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Surgical options - Hip
Hip Replacement Surgery
Over time, the impact of joint disease, arthritis, or excessive body weight can erode the hip joint.
According to the American Academy of Orthopaedic Surgeons, each year in the United States, about 193,000 hip replacements are performed. With the aging of the baby boom generation, that number is expected to grow as this large segment of the population moves into their 50s and 60s. It is estimated that more than 500,000 knee and hip replacements will be done each year by 2040. Also, the joint implant technology involved is improving, enabling the artificial joint to last longer.
The surgery itself, lasting between two to three hours, is performed on those who experience the chronic and debilitating effects of hip disease. An incision is made in the beauty of the patient. The surgeon then removes the diseased bone and cartilage and fits the prosthesis into the joint. The prosthesis is inserted and the incision is sutured.
Since hip prosthesis rarely lasts longer that 15 to 20 years, and outcomes of revisions are less effective than original replacements, young people are not good candidates for the surgery. In fact, in the United States, 65 percent of hip replacements are given to those over the age of 65. It is also not recommended for the extremely obese, those with a terminal illness, those with nerve disease, those lacking ample skin around the hip.
Options in hip replacement surgery
Direct Anterior Hip Replacement
University Orthopedics performs direct anterior minimally invasive total hip replacement surgery, a procedure that may have benefits for younger patients, more active patients, and for patients who want to return to certain sports like skiing or surfing.
Direct Anterior Hip Replacement is a surgery method that is an alternative to the standard conventional hip replacement surgery. In the past, hip replacement surgery required cutting certain muscles and tendons in order to access the area being fixed, where as direct anterior hip replacement uses a technique that does not require the cutting of muscles or tendons to expose the joint being treated. This new process can be more challenging and requires special equipment including surgical instruments and operating tables.
Studies have shown that Direct Anterior Hip Replacement surgery patients complain of less post operative pain and discomfort than traditional approaches. Furthermore, it has been reported that many patients experience a faster recovery.
Direct Anterior Hip Replacement surgery is not for all candidates. Check with your doctor to see if this method is right for you.
Abrasion Arthroplasty is a surgical procedure to reshape the joint by grinding down the damaged surface and removing rough areas, which allows blood and bone marrow cells to develop on the newly grinded down surface.
The raw bony surface may be stimulated to grow a new joint surface, albeit one which is not as perfect as the normal hyaline cartilage of a natural joint surface. The bone at the base of the crater is either picked or burred. This procedure is called abrasion arthroplasty. The aim is to expose small subsurface blood vessels, which will grow into the area and bring with them the growth factors that will eventually produce fibrocartilage. Although not as durable as hyaline cartilage, this substitute often works well especially if a patient is young and the defect small. It can be performed arthroscopically and has been used for decades with reasonable success. However, the larger the hole the less likely it is to be successful.
Types of Hip Prosthesis
Acrylic with Cement Fixation
This is the first type of hip prosthesis developed. Essentially, the prosthesis is secured to the hip with a cement adhesive. Over time (10 to 15 years) the cement will erode and need to be replaced. Usually these implants are used in older, less active adults or in people with weaker bones. The recovery time for this prosthesis is faster than other methods.
Without Cement Fixation
The difference between the cement and uncemented version of the hip prosthesis is the lattice grid that comprises the socket part of the uncemented prosthesis. After the diseased bone and cartilage has been removed, the latticed grid is inserted into the socket. After a while during healing, the remaining hip bone will grow into the grid much like ivy grows into a trellis and suture itself to the prosthesis. The new bone grows into the implant, securing it in place. This is a much more natural cohesion and lasts longer than the traditional prosthesis. Also, it affords much more mobility to the active hip replacement recipient than the cemented type.
Scientists are currently in the process of developing joint replacement methods that will last much longer than the current prototype. While doctors now use a glue to bind the old bone with the new prosthesis, they one day hope to use ceramics as a bone substitute.
When a bone breaks in the body, the bone cells will form together to rejoin the broken bone. In the same way, bone cells can join with coral or ceramics forming one, continuous bone. While the glue or cement that doctors use will eventually deteriorate, ceramics will last much longer as they have better chances of being accepted by the cells. While recovery may take longer initially, the effects of surgery will last much longer than current replacement methods.
The hybrid fixation is where one part of the hip prosthesis (generally the stem) is cemented together while the other part of the hip (generally the socket) is inserted without cement.
Scientists are now working on using ceramics and coral to be used as joint replacements in the future. Hospital stay after surgery usually lasts for five days. After the hospital stay, the patient will probably require the aid of a walker for a few days before putting full weight on the leg.
Before your surgery
You should schedule a surgical consultation with an orthopedic specialist when you start to notice that you have daily hip joint pain from arthritis felt in your groin or thigh and experience limited walking ability.
If it is determined that you need hip replacement surgery, you will need to get some lab work done consisting of blood test, urine test and an EKG.
Your doctor will want you to take an iron supplement. This may make you constipated. You will usually be on an iron supplement one month prior to surgery, and one month after surgery.
All patients require pre-operative blood work. There are two types of blood transfusions.
Autologous blood transfusion is your own blood. It is the safest blood you can receive. This type of transfusion requires someone to donate blood before their surgery. It is common to donate one unit of blood each week before surgery, depending on the amount of blood needed on hand. Your stored blood will help replace any blood you lose during surgery.
Allogeneic blood transfusion is receiving blood from a blood bank donor. Relative or friends with your blood type can also donate blood for your use called designated donors. All blood donors are carefully screened for health and medical history. All blood is tested for infections. Blood is classified into 4 groups: A, B, AB, and O, and into 2 Rh types: + or - . This allows for eight different blood types and donor blood must be compatible with patient blood.
It is advised to have any dentist operations at least three weeks before surgery. After surgery, it is not recommended to return to the dentist for at least six months after surgery.
Your doctor may enroll you in a Joint Replacement Class. It is free for people that are having hip replacement surgery. Family is encouraged to attend to help learn things that will help after surgery. You will learn about precautions to take and how to take care of the patient at home.
You will need to do some things around your home to make it more comfortable and safe for you after surgery. You need to prepare your bathing area with cleansing supplies and hand grips for stability if possible. Remove any floor rugs or obstacles that could get in your way. Prepare a meal list filled with nutrients to help speed your recovery. Place anything to expect using in a reachable level.
Do not take medications that contain aspirin or ibuprofen for seven days before your surgery. Do not take any medications the day of your surgery unless your doctor approves so. Notify the doctor of all the medications you take, and what medications you want to take after surgery.
Do not eat or drink anything after midnight the night before your surgery.
Do not swallow any liquid the morning you wake up of the surgery.
Only take half of your morning dose of insulin that day of surgery.
Do not smoke the morning of your surgery.
Do not chew gun or eat candy on the morning of your surgery.
Do not wear any makeup, nail polish, or jewelry including any type of ring.
You should wear something that you feel is comfortable to easily get out of.
It is important to bathe the night before the surgery. You need to use some type of antibacterial to help clean all areas of your body. Do not apply any perfumes or scented lotions after showering.
It is important to be on time for your surgery. You will be asked to read and sign a few papers. It is common that the anesthesiologist will come to visit you in your hospital room and run over a few things before your surgery. You will put on a hospital gown and an intravenous line (IV) will be started in your arm. This will allow the anesthesiologist to give you fluids and medications during the surgery. Your doctor will put his initials on the hip that is going to be replaced. This is done to prevent any confusion in the operating room.
Start your recovery after surgery
When the surgery is completed
After the surgery you will be taken to a recovery room for around two hours. They will monitor your blood pressure, breathing, pulse and temperature.
When you are discharged from the hospital, you should remain in bed all day at home. Doing ankle pump exercises while in bed will help increase circulation and stops blood clots. There are always inherent risks with any major surgery, but medications are given to reduce the risk of blood clots and antibiotics to help ward off infection after surgery.
It is important to let your doctor know if you experience constant swelling or high amounts of drainage at the incision site, high fever or unable to bear weight on your operated leg. Notify your doctor if you experience consistent pain in your calf muscle. This can be a symptom of a blood clot in your calf.
Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein. If not treated, the clot can travel to your lungs and cause life-threatening complications. The risk factors for getting a blood clot include being inactive for longs period of times, injury to a vein, family history, and recent surgery. Common symptoms usually occur suddenly and in only one leg. They include pain in the deep muscle, swelling, aching or tenderness, and red or warm skin.
After surgery medications
Coumadin (warfarin) helps keeps your blood from clotting, but can increase your risk for bleeding. Take coumadin at the same time each day. Don’t take any other medications without checking with your healthcare provider first. Report to your doctor before taking another dose if you experience bleeding that doesn’t stop in 10 minutes, heavy menstrual period, coughing up blood, diarrhea, dark urine or stool, dizziness, red or back and blue marks on the skin, or chest pain. Keep eating a healthy diet and contains some form of Vitamin K. Vitamin K helps your blood clot.
After surgery you may feel hip pain, pain and soreness in the upper legs, swelling, minor bloody drainage coming from incision site, numbness around the incision, and a low-grade temperature. This is all normal. After 24-48 hours after the surgery, the pain will reduce significantly and prescription pain medicine will be available if needed. You may experience pain during activity due to trying to achieve full range of motion and normal strength with a brand new hip.
Your doctor will try to assist with minimizing your pain. Narcotics will be prescribed for moderate to severe pain. If is important to ask any questions that you have to the pharmacist when picking up your medicine and read all labels and following the directions. Acetaminophen (Tylenol) and Ibuprofen (Advil) can help with less severe pain.
Deep coughing is strongly encouraged. This helps keep your lungs clear and get better faster. Sit on the edge of a bed or chair, or lie on your back. Lean forward slightly and hold a pillow against your incision site. Breathe out normally, then breathe in slowly and deeply through your nose. Breathe out fully through your mouth. Take a deep breath and cough two or three times in a row. Try to push all the air out of your lungs as your coughing. Then relax for 20 seconds and repeat coughing a couple times a day.
First Day After Surgery
On the first day after your surgery, the doctor will check up on you and you will start to begin physical therapy according to the plan you and your therapist have established. It is important to see your therapist three to four days a week. It is very important to work with a physical therapist to help you establish a plan that will help with gaining strength and getting back to full health in a timely fashion.
It is recommended that after surgery, you have someone stay with you for about a week. After that first week, someone needs to come check on you at a daily basis. After two-four weeks, you will be reasonably independent. Arrangements can also be made to stay at a rehabilitation facility after your surgery.
In order to walk around, it is recommended to use a walker for up to three weeks.
Depending on what hip and the severity of the hip surgery, it will be from two-six weeks to be able to operate a car efficiently.
It will take around two to four weeks to go back to work if your job requires you to sit all day. If you have to stand up all day, then it will be around eight to twelve weeks before going back to work.
The normal follow up schedule with your doctor is a visit at the two-week, six week, three months, six months, and one year after surgery.
Some life long restrictions you need to observe to protect your new hip include avoiding running on hard surfaces, contact sports, or extreme sports. These have the highest changes of damaging your hip.
If the patient stays healthy, active and avoids heavy impact, then the new hip will last an average of 15 years or even longer.
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