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Total Hip Replacement
If your hip is severely worn with arthritis, or damaged from a fracture, injury or another condition, it may be hard for you to perform simple activities such as walking. Even getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
If nonsurgical treatments like medications, injections or using a cane or walker are no longer providing enough relief, you may want to consider total hip replacement. Hip replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities. Hip replacement surgeries one of the most successful procedures in all of medicine.
The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is the cup-like part of the pelvis bone. The rounded head of the femur (on the upper end of the thigh bone) forms the ball of the joint.
The bone surfaces of the ball and socket are covered with "articular cartilage," a smooth, slippery rubber-like layer that protects and cushions the ends of the bones and enables them to move easily. This cartilage allows the hip to move smoothly without resistance. Damage to this cartilage leads to arthritis, also called degenerative joint disease.
CAUSES OF HIP PAIN
There are many factors that can lead to damage of the hip joint. The most common cause of chronic hip pain and disability include:
- Rheumatoid arthritis
- Post-traumatic arthritis
- Avascular necrosis
- Childhood hip diseases
As the cartilage surface of the hip joint wears out, it deteriorates and becomes rough over time. This leads to chronic inflammation in the hip. Bone spurs can form along the edges of the joint. As the cartilage wears all the way through the under lying bone begins to rub bone on bone, like sand paper on wood. This is very irritating to the joint and causes increased inflammation, pain, stiffness and reduced function.
Worn cartilage does not heal and cannot regenerate. Pain and inflammation can become persistent. When the simple treatments such as medications, injections and exercises fail to give relief, the debilitating symptoms of severe hip arthritis can be still be relieved by hip replacement surgery. A hip replacement is a long term solution, providing new smooth bearing surfaces in the joint, eliminating friction and inflammation.
TOTAL HIP REPLACEMENT PROCEDURE
In a total hip replacement (also called "total hip arthroplasty"), the damaged bone and cartilage is removed and replaced with prosthetic components. The surgery takes about 1-2 hours. During the procedure the following steps are performed:
- The damaged femoral head is removed and replaced with a titanium stem that is placed into the hollow center of the thigh bone (femur).
- A ceramic ball is placed on the upper part of the stem. This ball replaces the damaged ball (femoral head) that was removed.
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a titanium socket.
- A plastic, liner is inserted between the new ball and the socket to allow for a smooth gliding surface.
Traditional hip replacements are performed with the incision on the side or back of the hip. When a hip replacement is done this way muscles have to be split and detached from the bone during surgery. This can mean more pain and a higher risk of dislocation. This is when the ball comes out of the socket. Because of this, there are usually long term restrictions in bending down and leaning forward after having this type of hip replacement.
Dr. Latteier specializes in a technique called the Anterior Hip replacement where the incision is in the front of the hip. Unlike the other approaches there is no need to split or detach any muscles to the hip replacement. It can be performed through a smaller incision about 3-4 inches long, with less damage to the muscles and soft tissues. This typically means less pain and a quicker recovery. Since there is less damage to muscles there is also a lower risk of dislocation. Once you recover, you will able to bend forward, tie your shoes and move around without having to worry about that. (Please see page on anterior hip replacement for more details.)
After surgery, you will be allowed to put your full weight on your leg, and be able to be move around on a walker the same day. With this kind of hip surgery many patients are able to go home the same day. We can do this procedure on an outpatient basis or with an overnight stay in the hospital.
Recovery varies from patient to patient. Plan for a cane or walker for any where between 2-6 weeks. It takes about 6 weeks for the incision and soft tissues to heal and for some of the tenderness to subside. It is common to have some swelling and aching, especially at night during this time. Although the arthritic pain in your hip will feel better, other than for the therapy exercises, avoid vigorous activities during this time. It is ok to increase your activity as you feel better.
After surgery, you will feel some pain. This is a natural part of the healing process. With the anterior hip approach there is typically less pain. We use a multimodal pain management approach including nerve blocks, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics and narcotic (opioid) pain medications. You will be prescribed a combination of these medications to improve pain relief, as well as minimize the need for pain pills.
Dr. Latteier uses a plastic surgery type of wound closure, where the sutures are under the surface, and will dissolve. There will be no clips staples or stitches on the outside. The skin is sealed with skin glue. A water tight clear plastic dressing is used to protect the incision. With this closure there is rarely any drainage, but if you notice any increasing redness or bleeding under the dressing, be sure to let me know right away. Showering is ok, but avoid soaking the wound in water until it has thoroughly sealed and dried.
We will set up a Physical therapy visit before surgery to teach you some exercises to help prepare you for surgery. We also schedule a physical therapist to come to your house the day after you return home. They will help you get comfortable navigating your house, practice any stairs you may have, and go over some exercises to help you recover. Most patients are good after 2-4 visits and can continue exercises on their own. Physical therapy after anterior hip replacement is not very intense. Hips do not tend to get stiff, and strength comes back as you begin to increase your regular activities.
When is it time to consider surgery?
If your symptoms have advanced and nonsurgical treatment options are no longer relieving your symptoms, knee replacement surgery may be recommended. Modern hip replacements have demonstrated excellent medium and long term results in both younger and older patients. There are no absolute age or weight restrictions for total hip replacements. Recommendations for surgery are based on a patient's pain and disability; patients are evaluated individually. People who benefit from hip replacement surgery often have:
- Hip pain that limits everyday activities, such as walking or bending, and getting in and out of chairs.
- Stiffness in a hip that limits the ability to move or lift the leg
- Inadequate pain relief from anti-inflammatory drugs, injections, physical therapy, or walking supports
- Severe wear and tear on X-rays
- Quality of life is beginning to suffer due to your hip symptoms.
If you are experiencing these hip symptoms, we recommend a thorough evaluation. Will can determine whether you are a good candidate for a hip replacement. This consists of:
- Medical History
- Physical Examination
- X-rays / Imaging Tests
We will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered. In addition, he will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. More than 90% of people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
You will feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery. Even with a hip replacement it is not uncommon to have occasional aches and pains if you over do it, or if the weather changes.
There are many things you can do to protect your hip replacement and extend the life of your hip implant.
- Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
- Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
- Make sure your dentist knows that you have a hip replacement. Follow the antibiotic protocol for dental and other procedures after your surgery to avoid infection.
- Periodic routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.
Although some hip replacements may begin to wear out at the 15-20 year mark, follow-up studies have shown that more than 80% of modern total hip replacements are still functioning well 20 years after the surgery. With our newer technology we hope they will last even longer than that. Taking care to protect your hip replacement and your general health are important ways you can contribute to the final success of your surgery. With appropriate activity modification, hip replacements can last for many years.