Hip Replacement
Introduction
When pain and stiffness in your hip keep you from your daily activities, you may need total hip replacement. The development of total hip replacement began over 40 years ago. Today, more than 180,000 people in the United States annually undergo hip replacement surgery to diminish pain and stiffness and restore mobility.
The most frequent source of debilitating pain is arthritis. It is estimated that 40 million people in the United States have some form of arthritis. That's one in every seven people, or one in every three families. Of the more than 100 types of arthritis, the following three are the most common causes of joint damage.
- Osteoarthritis, sometimes called degenerative arthritis, is a disease which involves the breakdown of the tissue (cartilage) that normally allows the joint to move smoothly. When the gliding surface of the cartilage is gone, the bones grind against each other, creating popping sounds, pain and loss of normal movement. Although this condition occurs primarily in people over 50, it can begin at a younger age as a result of injury or overuse. Osteoarthritis commonly affects the hip, hip and shoulder.
- Rheumatoid arthritis is considered a systemic disease because it can attack any or all joints of the body. It affects women more often than men, and can strike both young and old, but usually occurs in adults over 30 years of age. Rheumatoid arthritis causes the body's immune system to produce a chemical that attacks and destroys the protective cartilage that covers the joint surface. The joint linings swell and pain and stiffness are usually present even when the joint is not in use. This usually occurs in the hands and feet, but larger joints such as the hips, hips and elbows may be involved.
- Trauma-related arthritis results when the joint is injured, either by fracture, dislocation or damage to the ligaments surrounding the joint causing instability or damage to the joint surfaces.
When conservative methods of treatment fail to provide adequate relief, total hip replacement is considered. If your X-rays show destruction of the joint, you and your surgeon will decide if the degree of pain, deterioration and loss of movement is severe enough that you should undergo the operation.
Today, your orthopaedic surgeon can replace your problem hip thanks to the development of total hip implants, which have been shown to provide long-term relief. Total joint replacement is a remarkably successful operation that has transformed the lives of many people by enabling them to be active and pain-free.
The Hip Joint
A joint is a junction where two or more bones meet. The hip joint forms where the top of the femur (thigh bone) meets the acetabulum (the socket of the pelvic bone). The top of the femur is ball-shaped and fits snugly in the socket formed by the acetabulum. The bones of the hip joint are covered by a layer of smooth, shiny cartilage that cushions and protects the bones while allowing easy motion. Surrounding the hip joint is the synovial lining, which produces a moisturizing lubricant. Tough fibers, called ligaments, connect the bones of the joint and hold them in place, while adding strength and elasticity for movement. Muscles and tendons also play an important role in keeping the joint stable.
Your Hip Evaluation
Your hip evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary. It helps the surgeon understand your pain, limitations in activity and the progression of your hip problem.
After your history is taken, a physical exam is performed. The range of motion of your hips and knees are measured and your muscle strength is evaluated. The surgeon will observe how you walk, sit, bend and move.
X-rays are taken of your hip joint. Bring any X-rays that may have been taken of your hip in the past. These X-rays will help your surgeon plan the surgery and evaluate the fit of your new hip prosthesis.
A small amount of fluid may be taken from your hip joint to check for infection.
After your initial orthopaedic evaluation, the surgeon will discuss possible alternatives to surgery. If the X-rays show severe joint damage and no other means of treatment has provided relief, total hip replacement may be recommended.
Total hip Replacement
Total hip replacement or "arthroplasty" is the replacement of the ball and socket of the hip joint with artificial parts called prostheses. There are two main components used in total hip replacement. The femoral component is made of metal and replaces the ball. The acetabular component replaces the socket and may be made entirely of a very hard medical-grade plastic called polyethylene. It may also be made of a metal and polyethylene combination in which the polyethylene cup is placed inside a metal shell. The acetabular component is then secured inside the natural pelvic socket.
The natural ball portion of the femur (thigh bone) is removed during surgery and the inside of the femur (the canal) is drilled and enlarged to fit the femoral component of the hip prosthesis. The socket portion of the pelvis is also enlarged with a special surgical instrument to make room for the new artificial socket component. The femoral component is inserted down the enlarged shaft of the thigh bone. The acetabular component is inserted into the enlarged socket. The ball and socket are then fitted together and stabilized with the surrounding ligaments and muscles, just as your original hip had been.
Before Surgery
You may be asked to see your family physician or an internal medicine doctor for a more thorough medical evaluation. To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop two weeks prior to surgery. If you are taking aspirin or certain arthritis medications, inform your surgeon; you may need to stop taking these two weeks before surgery. If you take estrogen (i.e. Premarin), your surgeon will probably advise you to stop taking it one month prior to surgery. Your doctor may want you to donate your own blood ahead of time for a possible transfusion during surgery.
You will probably be admitted to the hospital the morning of surgery. You cannot eat or drink anything after midnight the day of surgery.
In order to receive medications and blood transfusions during surgery, an intravenous (IV) line will be started. The anesthesiologist will speak to you before surgery and discuss the type of anesthetic to be used.
What To Expect After Surgery
You will awaken after your surgery in the Post-Anesthesia Recovery Room. You will remain there until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You may feel as though you only left your room for a few minutes. If you experience pain, medication will be available.
You may have a tube or drain coming through the surgical dressing that is attached to a drainage apparatus. This system provides gentle, continuous suction to remove any blood that may accumulate in the surgical area. The drain will probably be removed several days after surgery. Your dressing will be changed and a smaller one applied.
You may move the leg that was not operated on as soon as you awaken. As you lie on your back, flexing the non-operative hip will reduce aching in your lower back. The nurse will help you find comfortable positions. You may turn with a pillow between your legs. The nurse will encourage you to do ankle pumping exercises every hour to protect against blood clots.
An IV may remain in your arm for several days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon.
To prevent problems in your lungs, you may receive an incentive spirometer after surgery to encourage you to cough and breathe deeply. This is used every hour while you are awake.
It is normal to feel discomfort after surgery. Inform the nurse of your pain, and medication will be ordered.
Physical Therapy
A hip rehabilitation program begins right after surgery and is ordered by your surgeon. Isometric exercises (tightening muscles without moving the joint) will begin while you are still in bed. You will be instructed to do these exercises a number of times per day while awake. You will be encouraged by the physical therapist to move your ankle and other joints so that you will remain strong. These exercises will help you regain strength and mobility. The day after surgery, you will probably begin walking and performing exercises that move your hip joint. Initially, the physical therapist will assist you in getting out of bed and standing at the bedside with a walker. For your entire hospital stay, you will probably walk, with a walker or crutches, two times per day under the supervision of the therapist. Your walking distance will gradually increase.
To protect your hip, you will not be permitted to sit past a 90-degree angle. To accommodate sitting, there will be an elevated chair and an elevated toilet available for your use. This will allow your hip to be higher than or equal to your knee while sitting.
The therapist will teach you how to dress, get out of bed without help and use a walker or crutches. You will continue to work to strengthen yourself in preparation for your return home.
Preparing To Go Home
The usual hospital stay for hip joint replacement is three to five days. You will quickly gain independence after your surgery. Just prior to your discharge, you will receive instructions for your at-home recovery. Until you see the surgeon for your follow-up visit, you must take certain activity precautions. It is important for you to adhere to your doctor's directions and follow proper positioning techniques throughout your rehabilitation. By the time you leave the hospital, you normally will be progressing well in regaining mobility and stability. If sutures or clips are not ready to be removed before discharge, you will be advised about who will remove them and where this will be done.
It is normal for you to have some discomfort. You will probably receive a prescription for pain medication before you go home. If a refill is needed, please call your surgeon's nurse at least five days before you run out of pills.
Look for any changes around your incision. Contact your surgeon if you develop any of the following:
- Drainage and/or foul odor coming from the incision.
- Fever (temperature about 101 degrees F or 38 degrees C) for two days.
- Increased swelling, tenderness, redness and/or pain.
Take time to adjust to your home environment. It is normal to feel frustrated, but these frustrations will soon pass. It is okay to take it easy.
Resuming Activities
Depending upon the physical demands of your job, you normally can resume work when authorized by your surgeon. You usually may begin driving once you are able to bear full weight on your hip. Be sure you are comfortable with your strength. Be sure to practice driving in a safe area. Once you are comfortable with your mobility, you generally may drive anywhere.
Sexual intercourse may be resumed at any time as long as all hip precautions are kept in mind.
We encourage you to be active in order to control your weight and muscle tone. It is generally three to four months before you can resume low-impact aerobic activities such as walking, bicycling and swimming. Jogging, high-impact aerobics and certain sports should be avoided. Your new hip is artificial, and although made of extremely durable materials, it is subject to wear and tear.
Since your rehabilitation is an individual one, please seek advice on future activities from your surgeon.
Special Instructions
You may be seen six weeks, five months and twelve months after your surgery. It may be requested that you see your surgeon once a year after the first year, even if you are not having any problems, to check out the condition of your new hip joint.
Any infection must be promptly treated with proper antibiotics because infection can spread from one area to another through the blood stream. Every effort must be made to prevent infection in your artificial joint. You should always tell your dentist or physician that you have an artificial joint. If you are to have dental work performed, please call your surgeon prior to having this work done. Your surgeon will most likely prescribe an antibiotic for you. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.
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