Even if you are just beginning to explore treatment options or have decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article explains how a normal hip works, what causes hip pain, what to expect from hip replacement surgery, how exercises and activities can build your strength and help you return to daily activities.
If your hip has been damaged by osteoarthritis, fractures or other conditions, your daily activities such as sitting in a chair and getting up may be painful and difficult. Your hip may be stiff and it may be difficult to put on your shoes and socks. These pains may continue while you are resting and may cause you to feel uncomfortable.
If medications, changes in your daily activities, and the use of walking aids, such as some non-surgical treatments, do not help your symptoms adequately, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase movement, and help you enjoy normal daily activities.
Hip replacement surgery, first performed in 1960, is one of the most successful surgeries of all time. Since 1960, advances in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. More than 300,000 total hip replacements are performed in the United States each year.
The hip is one of the largest joints in the body
The pelvis and femur articulate with each other, and the surfaces of these bones are covered with articular cartilage, a smooth tissue that allows the ends of these bones to move easily.
A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane produces a small amount of fluid that lubricates the cartilage and eliminates nearly all friction during hip movement.
Bands of tissue called ligaments (hip capsule) connect the joint and provide stability to the joint.
Possible Causes of Hip Pain
The most common cause of long-term hip pain is arthritis. Osteoarthritis, rheumatoid arthritis and traumatic arthritis are the most common forms of this disease.
osteoarthritis, age-related “wear and tear” type arthritis. It is usually seen in those 50 years of age and older, and often in people with a family history of arthritis. The cartilage surrounding the hip bones wears away. The bones then rub against each other, causing hip pain and stiffness.
rheumatoid arthritis This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of diseases called “inflammatory arthritis”.
Post-traumatic arthritis This can follow a serious hip injury or fracture. Cartilage damage may occur and may cause hip pain and stiffness over time. Young age is a common cause of osteoarthritis.
Avascular Necrosis The blood supply of the femoral head may be limited for reasons that are not clearly known. This is called avascular necrosis (also commonly called “osteonecrosis”). Poor blood supply can cause the surface of the bone to collapse, resulting in arthritis. Certain diseases and steroid use can also cause avascular necrosis.
childhood disease Some babies and children have hip problems. Therefore, every newborn is routinely screened for hip problems in our country. Although the problems are successfully treated in childhood, they can cause osteoarthritis later in life.
What Kind of a Process
In total hip replacement (also called total hip replacement), damaged bone and cartilage are removed and replaced with prosthetic components.
• The damaged thigh head is removed and a metal stem is replaced inside the thigh. This metal is compressed into the bone, and thanks to its special coating, the bone grows on the metal and boils.
• A metal or ceramic ball is placed on top of this metal. This ball replaces the damaged thigh head that has been removed.
• Then the damaged pelvic cartilage surface is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
• A plastic, ceramic or metal spacer is placed between the new ball and the seat to provide a smooth sliding surface. The materials used are decided according to the general condition of the patient and the disease.
Is Hip Replacement Surgery Suitable for You?
The decision for hip replacement surgery should be a joint decision made by you, your family, and your orthopedic doctor. This decision starts with the recommendations of your orthopedic doctor for your pain, but the person who will make the final decision is the patient himself.
Candidates for Surgery
There are no absolute age or weight restrictions for total hip replacement.
Recommendations for surgery are made based on the patient’s pain and disability, not his age. Most patients undergoing total hip replacement are between 50 and 80 years old, but orthopedic surgeons evaluate patients individually. Total hip replacement surgery has been successfully performed at all ages, from a young child with juvenile arthritis to an elderly patient with degenerative arthritis.
In general, we want to perform this surgery in advanced ages, but if the pain is too much at young ages, we may prefer the operation so that the patient can spend his young years active.
When Surgery is Recommended
There are several reasons why your doctor might recommend hip replacement surgery. People who benefit from hip replacement surgery usually:
Hip pain that limits daily activities
Hip pain that continues day and night
Stiffness in the hip that limits the ability to move or lift the hip
Patients with ongoing pain who do not benefit from pain medications, physical therapy or walking aids.
Your medical history will collect information about your general health and will ask questions about the degree of your hip pain and how it affects your ability to perform daily activities.
Physical examination. This will assess hip mobility, strength, and any accompanying problems.
X-ray These images help determine the extent of damage or deformation in your hip.
Other tests. Sometimes, other tests, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your hip.
Deciding to Have Hip Replacement Surgery
Your orthopedic doctor will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method for relieving your pain and improving your mobility. Other treatment options may be considered, such as medications, physical therapy, or other types of surgery.
Also, your orthopedic doctor will explain the potential risks and complications of hip replacement surgery, including the surgery itself and those that may occur over time after surgery.
Do not hesitate to ask your doctor questions when you do not understand. The more you know, the better you can manage the changes you will make in your life with hip replacement surgery.
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who have hip replacement surgery see a dramatic reduction of hip pain and a significant improvement in activities of daily living.
With normal use and activity, the material between each hip replacement head and its socket begins to wear away. Overactivity or being overweight can accelerate this normal wear and tear and cause a hip replacement to become loose and painful. For this reason, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
Unrestricted activities following total hip replacement include unrestricted walking, swimming, golf, driving, hiking, cycling, dancing, and other low-impact sports.
With appropriate activity modification, the life of the hip replacement can last for many years.
If you decide to have hip replacement surgery, your doctor will evaluate your general health status and ask for an evaluation from related branches about your current diseases.
Various tests may be required to plan your surgery, such as blood and urine samples, electrocardiogram (ECG), and chest X-ray.
If you are overweight, your doctor may want you to lose weight before surgery to minimize stress on your new hips and possibly reduce the risks of surgery.
Although infections are not common after hip replacement, infection can occur if bacteria enter the bloodstream. Major dental procedures (such as tooth extraction and periodontal work) must be completed before your hip replacement surgery, as bacteria can enter the bloodstream during dental procedures. Routine cleaning of teeth should be postponed for a few weeks after surgery.
Individuals with a recent or history of frequent urinary tract infections should have a urological evaluation prior to surgery. Older men with prostate disease should consider completing the necessary treatment before surgery.
Although you will be able to walk with crutches or a walker shortly after surgery, you will need help with cooking, shopping, bathing and laundry for several weeks.
You will be admitted to the hospital 1 day before the operation.
After applying, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you sleep) or spinal, epidural or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team will determine which type of anesthesia would be best for you.
Many different types of designs and materials are used in artificial hip joints. All of these consist of two basic components: the ball component (made of a highly smoothed strong metal or ceramic material) and the socket component (a durable plastic, ceramic or metal container that may have an outer metal shell).
Prosthetic components can be clamped or replaced on bone to allow your bone to extend over the components. The decision to press fit or cement the components is based on a number of factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket can also be used.
Your orthopedic doctor will choose the type of prosthesis that best meets your needs.
The surgical procedure takes several hours. Your orthopedic surgeon will remove the damaged cartilage and bone and place new metal or ceramic implants to restore your hip’s alignment and function.
After the surgery, you will be taken from the anesthesia to the recovery room. After you wake up, you will be taken to your hospital room.
The success of your surgery depends on how well you follow your orthopedic surgeon’s instructions regarding home care during the first few weeks after surgery.
You may have stitches or staples along the wound or in a suture under your skin. Stitches will be removed approximately 2 weeks after surgery.
It is forbidden to wet the wound. You can continue to bandage the wound to prevent irritation from clothing and support stockings.
A balanced diet, often with iron supplementation, is important to support proper tissue healing and improve muscle strength. Make sure you drink plenty of fluids.
You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. A small amount of pain with activity is common for several weeks.
It will be appropriate to gradually increase your mobility at home and then outside.
No restrictions on other normal household activities such as sitting, standing and climbing stairs
Possible Complications of Surgery
The complication rate after hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as a heart attack or stroke, occur less frequently. However, chronic diseases can increase the potential for complications. Although rare, these complications can prolong or limit full recovery when they occur.
Infection may occur superficially deep into the wound or around the prosthesis. It can happen in the hospital or after you go home. It can occur even years later.
Minor infections of the wound are usually treated with antibiotics. Major or deep infections may require further surgery and removal of the prosthesis.
Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they drain and travel to your lungs. Your orthopedic surgeon will outline a prevention program that includes blood-thinning medications, ankle exercises, and early mobilization.
Leg Length Inequality
Sometimes after hip replacement, one leg may feel longer or shorter than the other. Your orthopedic surgeon will make every effort to equalize your leg lengths, but may lengthen or shorten your leg slightly to maximize hip stability and biomechanics. Some patients may feel more comfortable with shoe support after surgery.
The risk of dislocation during the healing of tissues is highest in the first few months after surgery. With a closed seat, it can usually be put back in place without the need for further surgery. In cases where hip dislocation persists, further surgery may be required.
Loosening and Implant Wear
Over the years, a hip replacement can wear out or become loose. This is usually caused by daily activities. It can also be caused by the biological thinning of bone called osteolysis. If the relaxation is painful, a second surgery, called a revision, may be needed.