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Total Hip Replacement: Stop Living In Pain!

Andrew Louis DEGRUCCIO
Andrew Louis DEGRUCCIO MD
Kentucky, Louisville
Orthopedics
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* Date : 05-05-2008 - 02:49 AM (5807 days ago),

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Total Hip Replacement: Stop Living In Pain!

Hip pain may have many causes. Unfortunately, for many Americans, the cause is arthritis. Although arthritis has many forms, the common thread is that arthritis is progressive once established. Orthopedic surgeons and Rheumatologists currently do not have a treatment to stop this progression. Many treatments exist to alleviate the discomfort and disability created by arthritis, but none currently stop or reverse the changes in the hip created by arthritis.

The warning signs of hip arthritis include stiffness, pain, catching, and limping. The pain from hip arthritis is often felt at the hip, but also occasionally refers down to the knee. Throbbing and night pain are common. Increasing pain with walking, and difficulty with getting in and out of cars is common. A progressive limp often ensues.

Many people can tolerate their hip arthritis for years, with only minimal medical interventions. Anti-inflammatory medications often reduce the symptoms. Glucosamine and Chondroiton have been found to be helpful. Maintenance of ideal body weight reduces the stresses across the arthritic hip. Low-impact exercise, with a flexibility program helps maintain the range of motion of the hip.

When the above measures are not adequate, and the pain starts to interfere with normal daily living activities, then surgical options become necessary. Currently, total hip replacement is recommended for people with hip arthritis as they are approaching 60 years old, but, frequently, even younger patients require hip replacement. Current research indicates that most hip replacements last 20 years 90% of the time. The younger the patient, the shorter the life span of the hip replacement. Simply stated, the more active you are on a hip replacement, the more likely it will eventually fail.

Once a hip replacement is done, activities can be modified to improve the eventual life span of the hip. High impact activities must be reduced, such as running, jumping, etc. Many activities remain that are considered acceptable for hip replacement recipients, like doubles tennis, golf, bicycling, swimming, etc. These activities should be reviewed with your physician.

Two important cautions exist for hip replacement patients for the rest of their lives. The first is hip dislocation precautions. Putting the hip in a hyperflexed, and internally rotated position creates a risk for dislocation. Often very low chairs, car seats, or benches can be risky for hyperflexion at the hip. The second is hip infection precautions. The hip prosthesis, being a foreign body, is at risk for infection throughout its life span. Similar to heart valve prostheses, patients must protect their hip replacement utilizing antibiotic prophylaxis whenever undergoing invasive procedures that may introduce bacteria into the bloodstream, such as getting your teeth cleaned, having a heart catheterization, etc. The literature suggests that the greatest risk for infection is within the first two years of the hip’s life.

Current advances in surgery have made hip replacement safer than ever. The usual inpatient hospital stay is less than 5 days, followed by a short rehabilitation stay or return to home with home nursing. Most patients are up on their new hip the day after surgery, and, often, the pain from surgery is less than the patient’s previous arthritic pain. Less than 5% of patients require blood transfusions following hip replacement. The universal risk initially after hip replacement is blood clot formation, which occurs greater than 60% of the time. Considering this risk, many physicians opt to “thin the blood” of their patients for a while after surgery. The vast majority of patients do very well with the surgery. In fact, within 3 months of the procedure, most patients have resumed normal activity levels.

All in all, hip replacement has become a very common orthopedic procedure, performed to improve the quality of life for its recipients. Maintaining a healthy, active lifestyle after surgery is the goal of hip replacement. The technological advances of the prostheses are allowing orthopedic surgeons to extend the indications of the procedure to appropriate patients at younger and younger ages. At the same time, anesthetic advances are making the surgery safer and safer, such that patients who might think they are too old for the procedure would do fine.

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