Total Hip Replacement

Overview

Your hips carry out important functions like balancing your body weight and connecting bones in your lower and upper legs. Injured hips can significantly interfere with your ability to perform almost every routine movement imaginable. Severely injured or diseased hips can be restored through a medical procedure called total hip replacement.

Anatomy

Your hips are large ball-and-socket joints connecting your upper leg and thigh bones to your hip. The surfaces of these bones are protected by a rubbery material called cartilage. The bones are connected to the hip joint by soft tissues known as ligaments.

Illnesses Causing Hip Deterioration

Over time, inflammation holds the potential to weaken these structures. Inflammation results from several different conditions, such as:

• Osteoarthritis – Osteoarthritis commonly leads to hip deterioration. It typically arises from normal age-related decline. Congenital irregularities and genetic flaws can also contribute to its development. The condition occurs when the cartilage gradually weakens and wears.
• Osteonecrosis – This disease happens when the hip’s blood supply is limited or cut off. It typically results from serious injuries like hip fractures or dislocations. Certain underlying diseases can also be the cause. As the issue progresses, portions of bone die and can even collapse.
• Rheumatoid Arthritis – This form of arthritis results from immune system abnormalities. Over time, significant cartilage damage occurs.
• Post-Traumatic Arthritis – Traumatic events like falls or automobile accidents can lead to hip fractures or dislocations that fail to heal and develop arthritis.
• Childhood Hip Diseases – These conditions can stunt hip growth or cause physical features to experience irregular growth patterns. Such events increase one’s risk of contracting arthritis as an adult.

Shoulder X-rays are necessary to confirm the diagnosis and make sure that a clavicle fracture isn’t present. Unless an AC Joint injury occurs in a young manual laborer or an overhead athlete, it’s often best to wait for at least three months before considering any surgical reconstruction, even in a professional (non-overhead) athlete.

Diagnosing The Need

Before recommending a total hip replacement, your doctor will perform a diagnostic process known as a full orthopedic evaluation. It is divided into several key stages such as:

• Taking A Medical History – Your doctor will measure your vital statistics and ask important questions such as when did your pain begin, does any activity worsen the discomfort, what type of leisure activities you partake in, the kind of job you hold, and if you have a family history of hip problems.
• Movement Tests – Your doctor will likely ask you to perform various movement tests designed to determine your injured hip’s motion range, strength, and positioning.
• Internal Imaging Tests – Your doctor will likely take X-rays of your hip. These internal images reveal if and how bad the damage to your hip bones is. Your doctor might perform tests using diagnostic tools like magnetic resonance imaging (MRI). MRI scans allow doctors to examine soft tissues like cartilage and ligaments.

Symptoms Of Significant Hip Problems

Pain is the most significant indicator of significant hip injury or illness. This discomfort often intensifies during exercise or after sitting or standing for extended timeframes. The uncomfortable sensations could spread to neighboring areas such as your groin, thighs, and buttocks.

Other problems include stiffness, creaking or crackling sounds coming from the hip when you move, weakness, hip stability issues, and mobility difficulties.

Determining Your Candidacy for Total Hip Replacement

Doctors consider several factors before recommending a patient for total hip replacement, including:

• The extent of your injury.
• The specific underlying cause and its severity.
• If associated symptoms interfere with your ability to perform routine functions.
• If you experience movement difficulties.
• If your hip displays any degree of instability.
• If other less aggressive treatment options have not produced favorable results.
• Your body mass index (BMI).

The procedure is most often performed on persons between 50 and 80, but it can be performed on anyone if the need exists.

Individuals Who Are Not Suitable Candidates

You are advised not to undergo total hip replacement if you have been diagnosed with a serious muscle weakness-causing illness, are obese, or have a major disease or infection.

Preparation

While planning the procedure, doctors will ask you to disclose the medications you routinely use. Certain drugs increase your risk of surgical and post-surgical complications.

Necessary dental work should be completed well in advance of a total hip replacement. During certain dental procedures, tiny amounts of bacteria enter your bloodstream, which could increase your risk of infection following hip replacement surgery.

If you live alone, you are urged to arrange for post-operative help. You will likely need help getting around for at least several weeks after your operation.

The Procedure

Before surgery begins, you will receive anesthesia. The specific type and the amount given will depend on several factors your doctors will carefully consider.

The typical hip replacement operation takes one to two hours. Surgeons replace the ball and socket joint with artificial components made of metal, ceramic, and plastic.

Recovery Process

You will likely spend several days in the hospital following the procedure. It is difficult for doctors to pinpoint specific full recovery timeframes. How quickly you return to your previous routine will hinge on several key factors, including:

• Wound Care – Doctors stitch the area where surgical incisions were made. Your stitches remain in place until removed by your doctor several weeks following your operation. While stitches are in place, you must prevent the healing wound from getting wet and change bandages as instructed by your surgical and post-op care team.
• Diet – You will likely be prescribed an iron supplement. Iron plays a crucial role in healing and rebuilding muscle strength. You must remain properly hydrated.
• Physical Therapy – You will likely undergo a course of physical therapy geared towards helping your healing hip recapture lost motion and strength. These exercises will be light to start and increase in intensity as your wound heals and your hip strengthens.

Potential Risks

Though uncommon, total hip replacement surgery does involve certain risks, such as:

• Hip dislocation.
• Leg-length unevenness.
• Infections.
• Blood clots.

Other possible complications include loosening of the artificial implant, bleeding, nerve damage, and lingering post-surgical pain.

Outlook

Researchers estimate that total hip replacement eases a recipient’s pain and mobility issues in roughly 95% of cases. You can increase your chances for long-lasting success by engaging in post-operative safeguards such as:

• Exercising – Participation in continual light exercise programs helps keep your new hips strong and mobile.
• Using Caution When Undergoing Dental Procedures – Dental procedures can heighten your risk for infection. You might need to use antibiotics before undergoing any type of oral surgery.
• Being Extra Careful – Preventing mishaps like falls is not always possible. You must use extra vigilance in trying to prevent such events. Suggested precautionary actions include not climbing ladders, avoiding particularly wet or icy surfaces, holding onto railings while walking up stairs, and not engaging in contact sports.
• Receiving Periodic Checkups – Above all, you are firmly urged to undergo periodic checkups. Doctors can track your new hip’s progress and correct any problems in their earliest possible stages.

Next Steps

Renowned orthopedic surgeon and sports medicine specialist Doctor Peter Howard has performed countless hip replacement procedures, using an anterolateral approach. If you were told that you are a good candidate for total hip replacement, please consult with Dr. Peter Howard.