Hip joint replacement is a surgical procedure where the physician will surgically remove a painful hip joint that has been damaged by arthritis and replace it with an artificial joint. This is usually done when all other treatment options have failed to provide appropriate relief for the individual. The goal of the treatments is to relieve a painful hip joint and make walking easier for the individual.
The American Academy of Orthopedic Surgeons calls a total hip replacement an orthopedic success story. In the past hip replacement surgery was reserved for those individuals who had reached a certain age but today replacements are being performed based on more criteria then just age. In 2001 approximately 165,000 hip joints were replaced according to the National Center for Health Statistics.
But, despite their success, hip and knee replacements still have some drawbacks. As artificial joints and surgical techniques continue to improve the medical community and patients hold out hope that joint replacements will cause fewer problems, last longer and move more like a healthy natural joint.
The most common reason for having a hip replacement is osteoarthritis. This is a degenerative joint disease that breaks down the cartilage and is not limited to older people. In other instances people born with a deformed joints or defective cartilage can lead to arthritis. And obesity, joint fracture, ligament tears and other injuries can damage the cartilage and later lead to osteoarthritis.
During the surgical procedure the surgeon removes the arthritic ball of the upper femur or thighbone as well as the damaged bone and cartilage from the hip socket. These are replaced with implants made from materials which include metal alloys, plastic or ceramic. The implants are designed to create a new functioning joint that replaces painful bone-on-bone contact.
The risk of a total hip replacement includes developing blood clots in the lower extremities which can result in pulmonary embolism if they break off and travel through the venous system. Severe cases of pulmonary embolism are rare but can cause respiratory failure, shock and death. Other problems may include difficulty with urination, local skin or joint infection, fracture of the bone during and after surgery, scarring and limitation of motion at of the hip joint or later loosening of the prosthesis which will eventually lead to failure of the hip. And because general anesthesia is necessary, the usual risks associated with general anesthesia apply.
Because total hip replacement can involve significant blood loss patients may donate their own blood to be banked for transfusion during the surgery. Preoperatively patients will be evaluated for any medications in their daily routine as well as evaluation for blood counts, liver and kidney function, urinalysis, chest x-ray, EKG and a physical examination. Any indication that there is an ongoing infection or severe lung or heart disease will postpone a planned surgery.
The surgery usually takes between two and four hours. There will be additional preparation prior to surgery and recovery can last between one and four hours. During the immediate period after surgery individuals will receive intravenous fluids to maintain electrolyte balance and antibiotics prophylactically. An appropriate amount of pain control medications will be administered and determined by the patient themselves. Measures will be taken to prevent blood clots in the lower extremities and patients will be encouraged to perform deep breathing and coughing to avoid congestion and pneumonia.
An alternative to hip replacement is an operation called hip resurfacing in which a prosthesis is designed to allow the femoral head to be preserved and reshaped. In the United States hip resurfacing is being conducted only in FDA approved clinical studies. Because not everyone is a candidate for resurfacing more intensive evaluations are necessary before patients can be enrolled in the clinical studies
Although each prosthesis is made of highly polished metal or polyethylene intended to be wear resistant, the daily use of these surfaces will lead to particles of debris which can damage the surrounding bone. The Achilles\’ tendon of any artificial joint is a long term wear.
Following surgery individuals will be enrolled in a rehabilitation program with physical therapist to strengthen the muscles and tendons which hold a joint in place. For anywhere from six to 12 months after surgery any pivoting or twisting on the leg must be avoided. This includes crossing legs or bending the hip past 90° both foreward and squatting.
The physical therapist will provide the individual with techniques and adaptive equipment that will help follow any of these guidelines and precautions while performing daily living activities. If an individual does not follow the guidelines there is a significant risk of dislocating the newly replaced hip joint and requiring another surgery.
The results after a hip joint replacement are usually excellent. The operation immediately relieve pain and stiffness and most patients need no help walking. Postoperatively patients remain in the hospital for three to five days. Some people may need to stay longer if significant mobility has not been attained. Many patients require the use of crutches or a walker for as long as three months in order to assist the healing process of the hip.
Individuals who may be interested in considering either hip joint replacement or hip resurfacing should be evaluated by an orthopedic surgeon in order to be sure they are good candidates for the surgery.
RESOURCES
MedlinePlus: Hip Joint Replacement
MayoClinic: Hip Replacement
University of Maryland Medical Center: Hip Joint Replacement
American Academy of Orthopedic Surgeons: Total Hip Replacement
New York University Hopsital for Joint Disease: http://cmc.med.nyu.edu/
Main medical Center: Joint REplacement
Medline Plus: Hip Joint Replacement
St. Mary\’s Health Center: Hip-Joint Replacement Surgery
University of Colorado Hospital: Joint Preservation and Replacement