip replacement, your leg length may become unequal, or could become worse if you already had an inequality issue. Your surgeon will make sure to take this into account as well as stability of the hip and other issues that could cause complications. A shoe lift may make some patients feel a bit more comfortable after surgery. A small number of patients can feel new pain or continuous pain even after surgery.
It’s a good thing to warn you that over the years a hip prosthesis may loosen. However, this issue may become a lot easier to handle as the years progress since new technology, materials, and techniques are introduced. Bone loss may occur when the prosthesis wears out because of the wearing surface’s small partials. This process is osteolysis.
RECOVERY
Following your surgeon’s instructions on how to take care of yourself will result in proper success of your surgery.
WOUND CARE
Your stitches, or staples, that have been placed along your wound or under your skin will usually be removed around two weeks after your surgery.
Do not get your wound wet until you are positive that it has fully sealed and dried. In order to prevent possibly irritation from clothing, it’s suggested to place a bandage over the wound.
DIET
Some patients after surgery can lose their appetite, which is quite common. Iron supplement as well as a balanced diet is really important in order to get your tissue to heal and restore your muscle strength. Drinking enough fluids is also quite important.
ACTIVITY
After your surgery, taking care of yourself and doing the prescribed exercise is a critical component of recovery. Within three to six weeks after surgery, you should be able to go back to your normal light activities. However, please be warned that you might have some discomfort for several weeks. A good activity schedule should include:
- Resuming normal household activities
- Physical therapy at home
- Specific exercises to restore and strengthen movement and better your hip
- Walking, standing and moving up and down stairs.
- Creating a walking program which could start in your home and later move outside.
AVOIDING PROBLEMS AFTER SURGERY
Blood Clot Prevention
Make sure to follow any instructions that your surgeon has given you just to make sure to minimize any risk of blood clots. These can easily happen within the first weeks of your recovery.
Warning signs of blood clots can include:
- The calf becoming tender or red.
- Your foot, ankle, calf or even your thigh can become swollen
- Pain in your leg or calf that is not related to your incision.
Warning signs that a possible blood clot moved to your lungs:
- Chest pains while breathing.
- Shortness of breath
If you have any of these symptoms please contact your doctor as soon as possible.
Preventing Infection
Bacteria can enter the bloodstream extremely easy after hip replacement surgery, and it’s extremely important to make sure this does not happen so that the bacteria does not get around your prosthesis.
After your surgery, it’s required to take antibiotics before any dental work, because of the potential of bacteria entering your bloodstream.
Warning signs of hip replacement infections include:
- Hip wound drainage
- Increasing hip pain even with rest
- Shaking and chills
- A fever higher than 100°F
- Swelling of the hip wound, or general tenderness or redness.
If you develop any of these signs, please notify your doctor as soon as possible.
Avoiding Falls
After a hip replacement surgery, a fall can be extremely dangerous and can damage your new hip. It could require more surgery. It’s mandatory to try to avoid hazards like stairs until your hip is stronger. While you are improving your strength, balance and flexibility, make sure to utilize a cane, handrail or walker. Another suggestion is possibly having someone around to help you get around until you are stronger.
Together your physical therapist and orthopedic doctor will make sure to let you know what types of aides will need to be used after your surgery, as well as when you can stop using aides.
Other Precautions
In order to make sure your prosthesis is not dislocated and you can have a proper recovery, make sure to follow these steps:
- Do not bend your hips more than ninety degrees.
- Use a pillow between your legs while you’re sleeping.
- Do not turn your feet outward or inward excessively.
- Do not cross your legs.
Before you are let go from the hospital, your surgeon and physical therapist should give you more specific instructions.
HOW YOUR NEW HIP IS DIFFERENT
Around your incision, you may feel some numbness in the skin, as well as possible stiffness, which can be caused by excessive bending. Usually these differences fade away through time, and the pain and functioning ability is quite minimal to what the patient might have been used to prior to the surgery.
Be warned that while at the airport, your new hip may possibly activate the metal detectors. Make sure to warn a security agent about your hip replacement if the alarm is activated. For extra precautions, it’s smart to ask your orthopedic surgeon for a card to confirm your prosthesis.
After your hip surgery, you should do the following things:
- Make sure to routinely see your orthopedic doctor to make sure that your hip replacement is doing fine.
- Create yourself a light exercise program to maintain proper mobility and strength.
- Avoid any and all falls or injuries at all costs because any damage may possibly require more surgery afterwards.
- Notify your dentist about your hip replacement because you will need to take antibiotics before any sort of procedure.
