Are You Living with Hip Pain?
The hip is called a ball-and-socket joint because the round ball-shaped head of the thighbone (femur) moves inside the cup-shaped hollow socket (acetabulum) of the pelvis. These bones are covered by cartilage, a layer of strong tissue that cushions the bones and allows smooth, easy movement of the joint.
Degenerative joint disease (DJD) can cause a loss of cartilage, resulting in bone-on-bone contact that may result in pain, swelling and stiffness.
What causes degenerative joint disease?
The risk of developing symptomatic DJD is influenced by multiple factors such as age, gender and inherited traits that can affect the shape and stability of your joints. Other factors can include a previous hip injury, repetitive strain on the hip, improper joint alignment, being overweight and/or sports-generated stress placed on the hip joint.
There are different types of arthritis that may cause hip pain. An orthopedic surgeon may diagnose:
- Osteoarthritis (OA), also called “wear-and-tear arthritis,” in which cartilage wears down over time, is the most common type of hip arthritis
- Post-traumatic arthritis, which results from a severe fracture or fracture or dislocation of the hip
- Rheumatoid arthritis (RA), an inflammatory arthritis of the joints
- Avascular necrosis (AVN), a condition where the “ball” or femoral head has lost a healthy supply of blood flow, causing the bone to die and the femoral head to become misshapen
- Hip dysplasia, a condition in which bones around the hip did not form properly, which may cause misalignment of the hip joint
Cartilage has no nerves, so the break-down itself does not directly cause pain. However, the decreased “shock absorption” that results from a loss of cartilage causes increased stress to surrounding structures such as bones, muscles and the lining of the joint. This can lead to sudden “flares” of pain when these tissues get irritated.
Joint replacement surgery is considered a treatment option to relieve arthritis pain and restore function to the affected joint. Conservative treatment options are usually tried before surgery is recommended. Joint replacement surgery is recommended when pain is no longer well-controlled and joint damage significantly affects quality of life.
How do you know if you need a joint replacement? Ask yourself these questions:
- Have I tried medication and other conservative pain-relieving treatment options?
- Do I have unrelenting pain in the affected joint?
- Do I have significant difficulty with usual daily activities, such as walking, climbing stairs, cooking, cleaning, and more?
- Has my quality of life suffered due to arthritis pain and joint damage?
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
- The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone.
- A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. The position of this cup is critical to the stability and longevity of the hip replacement
- A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
Is Hip Replacement Surgery for You?
The decision to have hip replacement surgery should be a cooperative one made by you, your family and your orthopedic surgeon.
Candidates for Surgery
There are no absolute age or weight restrictions for total hip replacements.
Recommendations for surgery are based on a patient’s pain, disability, and x-ray findings of arthritis. Most patients who undergo total hip replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
When Surgery Is Recommended?
There are several reasons why your doctor 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
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. Realistic activities following total hip replacement include unlimited walking, downhill skiing, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
The surgeon at Vachhani Hospital 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, we 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. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.
Hundreds of thousands of hip replacement surgeries are performed each year, and they are highly successful in eliminating pain, restoring mobility and improving quality of life. If a hip replacement is properly done, over 95% of hip replacements will last at least 15 years.
However, problems do occur with hip replacements. When the implant wears out or another problem develops, people often need a second “revision” surgery in which the existing implant or components are taken out and replaced. The surgeon at the Vachhani Hospital is fellowship trained in joint replacement and have the expertise and knowledge necessary to evaluate and treat failed or problematic hip replacements. If you have a hip replacement that needs evaluation, we are happy to assist and provide treatment recommendations.
What are the common reasons for revision hip replacement?
- Loosening of the implant – the hip replacement may become painful after many years because the components have begun to wear and loosen.
- Fracture – a fall or severe blow can cause a fracture of the bone near the hip replacement that may require a revision of the hip replacement and/or or operative fixation of the fracture.
- Infection – this can be a very serious complication. If a deep infection develops in a hip replacement, revision is often needed to eradicate the infection and to implant new non-infected components.
- Dislocation – for a variety of reason a hip replacement can become unstable, meaning that the ball and socket become dislocated. If this is a recurrent problem, it may require a revision surgery to make the replacement more stable and prevent future dislocations.
- Implant recall – on occasion, the implant used in joint replacement is found to have a problem. As a result, patients with a recalled implant should be closely monitored by their surgeon to evaluate if the recalled implant is causing a problem. Revision surgery is sometimes necessary when an implant is recalled.
Be aware of warning signs that there may be a problem, such as pain that comes on suddenly, trouble walking, a sensation that the hip replacement is loose or unstable, or changes in the wound appearance.
A revision joint replacement is more complicated than the initial operation and many physicians who perform primary joint replacements will refer their patients to the revision surgery experts at Vachhani Hospital.
How can you make the replacement last longer?
- We advise patients to avoid high impact activity such as running, which can shorten the lifespan of the joint replacement. Walking for exercise is better than running.
- Maintain a healthy weight. Being overweight, especially obese, is a main factor in developing arthritis in the first place. People who are overweight are more likely to experience loosening of an implant.
- Once the initial healing has taken place and discomfort has diminished, see your orthopedic surgeon if pain develops suddenly. Do not wait to have a problem evaluated.
- If you develop a bacterial infection in another part of your body after joint replacement, be sure to see your medical doctor for appropriate antibiotics.
- Pay a visit to your orthopedic surgeon every few years after hip replacement, even if the joint feels good. The physician can check for early loosening of the implant or another minor problem before it causes a major headache, such as dislocation.
- Have your primary hip replacement with an experienced surgeon who specializes in the procedure and at a center that performs a high number of joint replacements to ensure the best outcome and lower the risk of complications.
Mini-Posterolateral Total Hip Replacement
The most common approach today is referred to as the “posterior approach,” which is done from the back of the hip. Recent improvements to this approach allow a smaller incision and less tissue trauma, enabling a more rapid post-operative recovery. This modification of the posterior approach has been called the “mini posterior approach.” The mini-posterior approach allows our surgeons to perform total hip replacement through a relatively small incision without cutting the important abductor muscles that are critical to hip stability and gait. Since this is the most commonly used approach, it is very safe with minimal risk of nerve damage, femur fracture, and less blood loss in comparison to other approaches. In addition, if needed, this approach can be quickly expanded to access the pelvis or femur in more complex cases such as hip revision surgery. Not every patient is a candidate for every surgical approach, and excellent outcomes can be obtained with any approach. As a result, we work with our patients to ensure the surgical approach is customized to meet the patient’s needs and provide the safest, most successful hip replacement possible.
What to Expect Before Hip Replacement Surgery
Joint replacement can help relieve pain and enable you to live a fuller, more active life. If you are deemed a good candidate for joint replacement and decide to have surgery, it is good to be prepared, both mentally and physically before surgery. Planning ahead for the challenges of surgery and recovery will help ensure a more successful outcome. Below are answers to some frequently asked questions before surgery:
- What tests are needed before surgery? Prior to hip replacement, you will complete a variety of tests such as x-rays, and ECG, and blood tests. These medical studies ensure that you are healthy enough for surgery and enable your providers to ensure the best care after surgery.
- What type of anesthesia will I receive?Most of our patients receive a spinal block, intravenous sedation for hip replacement surgery. This combination ensures a safe and rapid recovery with a lower likelihood of nausea and vomiting, respiratory complications, prolonged sedation, and other issues often seen with general anesthesia.
- What type of implant or prosthesis will be used? We use implants with a design that has been shown to have good long-term survival. If you want specific brand names please discuss this with your surgeon before surgery.
- How long will I stay in the hospital? Most patient stay in the hospital 3-4 days following hip replacement.The majority of patient will go home on day 4 and will continue physiotherapy at home.
- How long will my recovery take? Most patients will obtain almost full recovery by 3 months after surgery. We advise you avoid high-impact activities such as running after a knee replacement. If you have a sedentary job, you should be able to return to work within 3-6 weeks. More physical jobs often require more time off for recovery.
- How will my pain be managed after surgery? We use “multimodal” pain management, meaning that we use a combination of medications such as opioid analgesics and anti-inflammatories as well as ice to control your pain.
- Do I need physical therapy before surgery? Formal physical therapy is not required before surgery, but it is advised to get in the best physical shape possible before surgery to lessen the change for complication and shorten your recovery time.
- What medications should I stop taking before surgery? You will stop all medications that thin your blood 3 days before surgery such as aspirin and clopidogrel.
- What if I smoke or drink alcohol? If you smoke, cut down or quit. Smoking affects blood circulation, delays healing and slows recovery. Eat a nutritious, well-balanced diet. If you drink, do not consume any alcohol for at least 48 hours before surgery. If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can cause complications and impact your surgery.
What to Expect After Hip Replacement Surgery
The day after surgery, you will begin working with physical therapy to become comfortable using your new hip. They will begin basic movements and walking with either a walker or crutches. Physical therapy is a critical component of your recovery, helping to restore joint strength and mobility. If you have a posterior approach, there will be three “motion restrictions” that you must follow for 3 months to allow for soft tissue healing and prevent dislocation after surgery:
- Do not cross your legs
- Do not bend your hip past a 90 degree angle
- Do not twist your hip inwards – keep knees and toes pointed upwards
Joint replacement is major surgery and your recovery will take several weeks, but there are steps you can take now to make your time at home safer and more comfortable:
- If you live alone or have special needs, consider going to a specialized rehabilitation facility after discharge from the hospital. Your doctor can suggest appropriate places to consider.
- Arrange for someone to drive you home from the hospital and stay with you for several days after your surgery. Do not drive until cleared by your surgeon.
- Place items that you use frequently within easy reach.
- Use a walker or pair of crutches to see how well you can maneuver through your home. You may need to rearrange furniture or temporarily change rooms (make the living room your bedroom, for example).
- Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- Consider modifying your bathroom to include a shower chair, gripping bar, or raised toilet seat. Place items that you use frequently within easy reach so that you do not have to reach up or bend down.