Hip Joint Replacement

The hip joint consists of two major parts, the hip socket (acetabulum) and the upper end of the thighbone (femoral head). Hip replacement, or total hip arthroplasty, is a surgical procedure to remove one or both damaged or worn out parts and replace them with an artificial joint, or prosthesis. It is the second most common joint replacement procedure. The surgery’s goal is to relieve hip pain that has not been relieved by other treatments.

A hip joint replacement is most often done to relieve pain and reduce physical limitations that are due to arthritis. The most common forms of arthritis are osteoarthritis, rheumatoid arthritis, and traumatic arthritis. Other reasons for a hip joint replacement are hip fractures and hip joint tumors. Damage to the hip for any of these reasons will cause pain and various degrees of limited mobility. You might be a candidate for a hip joint replacement if

• Pain limits your normal everyday activities;
• Pain does not subside when resting or sleeping;
• Stiffness hinders your ability to move or lift your leg;
• Anti-inflammatory drugs or glucosamine sulfate offer little or no pain relief;
• You experience side effects from medications for hip pain; or
• Pain is not relieved by other treatments including physical therapy or the use of a gait aid.

Your Jacksonville Orthopaedic Institute Beaches surgeon will help determine whether or not you should have hip replacement surgery through a medical history that will give a picture of your overall health as well as the extent of your pain and disability; a physical exam that will assess your hip’s strength, alignment, and mobility; and x-rays that will show the extent of damage to or deformity in your hip. Blood tests, Magnetic Resonance Imaging (MRI), or a bone scan might also be requested by your surgeon. Once the evaluation is completed, you and your JOI Beaches surgeon will discuss the results. Non-surgical options will be considered if at all possible. However, if surgery is warranted, your surgeon will explain the preparation steps, the procedure, and the aftercare. The possible risks and complications during each phase will also be explained.

Some preparation is necessary prior to your hip joint replacement surgery to ensure a successful surgery and recovery.
Medical planning can include one or more of the following measures:
• Advise your surgeon about all medications, supplements, and herbs that you take on a regular basis.
• If you are a smoker, stop smoking.
• If you are overweight, lose weight.
• Advise your surgeon if you have more than one or two alcoholic drinks a day.
• Advise your surgeon about any outbreaks of illness.
• At some point prior to surgery you may need to stop taking any drugs that make it harder for blood to clot or that make you more prone to get an infection.
• Ask your surgeon which drugs you should still take on the day of surgery.
• If you have medical conditions other than your hip problems, your surgeon may want you to see the doctor who treats you for those conditions.
• Consult with a physical therapist about pre-op conditioning exercises as well as post-op rehabilitation plans. Receive instructions, and practice using a walker, crutches, a cane, or a wheelchair to correctly shower, go up and down steps, and use the toilet.
• You may be advised to donate blood. It can be stored for your use during or after surgery if necessary.
• Because bacteria can enter the bloodstream during dental procedures, you should have such procedures prior to having hip replacement surgery.
Home planning can include one or more of the following measures:
• Make sure that all stairways have secure handrails.
• Prepare your bathroom by installing safety bars or handrails in the shower or bath. Obtain a shower bench or chair, a long-handled sponge, and a shower hose. Install a raised toilet seat.
• Make sure you have a stable chair with a firm seat cushion, a firm back, and two arms. It should allow your knees to be lower than your hips. Firm pillows can be used to raise the hips above the knees.
• Obtain a dressing stick, a sock aid, and a long-handled shoe horn to assist you with dressing.
• Get a “grabber” to assist in reaching objects.
• Remove loose rugs and electrical cords.
• Arrange for help at home or for placement in an extended care facility after your surgery.
• Make arrangements to have handicap parking access after surgery.
• Make arrangements to have documentation (usually a card) that confirms that you have a prosthesis. You will need it when being scanned by security metal detectors.

More than likely, you will be admitted to the hospital on your scheduled day of surgery. You will have fasted according to your surgeon’s instructions. You may be given a mild sedative to relax you prior to being prepped for surgery. The anesthesia team will administer the type of anesthesia that has previously been determined to be best for you. If you have general anesthesia, you will sleep throughout the procedure, and a machine will help you breath. If you have spinal anesthesia, you will not be fully asleep but will be anesthetized from the waist down. You will breathe on your own.

After you are given anesthesia, your JOI Beaches surgeon will make a surgical cut to open up the hip joint. Then your surgeon will
• Cut and remove the head of the thigh bone;
• Clean out the hip socket;
• Remove the remaining cartilage and damaged bone;
• Put the new hip socket (with liner) in place;
• Insert the metal stem in the thigh bone;
• Place the correct-sized metal or ceramic ball for the new joint;
• Secure the new parts in place;
• Repair muscles and tendons around the new joint; and
• Close the surgical cut.
The procedure can take up to a few hours. An alternative procedure involving one or two smaller incisions is available, but not suitable for all hip replacement candidates. Your JOI Beaches surgeon will determine which procedure is best for you. For more information on anterior hip replacement, click here.

After surgery, you are off to the recovery room where your recovery from anesthesia will be monitored. Later you will be taken to your hospital room. Your hospital stay will be long enough for you to recover from the anesthesia, to control the pain, and to begin standing, walking, and doing light activity. You will begin working with a physical therapist, who will continue working with you once you are discharged to your home or to a rehabilitation facility.

Although uncommon, complications can occur following hip replacement surgery. They can prolong or limit full recovery. Risks for any anesthesia include allergic reactions and breathing problems. Risks for any surgery include bleeding, blood clots in the legs that can travel to the lungs, heart attack or stroke during surgery, and infection at the site or in the lungs and urinary tract. Complications particular to hip joint replacement include dislocation, nerve injury, fractures due to falls, and the need for revision or additional hip surgery. There may be other complications due to other medical conditions specific to you.

The success of your surgery depends, in part, on how well you follow your surgeon’s instructions regarding home care. The following recommendations might be part of those instructions…
• You will need to care for your wound by keeping it clean and dry until it has sealed thoroughly.
• Keep all appointments to see your physical therapist and your surgeon.
• Take only recommended medications.
• Do not drive until your doctor clears you to do so.
• Notify your physician if you experience any signs of infection, increased pain, or numbness/tingling in the affected leg.
• Resume a healthy diet. Drink plenty of fluids.
• Resume a light activity/exercise level with the goal of returning to a normal level of activity/exercise.
• Take special precautions to avoid injuries and falls.
• If you have to have dental work done, advise your dentist about your hip replacement. You will probably need to take antibiotics prior to the dental procedure.

Hip joint replacement surgery usually results in a reduction of hip pain and stiffness as well as an improvement in ability to carry out normal day-to-day activities. However, it will not allow you to do more than you could before you developed a hip problem. And, over time, the prosthesis will loosen. If you are very active or are overweight, parts may wear out even before the prosthesis loosens. In either case, a second replacement may be necessary.

If you are experiencing hip pain or limited flexibility or mobility due to hip pain, you could be a candidate for hip joint replacement surgery. Please schedule a consultation at Jacksonville Orthopaedic Institute Beaches. One of our highly-skilled surgeons will be happy to discuss your pain, your lifestyle, and the steps necessary to ensure that you are back to your best self. Contact us today at 904-241-1204.

 

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