Hip Arthroplasty

What are some symptoms of a serious hip problem?

As people age, sore, stiff or achy hips become common. Indications of a more serious hip condition, however, may include: sudden onset of sharp, shooting hip pain; dull persistent pain in or around the hip joint; reduced flexibility or range of motion; difficulty walking; or unusual swelling in the hip or upper thigh. If you or a loved one is experiencing these symptoms, please notify your doctor immediately to discuss possible causes and treatments.

What are common causes of hip pain?

Hip pain can occur in people of all ages, living active or sedentary lifestyles. The most common causes of hip pain include:

• Inflammation: Overexertion can inflame the thick bands of tissue around hip (the “capsule”) and cause it to swell and fill with fluid, making the hip and surrounding area tender and painful.
• Hip fractures: Fractures of the hip are a particular problem in the elderly. With age, bones can become weak, brittle and more likely to break during a fall.
• Tendinitis: Tendons attach bones to muscles. Tendinitis is inflammation or irritation of tendons, which is usually caused by repetitive stress from overuse.
  Muscle or ligament strain: Repeated activities can put added strain on the muscles and ligaments that support the hips. When these structures become inflamed they can become painful, and prevent the hip from functioning normally.
• Trauma: Bumps, bruises and falls can produce localized pain and discomfort, or result in more serious damage, such as a hip fracture or dislocation.
• Disease: Hip pain may also be traced to debilitating diseases such as:
  • Osteoarthritis—often called ‘wear-and-tear’ arthritis because it causes the hip joint’s protective cartilage to thin and eventually deteriorate; osteoarthritis is the most common cause of hip pain in people over 50.
  • Rheumatoid arthritis—a painful autoimmune disease in which the body’s natural defenses attack its own joints, membranes and tissue and cause them to deteriorate.
  • Avascular necrosis—occurs from the temporary or permanent loss of blood supply to the bones, most often from a hip fracture or dislocation. Bone tissue may weaken and die, causing a joint or joint surface to collapse. Although it can affect other bones, avascular necrosis most often occurs in the hip.
  • Cancers—Cancerous tumors that start in or spread to the hip or thigh bone can cause severe pain and discomfort throughout the entire hip joint area.

What is hip fracture?

Hip fracture is a break in the upper portion of the thigh bone (femur). Hip fractures occur most commonly in elderly patients, especially those with ‘thinning’ bones or osteoporosis.

In the U.S. alone, about 300,000 individuals 65 and older suffer a hip fracture every year. Surgery could be required to repair or replace a fractured hip. Damage from a hip fracture is often obvious, but not always. Signs and symptoms can include:

• Inability to move immediately after a fall.
• Severe pain in the hip joint, upper thigh or groin.
• Stiffness, bruising and swelling in the hip area.
• Shorter leg on the side of your injured hip.
• A deformity of the leg.
• Loss of function or movement in the injured area.

What are some non-surgical treatments for hip pain?

The cause and severity of hip pain will determine how doctors treat it. Patients, caregivers and surgeons work closely to develop a treatment plan, which may include a range of non-surgical options, given alone or in combination, including:

• Rest: reducing or avoiding activities that may irritate the hip joint allows inflammation to subside.
• Application of ice and heat: to alternately reduce swelling, relax and loosen tissues, and stimulate blood flow to the area.
• Stretching: stretching joint-area muscles and tendons can help relieve some symptoms of hip pain.
• Anti-inflammatory medication: taken as prescribed, non-steroidal anti-inflammatory medicines (also called NSAIDs) can help reduce hip joint pain and swelling. The most common NSAIDs are ibuprofen and naproxen.
• Injections: sometimes anti-inflammatory medicines called corticosteroids are injected directly into the hip joint to control pain and inflammation. A lubricating, non-steroid injection may also be given to reduce pain and irritation.
• Supportive aids: if walking becomes too painful, or if maintaining balance becomes an issue, doctors may recommend a cane or walker to help maintain stability and reduce the risk of falling.
• Exercise and physical therapy: because can inactivity can actually worsen some hip conditions, therapeutic exercises such as strength, flexibility and balance training are often prescribed to treat hip pain.

What is a total hip replacement?

A total hip replacment, also called hip athroplasy, is a procedure in which a surgeon removes damaged joint surfaces on the upper thigh  bond and hip socket and replaces them with an artificial implant or prosthesis.

Total hip arthoplasty is the second most common joint replacement procedure, after knee replacements. The procedure usually takes a couple of hours, and is followed by weeks or months of carefully monitored recovery and rehabilitation.

What is a total hip replacement?

The hip joint is a “ball and socket” joint made up of two bones. A total hip replacement, also called hip arthroplasty, is a procedure in which a surgeon removes damaged joint surfaces on the upper thigh bone and hip socket and replaces them with an artificial implant or prosthesis.

Total hip arthroplasty is the second most common joint replacement procedure, after knee replacements. The procedure usually takes a couple of hours, and is followed by weeks or months of carefully monitored recovery and rehabilitation. Another surgical option, the hemi (or half) hip replacement, only replaces the ball portion of the joint.

When is a total hip replacement necessary?

A patient’s pain level and degree of disability determine whether hip replacement surgery is required. Doctors typically reserve the procedure for patients whose persistent pain is not alleviated by medication, physical therapy, use of supportive aids or other non-surgical treatments.

When is hip replacement surgery recommended?

There are several reasons why doctors recommend hip replacement surgery. Those who can benefit the most from hip replacement surgery frequently experience hip pain that:

• Limits daily life activities, such as walking, bending and going up and down stairs
• Continues throughout the day and night, or when resting
• Limits the ability to move or lift the affected leg
• Does not go away, even with use of anti-inflammatory drugs, physical therapy, or supportive walking aids

What are some benefits of hip replacement surgery?

For most who receive hip replacements, the benefits can include: increased mobility, decreased pain, and an overall improvement in the quality of life.

What is a “minimally invasive” hip replacement?

Minimally invasive hip replacement means that the procedure is performed through fewer and/or smaller incisions. Candidates for a minimally invasive hip replacement are typically younger, healthier and thinner than patients who undergo a total hip replacement. Because the surgery isn’t as extensive, patients usually experience less pain and muscle damage.

The hospital stay following a minimally invasive surgery may be as short as 1 or 2 days, though some patients return home the same day. Recovery and rehabilitation are also quicker. Implants for the minimally invasive surgery are the same as those used for a total hip replacement.

How long will a new hip implant last?

Like all medical devices, orthopedic implants have a limited life expectancy that’s affected by the patient’s body weight, age, activity level, rehabilitation plan compliance and other factors. This makes it difficult to predict how long a particular implant will last. On average, however, most high-quality hip implants should remain viable for 10 to 20 years. One large-scale clinical study of hip-replacement patients reports that in patients under 65 years of age, 80％ of hip replacements were functioning well after 15 years; in patients over 65, the number was 90％.

Hip Replacement Fast Facts

• Hip replacement surgery is one of the most successful procedures in all of medicine.
• About 285,000 total hip replacements are performed each year in the U.S.
• Most people who undergo total hip replacement are 50 to 80 years of age.
• Less than two percent of patients experience serious complications following a total hip replacement

How long before I can resume daily life activities?

As with any surgery, recovery times from a hip replacement vary from patient to patient. Some people can resume daily life activities in a few weeks, while others may take several months. Adhering to a prescribed exercise and recovery plan helps get patients back into their routine sooner, with few complications.

Upon returning home, patients are advised to stay active and be careful not to overexert. It’s always best to follow the instructions of doctors and physical therapists, but here are some general guidelines that may also be helpful:

Weight-bearing activities

Patient undergoing surgeries that include “supportive cement” can usually put some weight on the leg immediately after surgery, using a supportive aid like a cane or walker. Supportive aids are often used for four to six weeks to help muscles recover and strengthen.

For patients whose new hip was implanted without supportive cement, instructions will be given about the use of crutches or a walker, and how soon the affected leg can bear the weight of walking. This is usually about eight weeks.

Driving

Most patients can begin driving an automatic shift car within four to eight weeks following a hip replacement, provided they are no longer taking narcotic pain medication.

Climbing Stairs

If possible, stair climbing should be limited until adequate healing has begun. If using stairs is unavoidable, the unaffected leg should step up first, followed by the affected leg. Crutches or cane will come up last. To go do down stairs, the process is reversed: place crutches/cane on the lower step first, then the affected leg, then the unaffected leg.

Will I require physical therapy?

Yes. Physical therapy plays a very important role in recovery and rehabilitation. Providing there are no complications, treatment typically begins the day after surgery, starting with simple, assisted movements and activities. After returning home from the hospital, most people receive therapy several times per week until treatment goals are attained. Some patients are referred to an outpatient physical therapist or rehabilitation hospital. Typically, physical therapists coordinate with the operating surgeon to improve hip range of motion, strength and weight bearing ability. They also demonstrate safe and proper movement for standing, sitting, climbing stairs and getting in and out of cars.

What activities I should avoid?

During rehabilitation, patients must be very careful not to engage in activities that could dislocate their newly implanted hip. Pivoting or twisting on the affected leg should be avoided for six to twelve months. Hip flexion past 90 degrees, crossing the repaired leg over the other, and walking “pigeon toed” should also be avoided, along with high-impact sports that involve running, jumping or jogging. Regular, frequent, low-impact activities, such as walking, swimming, golf, hiking and biking are recommended to promote healing and strengthening the area, and to prevent the risk of dislocating the implant.

Source : http://www.uoc.com.tw