HIP ARTHRITIS – TOTAL HIP REPLACEMENT

Overview
 

During hip replacement, a surgeon removes the damaged sections of the hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.
 

Also called total hip arthroplasty, hip replacement surgery might be an option if hip pain interferes with daily activities and nonsurgical treatments haven't helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement.

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Why it's done
 

Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:

• Osteoarthritis. Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.

• Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.

• Osteonecrosis. If there isn't enough blood supplied to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone might collapse and deform.
   

Hip replacement may be an option if hip pain:

• Persists, despite pain medication

• Worsens with walking, even with a cane or walker

• Interferes with sleep

• Affects the ability to walk up or down stairs

• Makes it difficult to rise from a seated position

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Signs of Infection
 

Notify your doctor immediately if you notice:

• Fever greater than 100 F (37.8 C)

• Shaking chills

• Drainage from the surgical site

• Increasing redness, tenderness, swelling and pain in the knee
   

An infected knee replacement usually requires surgery to remove the artificial parts and antibiotics to kill the bacteria. After the infection is cleared, another surgery is performed to install a new knee.
 

Artificial knees can wear out
 

Another risk of knee replacement surgery is failure of the artificial joint. Daily use wears on even the strongest metal and plastic parts. Joint failure risk is higher if you stress the joint with high-impact activities or excessive weight.
 

How you prepare
 

Food and medications

Your doctor or anesthesiologist might advise you to stop taking certain medications and dietary supplements before your surgery. You'll likely be instructed not to eat anything after midnight on the day of your surgery.
 

Prepare for your recovery

For several weeks after the procedure, you might need to use crutches or a walker, so arrange for them before your surgery. Make sure you have a ride home from the hospital and help with everyday tasks, such as cooking, bathing and doing laundry. If you live alone, your surgeon's staff or hospital discharge planner can suggest a temporary caretaker.
 

To make your home safer and easier to navigate during recovery, consider doing the following:

• Create a living space on one floor since climbing stairs can be difficult.

• Install safety bars or a secure handrail in your shower or bath.

• Secure stairway handrails.

• Get a stable chair with a firm seat cushion and back, and a footstool to elevate your leg.

• Arrange for a toilet-seat riser with arms if you have a low toilet.

• Get a stable bench or chair for your shower.

• Remove loose rugs and cords.
   

What you can expect
 

Before the procedure

Knee replacement surgery requires anaesthesia. Your input and preference help the team decide whether to use general anaesthesia, which makes you unconscious or spinal anaesthesia, which leaves you awake but unable to feel pain from your waist down.

You'll be given an intravenous antibiotic before, during and after the procedure to help prevent post-surgical infection. You might also be given a nerve block around your knee to numb it. The numbness wears off gradually after the procedure.
 

During the procedure

Your knee will be in a bent position to expose all surfaces of the joint. After making an incision about 6 to 10 inches (15 to 25 centimeters) long, your surgeon moves aside your kneecap and cuts away the damaged joint surfaces.
 

After preparing the joint surfaces, the surgeon attaches the pieces of the artificial joint. Before closing the incision, he or she bends and rotates your knee, testing it to ensure proper function. The surgery lasts about two hours.
 

After the procedure

You'll be taken to a recovery room for one to two hours. How long you stay after surgery depends on your individual needs. Many people can go home that same day. Medications prescribed by your doctor should help control pain.

You'll be encouraged to move your foot and ankle, which increases blood flow to your leg muscles and helps prevent swelling and blood clots. You'll likely receive blood thinners and wear a support hose or compression boots to further protect against swelling and clotting.

You'll be asked to do frequent breathing exercises and gradually increase your activity level. A physical therapist will show you how to exercise your new knee. After you leave the hospital, you'll continue physical therapy at home or at a center.
 

Do your exercises regularly, as instructed. For the best recovery, follow all of your care team's instructions concerning wound care, diet and exercise.
 

More information

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Results

For most people, knee replacement provides pain relief, improved mobility and a better quality of life. And most knee replacements can be expected to last more than 15 years.
 

Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car, if you have enough muscle control to operate the brakes and accelerator, and if you're not still taking narcotic pain medications.
 

After recovery, you can engage in various low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.

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Blood Clot Prevention
 

After hip replacement surgery, you'll temporarily be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:

• Moving early. You'll be encouraged to sit up and walk with crutches or a walker soon after surgery.

• Applying pressure. Both during and after surgery, you might wear elastic compression stockings or inflatable air sleeves on your lower legs. The air sleeves squeeze and release your legs. That helps keep blood from pooling in the leg veins, reducing the chance that clots will form.

• Blood-thinning medications. Your surgeon might prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you might need blood thinners for several weeks after surgery.
   

Physical Therapy
 

Daily activity and exercise can help you regain the use of your joint and muscles. A physical therapist can recommend strengthening and mobility exercises and can help you learn how to use a walking aid, such as a walker, a cane or crutches. As therapy progresses, you'll gradually increase the amount of weight you put on your leg until you're able to walk without assistance.
 

Home Recovery
 

Before you leave the hospital, you and your caregivers will get tips on caring for your new hip. For a smooth transition:

• Arrange to have a friend or relative prepare some meals in advance

• Place everyday items at waist level, so you won't have to bend down or reach up

• Consider getting a raised toilet seat and a shower chair for your recovery at home

• Put your phone, tissues, TV remote, medicine and books near the area where you'll be spending most of your time during recovery
   

Results
 

Full recovery from a hip replacement varies from person to person, but most people are doing well three months after the surgery. Improvements typically continue during the first year after surgery.

The new hip joint can reduce pain and increase the hip's range of motion. But don't expect to do everything you could do before the hip became painful.
 

High-impact activities, such as running or playing basketball, might be too stressful on the artificial joint. But in time, most people can participate in lower-impact activities — such as swimming, golfing and bicycle riding.

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