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Total Hip Replacement
The Hip
Total Hip Replacement; a personal preview (Video)
To help you fully understand the process of Total Hip Replacement, it may be
useful to have an understanding of what a hip is and how it works.
What we call a ''hip'' is actually a ball and socket-type joint, which unites two
separate bones - the thigh bone, or femur, and the pelvis. The pelvis has two
cup-shaped depressions called the acetablua or sockets. The head of the femur
or ball fits into the acetabulum, forming a joint which allows the leg to move
forward, backward and sideways in a wide range. The acetabulum is lined with
cartilage, which cushions the bones and allows the joint to rotate smoothly and
with minimal friction. An envelope of tough ligaments connect the pelvis and
femur, covering the joint and stabilizing it. The cartilage also makes the joint
strong enough to support the weight of the upper body, and resilient enough to
absorb the impact of exercise and activity.
A healthy hip will allow the leg to move freely within its range of motion, while
supporting the upper body and absorbing the impact that accompanies activities
like running and jumping.
What is Arthritis?
Arthritis of the hip is a disease which wears away the cartilage between the
femoral head and the acetabulum, the two bones will scrape against each other,
raw bone on raw bone. When this happens, the joint becomes pitted, eroded and
uneven. The result is pain, stiffness and instability. In some cases, motion of the
leg may be greatly restricted.
What causes arthritis? There are several different forms of the disease, each with
its own causes. They included:
Osteoarthritis, which is the most common form of arthritis in the United States. It
is degenerative and although it most often occurs in patients over the age of 50,
it can occur at any age, especially if the joint is in some way damaged. It is
usually confined to the large weight-bearing joints of the lower extremities,
including the hips and knees, but may effect the spine and upper extremity joints,
too. Patients with osteoarthritis often develop large bone spurts, or osteophytes,
around the joint, further limiting motion.
Rheumatoid arthritis, which is often seen in younger people, particularly women.
This disease usually involves the deterioration of many joint surfaces causing
patients to complain of similar symptoms in their hands, feet, shoulders, hips and
knees. Other symptoms include anemia, weight loss and repeated bouts of
swelling in the affected joint, along with the pain, stiffness and instability normally
associated with arthritis.
Traumatic arthritis, which results from severe injury that damages the joint
surface and may be accompanied by torn ligaments, tendons and muscles
causing the hip to become grossly unstable.
Aseptic necrosis, which can occur in some hip fractures even after they have
healed. Aseptic necrosis refers to the death of the ''ball'' or head of the femur
caused by interruptions of its blood vessels. In addition to fractures, other causes
for this interruption in the blood supply to some part of the hip may be attributed
to sickle cell disease or a reaction to medication. Often, there is no identifiable
cause.
Infectious arthritis, which occurs when an infection in some other part of the body
travels through the bloodstream and lodges in the hip joint. The invading bacteria
and the body's response can rapidly destroy the joint cartilage within a matter of
days. Open wounds into the hip joint can also cause an infectious arthritis to
develop. Most patients with hip arthritis are successfully treated with prescribed
medication, physical therapy and by limiting those activities that over-stress the
hip joint.
Hip Replacement Surgery
Total Hip Replacement Surgery
The purpose of Total Hip Replacement
Surgery is to remove the damaged and worn
parts of the hip and replaces them with
artificial parts, called prostheses, which will
help make the hip strong, stable and flexible
again.
At surgery, an implant, selected by your doctor
to fit your hip, will be affixed to the area
between the femur and the pelvis. In most
cases, the implant will consist of two pieces: a
metal shaft with a ball at one end; and a metal
or polyethylene cup. These will replace the
socket and ball of the femur, and will form a
new hip joint.
For some patients, an acrylic cement called Polymethylmethacrylate
(PMMA) will be used for the fixation. This cement has been used
successfully by orthopaedists for over 25 years. It is a strong material,
well-tolerated by the body and set or cures within 15 minutes after it is
mixed. Before curing, the cement is pressure-injected and the implants
are seated. Most patients are able to bear weight on the operated leg
within several days of surgery.
For other patients, the implants are able to be affixed to the bones
without cement. Special surgical instruments are used to precisely
prepare the bones so as to enable a press fit. To supplement this joining,
supportive screws or pegs are often used. Bone is a living and growing
tissue. If an implant coated with metallic beads to form a porous
undersurface is placed in very close contact to living bone, tissues can
grow into the pores, further locking the implant in place. Porous-coated
hip prostheses have been used for many years and have shown
excellent results in many patients.
Preparing for Surgery
Preadmission Exam
Prior to surgery, you will receive several forms to take to your family
doctor for a physical exam and for preadmission testing. Part of the exam
will include a blood sample. Your doctor may suggest that you consider
donating your own blood to save in case you need it during or after
surgery.
Before Surgery
1. Do not eat or drink after midnight the night before surgery.
2. A sleeping medication may be ordered the evening before surgery.
3. In some cases, a blood thinner may be ordered a few days before
surgery.
4. Generally, aspirin and nonsteriod anti-inflammatory medications
should not be taken seven days prior to surgery.
Morning of Surgery
1. The nursing staff will take your temperature, pulse, respiration and
blood pressure.
2. You may brush your teeth and rinse your mouth, but do not swallow
any water.
3. A clean hospital gown will be provided.
4. An intravenous (IV) line will be started the morning of surgery.
5. Anti-embolism stockings (elastic) or a sequential compression device
may be provided to promote circulation to the leg.
Going to Surgery
1. You will be asked to empty your bladder.
2. Remove all jewelry, dentures, contact lenses and nail polish.
3. Rings not removed will be taped.
4. Relatives and friends will be given instructions on where to wait.
5. A surgical orderly will take you on a gurney to the preoperative waiting
area.
6. The anesthesiologist will discuss the type of anesthesia to be used.
7. You will be taken into the operating room.
What to Expect After Surgery
When the surgery is completed, you will be taken to a post-anesthesia
recovery room. When your blood pressure, pulse rate and breathing rate
have stabilized, you will be moved back to your regular hospital room.
You will also be instructed in breathing exercises to help reduce chest
congestion.
For the first day or so after the operation, nurses will closely monitor your
pulse and blood pressure. They will also make frequent observations of
your affected hip and leg to check for drainage, circulation, stiffness and
swelling. If, at any time, you experience discomfort or a loss of feeling,
you should notify a nurse immediately.
For the first couple of days after surgery, you will be given fluids
intavenoulsy. Once you can tolerate liquids, your diet will be increased
accordingly.
If an antibiotic is prescribed as a preventative measure against infection,
it may be given through the IV.
One or two small plastic suction tubes may be used to draw excess flued
from the area around your incision. The tubes are usually removed within
24 to 48 hours when the drainage decreases.
A moistened oxygen mask may be used to soothe your throat and loosen
secretions in your lungs. This mask can be removed for short periods of
time. A trapeze attached to your bed frame will assist you in moving more
easily and the side rails of your bed may be raised for your safety. While
it is normal to experience some pain or discomfort after surgery,
medication is available and ice can be applied to reduce swelling and
discomfort. Let your nurse know if you are experiencing pain or
discomfort.
Activity While in the Hospital
Your surgeon will let you know when you can get out of bed to sit in a
chair and when you can begin physical therapy. The nurse will help you
out of bed and a trapeze may be used as an assistive device. A
commode seat on wheels will help you to walk to the bathroom and use
the toilet.
Time
Most patients are hospitalized from four to six days. The surgery
generally takes two to four hours to perform. Patients must use support in
two hands for about six weeks after surgery while their muscles are
rehabilitating.
Results
Many patients are able to resume daily activities without restriction
following surgery. It is important to remember, however, that the replaced
hip is artificial and there may be occasional discomfort in the hip area, as
well as some numbness in the skin around the surgical scar.
The results of total hip replacement are based on patient determination,
the surgeon's skill and the bioengineer's well-designed implants and
instruments. Continued advances in the field can be expected to result in
continuing success in the future.
Going Home
Preparing for Home
Before the Surgery
Since you will be spending a lot of time at home following surgery and
your movements and activities will be restricted, it is important that you
arrange your furniture and household items ahead of time to maximize
your comfort and convenience during rehabilitation. Some things you
may wish to do before surgery:
1. Add extra cushions to couches and chairs for
comfort and to ensure that you will be sitting high
enough to accommodate your new hip during your
rehabilitation period. Since you should avoid bending
your hip past 90 degrees, it is important that you not
sit in a way that will bend your waist lower than your
knees.
2. Cover or remove all chairs without arms.
During rehabilitation, you should only sit in
armchairs, as you will need the arms to help you
sit down and get up.
3. Arrangements to have an elevated toilet seat
and/or support bars fitted in your bathroom
should be made when it is time to leave the
hospital.
4. Make sure that any items you may need to
reach have been moved to shelves or tables
above waist level. You should not be bending
past 90 degrees in rehabilitation.
5. Remove all throw rugs and anything else on
the floor that it might cause you to slip or trip.
Help at Home
The nurse assisting you and your family in planning for your care at
home can offer home healthcare sources and information.
Restrictions
Progress varies from patient to patient, so discharge instructions may
vary. You will receive specific instructions and precautions from your
surgeon, nurse and physical therapist. These instructions should be
continued until you return for your follow-up examination.
Therapy at Home
Therapy at Home
The majority of your therapy and rehabilitation will occur once you have
checked out of the hospital. Your PT will design an exercise program to
increase the motion and strength of your hip. Most of the exercises will
be the type you can do at home if you wish. No equipment will be
required for these exercises except a pillow. Your PT will give you a list
of exercises you should perform on a daily basis, with written instructions
on how to perform them. Your PT will also teach you each exercise,
making sure you know proper form before you begin.
The rate and effectiveness of your rehabilitation is completely dependent
on your commitment to the physical therapy program. If you perform all ll
the exercises that your PT assigns to you and avoid situations which will
place physical stress upon your hip or leg, your recovery should proceed
according to schedule, and you be in better shape once the rehabilitation
is complete.
Physical Therapy
Your doctor may want you to meet
with a Physical Therapist (PT) even
before the surgery. The PT may
give you some tips on preparing
your house for rehabilitation, on
how you should sleep, get out of
bed, sit, get up, and walk following
surgery. The PT may even give you
a few exercises to practice before
surgery so that they will be familiar
to you once surgery is completed.
Shortly after the surgery is completed, the PT will contact you to discuss
beginning therapy. Judging from you postoperative reports, and in
consultation with your surgeon, your PT will determine when and how
you should begin your rehabilitation program and what exercises you
should be doing.
You will start off between parallel bars in preparation for use of crutches
or a walker. These bars allow you to practice walking by supporting part
of your body weight with your arms rather than on your affected hip and
leg. As you become more comfortable with walking, your PT may allow
you to practice walking on the hospital unit with assistance.
It is recommended that you wear a short robe and low-heeled walking
shoes when learning to walk with a walker or crutches.
Before you go home, the PT will teach you to climb stairs and transfer
from a bed, chair, and car. Your PT may also give you a list of exercises
to be performed at home, every day. The objective is to help you become
as independent as possible in your personal care and daily activities
before you return home. Physical therapy will also help prepare you for
more intensive rehabilitation.
Diet
While your new hip will be supporting your weight just as your old hip
once did, it is important to remember that this is a new part of your body
and should not be strained by having to support too much weight.
Your physician may suggest a weight-control diet to help you achieve
and maintain your ideal weight. A dietitian will instruct you and your
family about diet and will also answer general nutrition questions.
Guidelines, Precautions
Basic Guidelines and Restrictions
1. Do not bend over past a 90 degree angle until your PT specifically tells you it
is all right to do so. You may dislocate your hip if you try to do so prematurely.
You will need to get assistance to put on your shoes and stockings, pick things
up off the floor, etc. The most common mistake patients make is twisting their
body while keeping one leg still. This can dislocate the hip as easily as twisting
the leg and keeping the body still.
2. During rehabilitation, avoid situations and activities that place extraordinary
stress upon the hip or leg such as running, jumping and high-impact or strenuous
exercises. Let your partner do the bending and twisting during sexual activity.
3. Put only the amount of weight on your operative hip and leg as instructed by
your physician or PT.
4. Don't rotate your hip when lying or walking, but keep it in a neutral position,
facing straight ahead.
5. Don't cross your legs when lying, standing or sitting and don't stand with your
toes turned inward.
6. Don't lie on your side without a pillow between your legs.
7. When rising from a chair, first move to the edge of the seat. Place the majority
of your weight on your unaffected leg. Place your affected in front.
8. When climbing stairs, lead with you unaffected leg. When descending, lead
with your affected leg.
9. Wear strong, low-heeled shoes that will provide good support.
10. Walk every day, at least 200 feet per day.
Pain
Before you leave the hospital, your surgeon will probably give you a prescription
for a medication to alleviate discomfort. The nurse will explain how and when to
use it. While discomfort and swelling are normal, you should contact your
surgeon if you experience increased discomfort, pain or swelling.
Special Precautions
Watch for changes around your incision and contact your surgeon if you develop
any of the following symptoms:
1. Drainage and/or foul odor from incision.
2. Fever/temperature above 100.4 degrees or 38 degrees Celsius for two days.
3. Pain, redness or swelling.
It will always be important to protect this new part of your body from infection.
If you ever have any of the following procedures, you will need antibiotics before
these procedures to help protect the joint from the possibility of infection.
1. Cystocopy, colonoscopy or proctoscopy.
2. Dental work, including teeth cleaning.
3. Surgery of any kind.
4. Urinary catheterization.
If you have any infection in any part of your body, contact your physician.
Special Note
Occasionally, a prosthetic device such as your hip may set off the alarm at the
airport security device. Your surgeon may provide you with a special airline card
to identify you as a person having a prosthetic device.