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Welcome to Orthopaedic Solutions & Sports Medicine Center, PA

Total Hip Replacement

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.

Common Causes of Hip Pain

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

  • Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.

  • Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis."

  • Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.

  • Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis. The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.

  • Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
When Surgery Is Recommended

There are several reasons why Dr. Parikh and his team may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

  • Hip pain that limits everyday activities, such as walking or bending

  • Hip pain that continues while resting, either day or night

  • Stiffness in a hip that limits the ability to move or lift the leg

  • nadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

Deciding to Have Hip Replacement Surgery

Talk With Your Doctor

Dr. Parikh and his team will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.

In addition, Dr. Parikh and his team will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.

Never hesitate to ask Dr. Parikh and his team questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.

Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.

With appropriate activity modification, hip replacements can last for many years.

Preparing for Surgery

Medical Evaluation

If you decide to have hip replacement surgery, Dr. Parikh and his team may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.

Tests

Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.

Blood Donations

You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.

Medications

Tell Dr. Parikh and his team about the medications you are taking. Dr. Parikh and his team or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.

Weight Loss

If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.

Home Planning

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

  • Securely fastened safety bars or handrails in your shower or bath

  • Secure handrails along all stairways

  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms

  • A raised toilet seat

  • A stable shower bench or chair for bathing

  • A long-handled sponge and shower hose

  • A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip

  • A reacher that will allow you to grab objects without excessive bending of your hips

  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips

  • Removal of all loose carpets and electrical cords from the areas where you walk in your home
Possible Complications of Surgery
  • Infection

  • Blood Clots

  • Leg-length Inequality

  • Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopaedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.

  • Dislocation

Following your surgery, you may need to take antibiotics prior to dental work, including dental cleanings, or any surgical procedure that could allow bacteria to enter your bloodstream. For many people with joint replacements and normal immune systems, Dr. Parikh and the American Academy of Orthopaedic Surgeons (AAOS) recommends taking preventative antibiotics before dental work.

Warning signs of infection. Notify Dr. Parikhs’s office immediately if you develop any of the following signs of a possible hip replacement infection:

  • Persistent fever (higher than 100°F orally)

  • Shaking chills

  • Increasing redness, tenderness, or swelling of the hip wound

  • Drainage from the hip wound

  • Increasing hip pain with both activity and rest Avoiding Falls

A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.

Dr. Parikh and his team and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

Other Precautions

To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions — usually for the first 6 weeks after the surgery:

  • Do not cross your legs

  • Do not bend your hips more than a right angle (90°)

  • Do not turn your feet excessively inward or outward

  • Use a pillow between your legs at night when sleeping until you are advised by Dr. Parikh and his team that you can remove it

Dr. Parikh and physical therapist will give you more instructions prior to your discharge from the hospital.

Outcomes

How Your New Hip Is Different

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.

Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated. You may ask your orthopaedic surgeon for a card confirming that you have an artificial hip.

Protecting Your Hip Replacement

There are many things you can do to protect your hip replacement and extend the life of your hip implant.

  • Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.

  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.

  • Make sure your dentist knows that you have a hip replacement. You will need to take antibiotics before any dental procedure.

  • See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.


Information obtain from www.orthoinfo.aaos.org

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