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Your hip joint replacement guide
Ready to consider hip joint replacement? You're not alone
If arthritis (or injury) has damaged your hip, and different treatments for your pain haven't
helped you get through your everyday activities comfortably, you may be ready to
consider hip replacement surgery. First performed in 1960, this procedure is considered
one of the most important surgical advances of the past 100 years. It has amply fulfilled
its promise of restoring many people to the lives they knew before their hip pain
worsened.
Understanding how hips work
By understanding how a normal, healthy hip works, it will be easier for you to understand
the way a hip joint prosthesis, or artificial hip joint, works -- and the difference it may
make in your life.
A joint is formed by the ends of 2 or more bones that are connected by thick bands of
tissue called ligaments. The hip -- which, like the knee joint, must bear the full force of
your weight -- consists of two main parts:
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A ball (femoral head) at the top of your thigh bone (femur).
A rounded socket (acetabulum) in your pelvis.
The ball (femoral head) on the thigh bone fits into the rounded socket (acetabulum) in
the pelvis. Ligaments, which are bands of tissue, connect the ball to the socket and help
keep the ball and socket steady. The surfaces of the ball and socket are covered by a
smooth, tough material called articular cartilage, which cushions the bones and lets them
move easily.
All the rest of the surfaces of the hip joint are covered by a thin, smooth tissue liner
called synovial membrane, which makes a small amount of fluid that acts as a lubricant
so that the bones in the hip joint will not rub against each other.
What causes hip joint pain?
One of the most common causes of joint pain is arthritis. The most common types of
arthritis are:
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Osteoarthritis (OA) -- sometimes called degenerative arthritis because it is a
"wearing out" condition involving the breakdown of cartilage in the joints. When
cartilage wears away, the bones rub against each other, causing pain and
stiffness. OA usually occurs in people aged 50 years and older, and frequently in
individuals with a family history of osteoarthritis.
Rheumatoid Arthritis (RA) -- produces chemical changes in the synovium that
cause it to become thickened and inflamed. In turn, the synovial fluid destroys
cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women
about 3 times more often than men, and may affect other organs of the body.
Post-traumatic Arthritis -- may develop after an injury to the joint in which the
bone and cartilage do not heal properly. The joint is no longer smooth, and these
irregularities lead to more wear on the joint surfaces.
Other causes of joint pain include avascular necrosis, which can result when bone is
deprived of its normal blood supply (for example, after organ transplantation or long-term
cortisone treatment), and deformity or direct injury to the joint.
In some cases, joint pain is made worse by the fact that a person will avoid using a
painful joint, weakening the muscles and making the joint even more difficult to move.
What's causing your hip joint pain? Is getting relief through joint replacement an option
for you? These are just some of the answers that an orthopedic surgeon can provide.
But first, it's a good idea to be sure you have information about joint replacement that will
help you understand what the surgeon tells you.
Learning what you should know about hip joint replacement
"Joint replacement" (the term orthopaedic surgeons use) is usually reserved for patients
who have severe arthritic conditions. Most patients who have artificial hip joints are over
55 years of age, but the operation is being performed in greater numbers on younger
patients thanks to new advances in artificial joint technology.
Circumstances vary, but generally patients are considered for total joint replacement if:
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Functional limitations restrict not only work and recreation, but also the ordinary
activities of daily living.
Pain is not relieved by more conservative methods of treatment -- such as
medications or physical therapy -- by the use of a cane, and/or by restricting
activities.
Stiffness in the joint is significant.
X-rays show advanced arthritis or other problems.
"I had to give up dancing, and I just love to dance! And I thought, I was too
young to have to give that up."
What is total joint replacement?
Total joint replacement is a surgical procedure in which certain parts of an arthritic or
damaged joint, such as a hip joint, are removed and replaced with a plastic or metal
device called a prosthesis, or artificial joint. The artificial joint is designed to move just
like a normal, healthy joint.
Hip replacement involves replacing the femur (head of the thigh bone) and the
acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong
metal or ceramic, and the artificial socket is made of polyethylene (a durable, wearresistant plastic) or metal backed with a plastic liner. The artificial joint may be cemented
in position or held securely in the bone without cement.
"I was at the point where I couldn't walk anymore. The pain was so bad. We
went shopping. I sat in the car with a library book... I decided there's got to
be a better way."
Possible complications of surgery
As with any major surgical procedure, patients who undergo total joint replacement are
at risk for certain complications, the vast majority of which can be successfully avoided
and/or treated. In fact, the complication rate following joint replacement surgery is very
low : Serious complications, such as joint infection, occur in less than 2% of patients.
(Besides infection, possible complications include blood clots and lung congestion, or
pneumonia.)
Will an artificial hip joint last forever?
As successful as most of these procedures are, over the years, an artificial joint can
become loose and unstable or wear out, requiring a revision (repeat) surgery. These
issues -- together with the fact that increasing numbers of younger and more active
patients are receiving total joint replacement, and patients are living longer -- have
challenged the orthopaedic industry to try to extend the life cycle of total joint
replacements.
Recent improvements in surgical techniques and instrumentation will help to further the
success of your treatment. The availability of advanced materials, such as titanium and
ceramic, and new plastic joint liners provides orthopaedic surgeons with options that
may help to increase the longevity of the artificial joint.
Having an orthopaedic evaluation
If you're ready to consider having hip joint replacement, the next important step is to talk
with an orthopaedic surgeon. The medical management of arthritis and joint
degeneration may be handled by a family doctor, an internist, or a rheumatologist.
However, when medical management is not effective, an orthopaedic surgeon should be
consulted to determine if surgery is an option. In some cases, the orthopaedic surgeon
may be the first physician to see a patient and make the diagnosis of arthritis.
"I would recommend asking questions and writing them down."
While every orthopaedic evaluation is different, there are many commonly used tests
that an orthopaedic surgeon may consider in evaluating a patient's condition. In general,
the orthopaedic evaluation usually consists of:
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A thorough review of your medical history
A physical examination
X-rays
Additional tests as needed
The information that the orthopaedic surgeon gathers during the medical history usually
suggests the possibility of several different diagnoses (causes). After the medical history
is taken, the orthopaedic surgeon conducts a physical examination: If you are
experiencing pain in your hip joint, your back may be examined, because hip pain may
actually be the result of problems in the lower spine.
After the physical examination, X-ray evaluation is usually the next step in making the
diagnosis. The X-rays help show how much joint damage or deformity exists. An
abnormal X-ray may reveal:
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Narrowing of the joint space
Cysts in the bone
Spurs on the edge of the bone
Areas of bony thickening called sclerosis
Deformity or incorrect alignment
Other abnormalities
Additional tests may include laboratory testing of blood, urine, or joint fluid and/or
magnetic resonance imaging or a bone scan of the joint and surrounding soft tissue.
Treatment Options
Following the orthopaedic evaluation, the orthopaedic surgeon will review and discuss
the results with you. Based on his or her diagnosis, your treatment options may include:
• Medication
• Physical therapy
• Hip joint fluid supplements (injections that provide temporary pain relief)
• Total hip joint replacement
If you and your orthopaedic surgeon decide that hip joint replacement surgery is an
option to relieve your pain, the orthopaedic surgeon will provide the specific-to-you
details of which type of artificial joint he or she will use, what you need to know to
prepare for the surgery, how the surgery will be performed, and what results you can
expect once you're up and moving again.
Next steps: adjusting to life with less hip joint pain
The vast majority of individuals who have joint replacement surgery experience a
dramatic reduction in joint pain and a significant improvement in their ability to participate
in the activities of daily living.
Keep in mind, however, that joint replacement surgery will not allow you to do more than
you could before joint problems developed. After joint replacement, a good rule of thumb
is that acceptable physical activities should:
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Not cause pain, including pain felt later.
Not jar the joint, as happens with running or jumping.
Not place the joint in the extremes of its range of motion
It is also important for an individual with a joint replacement to keep his or her body
weight as close to normal as possible. Joint wear and loosening increase with weight
increase.
When fully recovered, most patients can return to work, although some types of work -such as construction work, certain types of carpentry, and occupations that involve
repeated or high climbing -- may not be advisable for individuals with a joint
replacement. Also, athletic activities that place excessive stress on the joint replacement
should be avoided.
© Stryker, 2004