Total Hip Replacement
You have several treatment options. Can surgery be right for you?
Patients that are experiencing painful popping, clicking, catching, and/or locking in their hip can have their lives dramatically improved with treatment.
What is Total Hip Replacement?
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components. If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or 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 medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
After hip replacement you can expect nearly complete relief of pain. While an artificial hip is not a normal hip, you can expect to resume most activities of daily living with comfort and ease. Studies have confirmed that approximately 95% of all hip replacements can expect a very good result. Unlimited walking tolerance without pain is usually the case. Recreational activities such as bicycling, swimming and golf are likely to be possible. More strenuous sports such as jogging, tennis and skiing could damage the artificial hip and are not recommended. Many patients notice a significant improvement in their over-all energy level when the strain of constant pain is eliminated. Less dependence on others is another frequent benefit noted after total hip replacement.
Non-Surgical Alternatives to Hip Replacement
Prior to undergoing any surgical procedures, there are some nonoperative, conservative options for treating your hip pain that Dr. Rogerson will consider.
In some cases, Dr. Rogerson may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs do not relieve pain. Please note, however, that all medications have risks and should only be taken under the direction of Dr. Rogerson.
Non-steroidal anti-inflammatory drugs or NSAIDs, may help temporarily treat inflammation and pain in the hip joint. Please note, however, that all medications have risks and should only be taken under the direction of Dr. Rogerson.
An exercise program may be prescribed to strengthen the muscles in the hip joint and in many cases improve positioning of the hip and relieve pain.
Who is a Candidate for Total Hip Replacement?
There are no absolute age or weight restrictions for total hip replacements.
Recommendations for surgery are based on a patient’s pain and disability, not age. However, most patients who undergo total hip replacement are age 65 to 80 and suffering from degenerative arthritis. Dr. Rogerson evaluates each of his patients individually.
Potential Risks of Hip Replacement
No surgery is without risk. Understanding the risks of surgery is necessary in order to make an informed decision about your desire for surgery. Anesthesia in surgery places increased stress on the body. Serious complications such as heart attack, stroke or even death have been reported. Fortunately, these occurrences are extremely rare. A thorough medical evaluation prior to surgery minimizes these risks. Infection is also a very serious complication of joint replacement. Many precautions are taken to avoid infection and as a result, the risk of infection is very low (less than 0.5%). Further surgery would be necessary if infection should occur. Blood clots can occur after hip surgery but this occurrence has been minimized by the routine use of special “pump” stockings, thigh high compression stockings, and oral blood thinners after surgery. Even rarer complications could include artery or nerve damage or fractures of the bones near the hip. Most patients want to know how long they can expect their artificial hip to last. Over an extended period of time, the hip prosthesis may work loose from the bone. This occurs when the bond between the bone and the plastic cement breaks down. Even though this is the most common cause of artificial joint failure, it is quite unusual. More than 90% of artificial hips continue to function well after 10 years. If an artificial hip becomes loose and painful, it can usually be repaired with a second operation. Only rarely does a hip prosthesis become loose prior to 10 years.
Effects of Arthritis
Arthritis is the condition which results from gradual deterioration and loss of the joint surface articular cartilage. This deterioration of cartilage may occur due to the effects of previous injury or from progressive wear and tear which occurs with aging. In addition, inflammatory conditions such as rheumatoid arthritis, may destroy joint surface cartilage. Mild arthritis causes joint stiffness and some discomfort. As the cartilage deterioration progresses, nearly constant pain and permanent stiffness occur. At this point, normal activities of daily living become difficult to carry out. Patients with advanced arthritis are only able to walk short distances before needing to rest, have difficulty going up and downstairs, and need assistance getting out of a chair or car.
Your orthopedic evaluation assesses the severity of your arthritis. This evaluation leads to a treatment recommendation.
The evaluation begins with questions concerning the severity of your hip pain. We attempt to discover how your hip pain and stiffness limits your usual daily activities such as walking, stair climbing and driving and riding in a car. We also ask about previous treatments such as medications, cortisone shots and the use of a cane.
Examination of the hip includes assessment of the range of motion and the presence of any fixed contractures (stiffness). In addition, ability to walk and the presence of a limp are noted.
X-rays are very useful in determining the severity of arthritis. As arthritis and cartilage deterioration progresses, the “cartilage space” between the bones decreases in size and may disappear altogether (“bone rubbing on bone”). When this occurs pain usually becomes significant. Abnormal calcifications or spurs also develop as arthritis progresses.
After completion of the orthopedic examination (symptoms, exam, x-rays) the various treatment options and specific recommendations can be discussed.
With mild arthritis, some moderation of activities and arthritis medications may be adequate. Occasional use of a cane may be helpful and exercise and weight loss are often recommended. Physical therapy or a Cortisone injection into the affected joint may occasionally be of benefit.
As arthritis progresses, the hip pain and loss of function usually becomes more resistant to conservative or nonoperative treatment.
The question as to when to proceed with hip replacement surgery is a highly individual matter. This depends on the patient’s pain threshold, their activity level, their social situation, and the help that they may have available at home.
Most patients choose to proceed with hip replacement when their pain becomes generally disabling. This usually occurs when pain is present everyday and often with every step and interferes with realistic activities for the patient’s age. Night pain that interferes with sleep is a significant disability and usually prompts people to seek operative intervention. Most patients who come to hip replacement surgery have difficulty tying their shoes, going up and down stairs and getting in and out of a car. They are frequently dissatisfied with their general quality of life. One final factor that frequently is considered in joint replacement surgery is if the hip arthritis is aggravating arthritis elsewhere in the body, such as the knee or the spine to a significant degree.
As the pain becomes more severe or constant, and the inability to carry out daily activities increases, surgery with hip replacement may be the recommended treatment.
The standard hip replacement consists of two basic components. The acetabular or socket component is a high density polyethylene plastic which has an indentation for the metal ball of the femoral component. The socket component often includes a thin metal shell around the surface of the plastic where it meets the bone to help provide more stability. The femoral component is a long peg that extends down into the shaft of the femur or thigh bone. The top of the stem is made up of a round highly polished ball that articulates with the plastic socket. The ball is held into the socket by the muscles of the hip and gradually a new capsule around the ball is formed after surgery as the healing process occurs.
Total hip replacement surgery requires replacement of the damaged joint surfaces with metal and plastic components (prosthesis). Metal on plastic artificial joints have proven to be self-lubricating and show minimal wear despite years of use.
The artificial hip components are held to the bone with a plastic cement. In younger patients, components which allow “bone ingrowth” will be placed without cement. A more recent trend in hip replacement involves implanting a noncemented “bone ingrowth” acetabular (socket) component and cemented femoral component —- a “hybrid” total hip. Recommendations regarding the use of cement versus bony ingrowth fixation will be made on an individual basis preoperative based on your age, weight, activity level and bone density.