CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Total Hip Arthroplasty
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Injuries and Conditions: Total Hip Arthroplasty : Total Hip Arthroplasty : Treatment Options
 

Overview
  • Hip replacement surgery is generally very successful in reducing pain. Most artificial hip recipients indicate nearly complete elimination of their hip pain for as long as the replacement hip lasts.
  • The surgical procedure to replace a hip is a major operation. Surgery removes the damaged areas of the thighbone (femur) and the inside of the socket (the acetabulum). The femur is hollowed out to produce a central canal to allow the insertion of a rod capped with a metal or ceramic ball, and the socket of the hip is resurfaced with an alloy and polyethylene (plastic) implant or insert that is placed with the metal shell in the acetabulum.
  • Some patients may have degenerative conditions in both hips requiring the replacement of both hips; surgery to replace each hip during the same operation is usually not recommended under these circumstances. Patients requiring the replacement of both hips are recommended to have the 2nd hip replacement several months after the first operation, to allow for adequate rehabilitation.
  • Hip replacement is an elective surgery, and is considered an effective and long-lasting treatment for a degenerating hip.

    Treatment options:

    Total Hip Arthroplasty Overview
    Osteoarthritis, or other degenerative joint diseases, may be treated non-surgically during the early stages of the condition. Hip replacement surgery is considered for advanced conditions, which cause severe pain and greatly reduce a patient's ability to be active. The degenerated joint cannot rebuild itself; surgery will be required to replace the working surfaces of the hip with metals and plastics. A hip replacement will last 10-15 years in 90%-95% of patients.

    Evaluation of Patient for Surgery

  • Patients are given a complete physical examination to assess the patient's overall health.
  • An examination of the range of movement in both the involved and the uninvolved hip to evaluate motion and the production of pain.
  • Walking (gait) measurements and analysis are recorded.
  • Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
  • The hip will remain tender and slightly painful after surgery. However, the pain will tend to decrease as painkillers are administered and the hip recovers from the operation.

    Post-Operative Instructions

    Activity
  • Follow general post operative guidelines
  • Be aware of any signs of infection
  • Use crutches, cane or a walker to assist with walking, place weight on the operative leg as much as can be tolerated.
  • Do not engage in activities that increase the stress that is placed on the newly replaced hip.
  • Return to sedentary work (school or desk work)
  • Avoid long periods of sitting and traveling long distance without frequent breaks or stops.
  • Do not drive until given clearance to do so by your surgeon.
  • Home Exercise

  • Begin exercise 24 hours after surgery
  • Straight leg raises
  • Quad sets
  • Heel slides,
  • Ankle pumps
  • Rehabilitation Program
    A period of time is required for the body to adjust or acclimate to the replaced hip. Physical therapy will be required for 3 months to restore the muscle strength, flexibility and balance lost after surgery.

  • The joint will be used immediately after surgery, and the patient will be asked to walk with assistance the first day after surgery.
  • Hip replacement surgery usually requires a hospital stay of 3 to 5 days and require the use of crutches, cane or a walker for 4-6 weeks.
  • After 3 months, the hip will likely allow a return to moderate athletic activity such as bicycling, golf, and swimming.
  • To help maintain the replaced hip, continued gentle use of the joint will be required.
  • Long Term Expectations for Recovery

  • A replaced hip will usually allow patients to regain a significant amount of strength, stability, and motion of the hip.
  • The longevity of the replaced hip is dependent upon the type of use and stresses to which the hip is subjected. High impact, shock-producing activities like running, soccer or basketball should be avoided to insure a longer lasting hip.
  • Pain should be minimal throughout the life of the replaced hip. Increasing pain may indicate that the implants have begun to separate or loosen from the bone. A second surgical procedure, or revision, may be necessary to replace the implants if pain becomes severe enough, or the loosening risks further damage to the surrounding bone.
  • Under normal use a replaced hip can last more than 20 years.
  • Possible Complications and Risks

  • Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
  • DVT (Deep Vein Thrombosis) in which clots form within the blood vessels of the legs are a potential complication during this type of surgery.
  • Bleeding into the hip joint can be expected. The patient may have drains placed in the hip during surgery to lessen this accumulation of blood.
  • The most common reason artificial joints fail is due to the loosening of the cement where the implants meet the bone. As the artificial joint wears, increasing pain may mean that a revision, or second surgery, is required to replace the loosened implant.
  • Stiffness in the hip may result after surgery as scar tissue around the joint forms and interferes with motion. Unwanted growth of bone around the joint may occur infrequently after the surgery. If this severe problem occurs, a second surgery may be required to remove the bone to regain full motion.
  • It is possible that damage to adjacent nerves may occur during the surgical procedure.
  • Following the procedure, the hip may become dislocated.
  • Surgical Hardware Considerations

    There are a variety of materials available for use as a substitute for an arthritic hip. Polyethylene, an extremely high grade plastic, is a common choice for the socket. The ball, which fits snugly inside the socket, is often composed of very resilient, precisely machined metal. However, there are a wide variety of components available, from numerous materials. This is an ongoing area of great interest, as medical professionals seek longer-lasting, better performing materials to enhance the patient's quality of life.

    The choice of components for each patient is influenced by a variety of factors. Some variables which can affect the type of material the surgeon may use include the patient's age, expected level of activity, and the overall condition of the surrounding musculoskeletal structures.


    Factors in Transplant Source
    This procedure does not normally involve the transplanting of tissue.