Hip Replacement
Background
Hip joint replacement surgery has been performed in the United States for over 40 years for the treatment of disabling hip arthritis. It is one of the most successful pain-relieving operations in the United States today, with almost 300,000 procedures performed annually. The procedure is performed by many orthopaedic surgeons, who have historically used a ten-inch incision. Since the inception of this surgery, there have been numerous advances. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
Early prostheses were made of metal and plastic and were "glued" in place. For over 20 years, cement-less prostheses have been utilized which eliminate the glue and allow the bone to adhere directly to the prosthesis (bone ingrowth). Most recently, the use of alternative materials such as ultra strong plastics, or even all-metal or ceramic implants, promise greater longevity for arthritis surgery patients. Recent developments in other surgical specialties such as sports medicine, gynecology and general surgery have focused on techniques to perform procedures less invasively. Many of these concepts and (the benefits deriving from minimally invasive surgery) have been applied to hip replacement surgery as well.
A hip replacement is a surgical procedure whereby your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic or ceramic joint surfaces to restore the alignment and function of your hip. The normal hip joint is a ball and socket joint. The socket is a "cup-shaped" bone of the pelvis called the acetabulum. The ball is the head of the thigh bone (femur). Hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal ball and stem inserted into the femur bone and an artificial metal cup socket lined with either metal, plastic or ceramic material.
Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.
Hip Replacement Surgical Procedure
A hip joint replacement takes approximately two to four hours of surgical time. The preparation prior to surgery may take additional hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic or ceramic joint surfaces to restore the alignment and function of your hip.
Over the last several years, joint replacement surgeons have been exploring ways to adopt the newest and best minimally invasive techniques. Surgeons from Hinsdale Orthopaedics total joint team now perform the majority of implant procedures using modern minimal-incision techniques.
The majority of studies have shown that the techniques are safe and effective and are associated with high patient satisfaction. Surgeons and implant manufacturers continue to research new methods in order to develop safer and even less invasive approaches that will safely allow patients to resume their normal activities rapidly with less discomfort and inconvenience.
In comparison to traditional hip replacement that involved a 12-14" incision, newer techniques that are available today include Minimal Incision Post Hip Replacement, Direct Anterior Hip Replacement, Two-incision Approach and Mini Anterior.
Recovery after Hip Procedure
After hip joint replacement surgery, patients often start physical therapy immediately! On the first day after surgery, it is common to begin some minor physical therapy while sitting in a chair. Eventually, rehabilitation incorporates stepping, walking and climbing. Initially, supportive devices such as walker or crutches are used. Pain is monitored while exercise takes place. Some degree of discomfort is normal. It is often very gratifying for the patient to notice, even early on, substantial relief from the preoperative pain for which the total hip replacement was performed.
Physical therapy is extremely important in the overall outcome of any joint replacement surgery. The goals of physical therapy are to prevent contractures, improve patient education and strengthen muscles around the hip joint through controlled exercises. Contractures result from scarring of the tissues around the joint. Contractures do not permit full range of motion and therefore impede mobility of the replaced joint.
Patients are instructed not to strain the hip joint with heavy lifting or other unusual activities at home. For some surgical approaches, specific techniques of body posturing, sitting and using an elevated toilet seat can be extremely helpful. Patients are instructed not to cross the operated lower extremity across the midline of the body (not crossing the leg over the other leg) because of the risk of dislocating the replaced joint. They are discouraged from bending at the waist and are instructed to use a pillow between the legs when lying on the non-operated side in order to prevent the operated lower extremity from crossing over the midline. Patients are given home exercise programs to strengthen the muscles around the buttock and thigh. Most patients attend outpatient physical therapy for a period of time while incorporating home exercises regularly into their daily living.
Occupational therapists are also part of the rehabilitation process. These therapists review precautions with the patients related to everyday activities. They also educate the patients about the adaptive equipment that is available and the proper ways to do their "ADL's" or activities of daily living.
Hip Replacement: Who is a candidate?
Hip replacements are performed most commonly because of progressively severe arthritis in the hip joint. The most common type of arthritis leading to total hip replacement is degenerative arthritis (osteoarthritis) of the hip joint. This type of arthritis is generally seen with aging, congenital abnormality of the hip joint, or prior trauma to the hip joint. Other conditions leading to total hip replacement include bony fractures of the hip joint, rheumatoid arthritis, and death (aseptic necrosis) of the hip bone. Hip bone necrosis can be caused by fracture of the hip, diseases (such as systemic lupus erythematosus) and other medical conditions (such as kidney transplantation).
The progressively intense chronic pain together with impairment of daily functions including walking, climbing stairs, and even arising from a sitting position, eventually become reasons to consider a total hip replacement. Because replaced hip joints can fail with time, whether and when to perform total hip replacement are not easy decisions, especially in younger patients. Replacement is generally considered after pain becomes so severe that it impedes normal function despite use of anti-inflammatory and/or pain medications. A hip joint replacement is an elective procedure, which means that it is an option selected among other alternatives. It is a decision which is made with an understanding of the potential risks and benefits. A thorough understanding of both the procedure and anticipated outcome is an important part of the decision-making process.
