Hip Replacement

1 What is a Hip Replacement?

During hip replacement, a surgeon removes the damaged sections of your hip joint and replaces them with new parts which are usually constructed from metal and very robust plastic.

This artificial joint or prosthesis aids in the reduction of pain and improvement of function. Also known as a total hip arthroplasty, hip replacement surgery may be an option for you if your hip pain interferes with daily activities and more conservative treatments are ineffective.

Arthritis damage is the most common reason to require a hip replacement.

2 Reasons for Procedure

Here are the most common reasons to undergo a hip replacement procedure.

The following conditions can lead to the damage of the hip joint and can lead to the need for knee replacement:

Osteoarthritis

Commonly known as wear and tear arthritis, osteoarthritis destroys the slick cartilage that covers the ends of bones and places a part in the smooth movement of joints.

Rheumatoid arthritis

This condition is caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode and cartilage and deform joints.

Osteonecrosis

If there is insufficient blood supply to the ball portion of the hip joint, they joint may collapse and deform.

You might consider hip replacement if you experience pain that:

  • Persists despite pain medication.
  • Worsens with walking, even with a cane or walker.
  • Interferes with your sleep.
  • Affects your ability to go up or down.
  • Makes it hard to rise from a seated position.

3 Potential Risks

There are various risks associated with hip replacement. They may include:

Blood clots

There can be a formation of clots in your leg veins after the surgery. This can be very dangerous as the clot can break off and travel to your heart or lungs and in rare cases, your brain.

Infection

There can be an occurrence of infection at the site of your incision in the deeper tissue near your new hip. Most infections are treated with antibiotics, but minor infection near your prosthesis may require surgery to remove and replace the prosthesis.

Fracture

Healthy portions of your hip joint may fracture during surgery. In some cases, the fractures are so small that they heal on their own, but larger fractures may need to be corrected with wires, pins and possibly bone grafts.

Dislocation

Certain positions can lead to dislodging of the ball of your new joint. To prevent this, it is often recommended that after surgery you don't bend more than 90 degrees at the hip and don't allow you leg to cross the midline of your body.

Change in leg length

Your surgeon takes steps to prevent the problem, but occasionally, a new hip makes one leg longer or shorter than the others. In some cases, his is a cause of weakness in the muscles surrounding the hip. In this case, progressively strengthening and stretching those muscles may help.

Loosening

Although this problem is not common with new implants, you new joint may not become solidly fixed to your bone or may loosen with time.

Need for the second hip replacement

Your prosthetic hip joint may wear out eventually, you will probably have hip replacement surgery when you are older if you had it when you were younger. However, new materials are making implants last longer, so a second surgery may not be necessary for a long time.

Metal-on-metal complications

Most artificial hip joints have a polished metal or ceramic ball that fits into a cup liner that is made out of very robust plastic. Some types of prostheses make use of a metal cup liner, which may last longer but can cause other complications. Metal-on-metal prostheses are likely to release metal ions into your bloodstream, which can cause inflammation and bone erosion. Because of these concerns metal-on-metal prostheses are now rarely used.

4 Preparing for your Procedure

To prepare for the hip replacement procedure you need to meet with the orthopedic surgeon for an examination.

Your surgeon will do the following:

Ask about your medical history and current medications. Do a short general physical examination to make sure you are healthy enough to undergo surgery.

Examine your hip, paying attention to the range of motion in your joint and strength of the muscles that surround it. Order blood tests, an X-ray  and possibly an MRI.

This preoperative evaluation is a good opportunity for you to pose any questions about the procedure.

Be sure to find out which medications you should avoid or continue to take in a week before surgery.

5 What to Expect

Read on to learn more about what to expect before, during, and after your hip replacement procedure.

When you check in for your surgery, you'll be asked to remove your clothes and put on a hospital gown. You'll be given either a general anesthetic or a spinal block, which numbs the lower half of your body.

During the procedure

To perform a hip replacement, your surgeon:

  • Makes an incision over the front or side of your hip, through the layers of tissue
  • Removes diseased and damaged bone and cartilage, leaving healthy bone intact
  • Implants the prosthetic socket into your pelvic bone, to replace the damaged socket
  • Replaces the round top of your femur with the prosthetic ball, which is attached to a stem that fits into your thighbone

Techniques for hip replacement are evolving. As surgeons continue to develop less invasive surgical techniques, the hope is that these techniques might reduce recovery time and pain compared with standard hip replacements.

However, studies comparing the outcomes of standard hip replacement with those of minimally invasive hip replacement have had mixed results.

After the procedure

After surgery, you'll be moved to a recovery area for a few hours while your anesthesia wears off. Nurses or other anesthesia aides will watch you

  • blood pressure,
  • pulse,
  • alertness,
  • pain or comfort level,
  • your need for medications.

Blood clot prevention

After your surgery, you'll be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:

Early mobilization

You'll be encouraged to sit up and even try walking with crutches or a walker soon after surgery. This will likely happen the same day as your surgery or on the following day.

Pressure application

Both during and after surgery, you may wear elastic compression stockings or inflatable air sleeves similar to a blood pressure cuff on your lower legs. The pressure exerted by the inflated sleeves helps keep blood from pooling in the leg veins, reducing the chance that clots will form.

Blood-thinning medication

Your surgeon may prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you may need blood thinners for several more weeks after surgery.

Physical therapy

A physical therapist may help you with some exercises that you can do in the hospital and at home to speed recovery. Activity and exercise must be a regular part of your day to regain the use of your joint and muscles.

Your physical therapist will recommend strengthening and mobility exercises and will help you learn how to use a walking aid, such as

  • a walker,
  • a cane
  • crutches.

As therapy progresses, you'll gradually increase the weight you put on your leg until you're able to walk without assistance.

Home recovery and follow-up care

Before you leave the hospital, you and your caregivers will get tips on caring for your new hip.

For a smooth transition

  • Arrange to have a friend or relative prepare some meals for you
  • Place everyday items at waist level, so you can avoid having to bend down or reach up
  • Consider making some modifications to your home, such as getting a raised toilet seat
  • About six to eight weeks after surgery, you'll have a follow-up appointment with your surgeon to make sure your hip is healing properly.

If recovery is progressing well, most people resume their normal activities by this time — even if in a limited fashion. Further recovery with improving strength will often occur for six months to a year.

6 Procedure Results

Understanding the results of your hip replacement will be made possible by your doctor.

You should expect your new hip joint to decrease the pain you felt prior to the surgery and also an increase in the range of motion in your joint.

Do not expect to do everything you couldn't do before the surgery.

High-impact activities, such as:

  • running,
  • playing basketball

may be too stressful in your artificial joint.

However, in time, you may be able to:

  • swim,
  • play golf,
  • hike
  • ride a bike comfortably.
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