Hip joint replacement surgery was primarily reserved for people over 60 years of age in the past. It was though that older people are typically less active & therefore put less stress on the artificial hip when compared to younger people. However, in recent years orthopedists have found that hip replacement surgery can be very useful for younger people as well. Newer technology has dramatically improved artificial parts which allow them to withstand more of stress & strain & last longer as well. Nowadays, an individual’s overall health & activity level are more important than age in predicting success of hip replacement surgery.
Who Should Undergo Hip Joint Replacement Surgery?
Hip Replacement Surgery is an ideal treatment procedure for people who are having hip joint damage causing pain & interfering with daily activities despite availing a variety of nonsurgical treatments. Osteoarthritis is however one of the most common causes of this type of damage. Moreover, other orthopedic problems which call for hip joint replacement surgery include fractures, injuries, osteonecrosis or avascular necrosis (death of bone due to insufficient blood supply), rheumatoid arthritis causing chronic inflammation along with joint swelling, stiffness & pain & bone tumors leading to breakdown of hip joint. Nevertheless, hip replacement surgery can be problematic for some patients with certain health conditions, regardless of their age group. Like for example people having chronic disorders like Parkinson’s disease or other conditions which result in serious muscle weakness are most likely to damage or dislocate artificial hip than people without any chronic disease. People in poor health or at high risk for infections are also less likely to successfully recover following surgery. Another interesting fact which recent studies suggest is that people electing to undergo hip replacement surgery before occurrence of advanced joint deterioration tend to have better outcomes & easily recover as well.
Why Undergo Hip Replacement Surgery?
Majority of people who undergo hip replacement surgery enjoy the following benefits.
- Increased Mobility
- Decrease in Pain
- Improvement in Daily Living Activities
- Improvement in Quality of Life
What Alternative Options are Available for Hip Replacement Surgery?
Orthopedists would like to try various other methods of treatment like medications, exercise & walking aids before considering total hip joint replacement surgery. Exercise programs are also very useful & can help strengthen muscles around the hip joint. Walking aids like walkers & canes also may alleviate some amount of stress from damaged & painful hips & help people delay or avoid hip replacement surgery. Moreover, in some cases, stronger analgesic medications like tramadol or products containing narcotic analgesics & acetaminophen like codeine may also be necessary to control pain. Topical analgesic products can also provide additional relief. Some people also derive relief from pain by using a nutritional supplement combination of chondroitin & glucosamine. However, people taking herbs, nutritional supplements & various other alternative & complimentary medicines should consult with their doctors before taking them in order to avoid harmful interactions among drugs.
In a small number of patients doctors prescribe corticosteroids like cortisone or prednisone in case NSAIDs are unable to relieve pain. Corticosteroids generally reduce joint inflammation & are therefore frequently utilized to treat rheumatic diseases like rheumatoid arthritis. However, because serious side effects are invariably associated with corticosteroids, doctors usually prescribe & monitor these treatments. Moreover, corticosteroids are also injected into the hip joint in some cases.
When medications & exercise do not relieve pain or improve joint function, orthopedists may suggest less complex corrective surgical interventions before opting for hip replacement surgery. Osteotomy is one common alternative to hip replacement surgery. This surgical intervention involves cutting & realigning bone in order to shift weight from painful & damaged bone surfaces to healthier areas. However, recovery from osteotomy takes several months of time, following which function of hip joint may continue to worsen & require additional treatments as well. Length of time gain before another surgical procedure is required may vary & depend upon the condition of hip joint before undergoing procedure.
What is involved in Hip Replacement Surgery Procedure?
Hip joint is located at the upper end of thigh bone (femur) where it meets the hip bone (pelvis). There is a ball at the end of femur known as the femoral head & which fits in the acetabulum (socket) in pelvis in order to allow a wide range of motion. During traditional hip replacement surgery which usually lasts between 1 – 2 hours of time, orthopedic surgeons make a 6 – 8 inch incision over the side of the hip, cutting through muscles so as to remove diseased bone tissue & cartilage from the hip joint, while allowing healthy parts of the joint to stay intact. Following this, surgeons will replace head of femur & acetabulum with the new artificial implants. Artificial implants are generally made of materials which allow natural gliding motion of the hip joint. When orthopedists are performing minimally invasive or mini-incision hip replacement surgery, patients will then have smaller incisions & shorter recovery time for healing. However, ideal candidates for this type of surgery are usually under age 50 years, of normal weight based on BMI & healthier than candidates who are fit for traditional surgery.
Nevertheless, regardless of whether the patient is undergoing traditional or minimally invasive hip replacement surgery, artificial parts which are used for replacing joints are the same & come in a couple of main varieties, cemented or un-cemented. Cemented artificial parts are generally fastened to existing healthy bones with special glue called cement. Un-cemented artificial parts rely on a process known as biologic fixation so as to hold them in place. For this reason un-cemented artificial parts are made with a porous surface which allows the patient’s bone to grow into pores so as to hold the new artificial parts into place. Sometimes, orthopedic surgeons use a combination known as hybrid replacement which involves using a cemented artificial femur part & an un-cemented acetabular artificial part.
Which is a Better Option, Cemented or Un-Cemented Hip Replacement Prosthesis?
Since every person’s condition is uniquely different, the answer is different for different people. Orthopedic surgeons must therefore evaluate advantages & disadvantages of each case. Cemented artificial parts are frequently utilized for older & less active persons or people with weak bones like osteoporosis patients, while un-cemented artificial replacements are frequently used for more active & young patients. Success rates for both cemented & un-cemented artificial hip replacement surgeries are comparable, including patients requiring additional hip replacement or revision surgeries. Nevertheless, primary disadvantage of un-cemented prosthesis is the extended period of recovery since it takes longer time for natural bone to grow & attach itself with the prosthesis. People with un-cemented hip replacements must also limit activities for about 3 months of time in order to protect the hip joint. Moreover, it is common for people with un-cemented prosthesis to experience thigh pain for months following hip joint replacement surgery, while the bone is still growing into the prosthesis.
Also Read: Types of Hip Replacement Surgery
What Should Hip Replacement Patients Expect Immediately After Surgery?
Immediately after hip replacement surgery, patients will only be allowed limited movement. Pillows & special devices are usually placed to brace hip in the correct position while they are in bed. Patients will also receive fluids through an IV line so as to replace fluids lost during the procedure. There also may be a tube located near the incision site called catheter so as to drain fluids. Another catheter may be used to drain urine until the patient is able to use the bathroom. Orthopedists would also normally prescribe medications for pain & discomfort for patients following surgery. On the day or the day following hip joint replacement surgery, physical therapists usually teach exercises to improve recovery. Respiratory therapists would ask patients to breathe deeply, blow or cough into a device meant to measure lung capacity. These set of exercises are meant to reduce collection of fluid in lungs following surgery. Most patients are able to sit at the edge of bed, stand or even walk with assistance as early as a day or two following hip replacement surgery. Exercises taught by physical therapists generally include relaxing & contracting certain muscles so as to strengthen the hip. Physical therapists will also teach proper techniques for simple daily living activities like sitting & bending to prevent injury to the artificial hip because it has more limited range of movement than the natural healthy hip.
How is Recovery & Rehabilitation Following Hip Replacement Surgery?
Hip replacement surgery patients will not spend more than 3 – 5 days of time at the hospital. Full recovery after surgery usually takes about 3 – 6 months of time depending upon the type of surgery & overall health & success of rehabilitation of the patient. It is however important for patients to take instructions from orthopedists before discharge from the hospital & to carefully follow these after reaching home. This will help to ensure that they comfortably enjoy benefits of a successful surgery.
What Possible Complications are Associated with Hip Replacement Surgery?
Technological advancements in surgical techniques have largely reduced risks involved with hip joint replacement surgery. Most common problem which can arise after hip replacement is dislocation of hip. This is usually because the artificial ball & socket are smaller than the normal hip joint. With the new joint, the ball can dislodge from the socket when hip is placed in certain positions. One such dangerous position is pulling of knees up to the chest. Another complication which is found to occur later is inflammatory reaction to tiny particles which gradually wear off from the artificial joint surfaces & are absorbed by surrounding tissues. Resulting inflammation can trigger action of special cells which eat away some bone & cause implants to loosen in the process. Anti-inflammatory medications or revision surgery are generally recommended to treat such complications. However, newer materials are also being experimented & which can last longer while causing lesser inflammation. Other less common complications of hip joint replacement surgery include blood clots, infection & bone growth beyond defined edges of bone (heterotopic bone formation). It is however important that hip replacement surgery patients learn to prevent problems & recognize potential signs of complications & report to doctors so as to minimize risks. Common signs of blood clots include swelling of foot, ankle or thigh or redness, tenderness & swelling of calf. Warning signs of infection generally include chills, fever, swelling & tenderness or drainage from wound in some cases. Hip replacement surgery patients should immediately call the doctor in case they experience the above mentioned symptoms.
When is Revision Surgery Required?
Hip replacement surgery is one of the most successful orthopedic procedures performed nowadays. However, with more & more people having this procedure at a younger age, wearing away of the artificial joint surface usually becomes necessary after 15 – 20 years. This is the reason why revision surgery is becoming more common involving replacement of the worn-out artificial hip joint. Most often, revision surgery is more difficult than the first time procedure & outcomes are also not as good, therefore revision hip joint replacement surgery patients must explore all available options before undergoing additional surgery. Orthopedists usually consider revision surgery for the following reasons. Firstly, it is usually considered in case of bone loss or wearing down of joint surfaces, or loosening of joints show-up on x-rays. Other possible reasons suggesting revision surgery include infection, dislocation of artificial parts or fractures.
What Types of Exercises are Suitable for Hip Replacement Surgery Patients?
Proper exercises can drastically reduce stiffness while increasing flexibility & muscle strength in hip joint replacement surgery patients. People with artificial hip joints should therefore talk to orthopedists or physical therapists about developing a proper exercise program following surgery. Such exercise programs usually begin with safer range-of-motion activities & simple muscle strengthening exercises. Moreover, the therapist or orthopedist can decide as to when patients can move onto more demanding activities. However, orthopedists usually recommend that patients avoid high-impact sporting activities like tennis, jogging & basketball as they can damage the new hip or cause loosening of implant components. Some exercises which are commonly recommended by orthopedists to hip replacement patients include cross-country skiing, swimming, stationary bicycling & walking. These exercises can help in increasing cardiovascular fitness & muscle strength without injuring the new artificial hip.