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Hip Problems

If your hip pain does not respond adequately to conservative treatments, we may suggest you consider hip replacement surgery. This is one of the safest and most successful types of major surgery and one in which we have significant experience. In hip replacement, the diseased joint is removed and replaced with an artificial joint. We will help you weigh the potential benefits and risks of your surgical options and recommend which of three techniques is likely to work best for you.

Contending with Hip Pain

Pain in the hip can be debilitating, making it difficult to walk, climb stairs, or even pick up an object from the floor. It can limit your freedom of movement and ability to function independently. While hip pain can be caused by deformity or by direct injury, like trauma or a sports injury, the most common cause of hip pain is osteoarthritis (OA) also known as degenerative joint disease (DJD). Depending on factors including age, weight, joint function and activity, patients with arthritis find the hip’s cartilage lining wears away over time. That means bones rub against each other, resulting in friction, swelling, pain, stiffness, and instability.

How Hips Work

A joint is formed by the ends of two or more bones that are connected by thick tissues. For example, your hip joint is a ball-and-socket joint, formed by the ball, or femoral head, at the upper end of the thighbone, and the rounded socket, or acetabulum, in the pelvis. The bone ends of a joint are covered with a smooth, tough material called cartilage. Normal cartilage cushions the bones and allows nearly frictionless and pain-free movement. The rest of the surfaces of the joint are covered by a thin, smooth tissue lining called the synovium. The synovium produces fluid that acts as a lubricant to reduce friction and wear in the joint.

What is Hip Replacement?

Hip replacement involves replacing the femur (head of the thigh bone) and the acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong metal or ceramic, and the artificial socket is made of polyethylene (a durable, wear-resistant plastic) or metal backed with a plastic liner. The artificial joint may be cemented in position or held securely in the bone without cement.

What is MIS Hip Replacement?

Exciting News: Minimally Invasive Surgery for Total Hip Replacement

Stryker has partnered with orthopaedic surgeons world-wide to develop surgical techniques, implants and instruments that adapt the latest advances in minimally invasive surgery (MIS) for total hip replacement.

Minimally invasive surgery (MIS) is a general term used to describe a surgical procedure that uses one or more smaller incision(s) than conventional surgery. In some MIS procedures, the amount of soft tissue (muscles and tendons, etc.) that are disrupted during surgery may also be reduced.

MIS Hip Joint Replacement is a step forward in hip replacement because it may provide a number of potential benefits, which may include: a smaller scar, because of the smaller incision; a potentially faster recovery, because of less tissue disruption; and possibly less blood loss.

Results often vary from patient to patient. Not all patients may realize the potential benefits from these relatively new procedures. The risks that are identified for patients undergoing a conventional hip joint replacement, still remain.

Only your orthopaedic surgeon can properly evaluate whether you are a candidate for an MIS hip joint replacement procedure. Risk factors relating to your anatomy, weight, prior joint replacements and personal health issues should be addressed with your orthopaedic surgeon of choice. The long-term benefits, as well as the short-term benefits, of an MIS hip joint replacement should always be discussed.

Here are a few questions you should consider asking your Orthopaedic Surgeon about MIS hip joint replacement:

  • Is hip replacement surgery my only option?
  • Is joint replacement right for me?
  • Is MIS hip replacement surgery a realistic option for me?
  • What are the potential risks and benefits of this MIS surgical technique?
  • How long have you been performing MIS hip joint replacements?
  • Have you had any specialized training in performing this technique?
  • How many MIS procedures have you performed?
  • What should I realistically expect my recovery to be like?

Hip Replacement FAQ

What is a Hip Replacement?

Hip replacement involves the removal of arthritic bone ends and damaged cartilage and replacing them with prosthetic implants that replicate the hip joint. Hip replacement can help relieve pain and get you back to enjoying normal, everyday activities.

What are the Reasons for Total Hip Replacement?

Total hip replacement is often reserved for patients who:

  • Have a painful, disabling joint disease of the hip resulting from a severe form of arthritis
  • Are not likely to achieve satisfactory results from less invasive procedures, such as arthrodesis (artificial stiffening or fixation of the joint)
  • Have bone stock that is of poor quality or inadequate for other reconstructive techniques

How Is A Total Hip Replacement Performed?

In a total hip replacement operation, the surgeon replaces the worn surfaces of the hip joint with an artificial hip joint. The worn head of the femur (thighbone) is replaced with a metal or ceramic ball mounted on a stem; the stem is placed firmly into the canal of the thighbone at its upper end. The acetabulum (hip socket) is prepared and implanted with a metal cup and plastic or ceramic insert. The ball and insert glide together to replicate the hip joint.

Who Should Have A Hip Replacement?

Hip replacement surgery may be considered when arthritis limits your everyday activities such as walking and bending, when pain continues while resting, or stiffness in your hip limits your ability to move or lift your leg. Hip replacement may be recommended only after careful diagnosis of your joint problem. It may be time to consider surgery if you have little pain relief from anti-inflammatory drugs, or if other treatments, such as physical therapy, do not relieve hip pain.

How Long Is The Hospital Stay?

After hip replacement surgery, you will probably spend no more than 3 to 5 days in the hospital. Most hip replacement patients begin standing and walking with the help of a walker and a physical therapist the day after surgery.

How Long Is Recuperation?

Recovery varies with each person. It is essential that you follow your orthopaedic surgeon’s instructions regarding home care during the first few weeks after surgery, especially concerning the exercise program you are prescribed. You should be able to resume most normal light activities of daily living within three to six weeks following surgery. Some discomfort during activity and at night is common for several weeks. Complete recovery can take from about 3 to 6 months.

While most people will gradually increase their activities and play golf, doubles tennis, shuffle-board, or bowling, you will be advised to avoid more active sports, such as jogging, singles tennis, and other high-impact activities.

Are There Complications?

As with any surgery, there is a risk of complications after hip replacement surgery. However, they are relatively rare. Blood clots are the most common complication after surgery. Your orthopaedic surgeon may prescribe one or more measures to prevent a clot from forming in your leg veins. These measures may include special support hose, inflatable leg coverings, and blood thinners.

What Is The Success Rate?

Hip replacement is one of the most important surgical advances of this century. This surgery helps more than 300,000 Americans each year to relieve their pain, and get back to enjoying normal, everyday activities.

How Long Does A Hip Replacement Last?

The conventional arrangement of a metal ball into a special plastic (polyethylene) cup has been shown to have excellent results over the years. How long it will last depends not only on age, but also a patient’s activity level. Demand and activity levels are generally considered when the surgeon makes this decision and will likely be discussed with you.

Ceramic on Ceramic Hip Replacement Systems

Ceramic-on-Ceramic May Provide a Longer-Lasting Replacement Joint

Conventional total hip systems use an insert made of plastic and a head made of metal or an insert and a head made of metal. As total hip replacement becomes more common in younger and more active patients, and as patient life expectancies continue to increase, the orthopaedic industry is being challenged to extend the lifespan of total hip replacement components.

Ceramic-on-ceramic surfaces have demonstrated significantly lower wear versus conventional plastic-on-metal and metal-on-metal hip systems in the laboratory; higher-wear rates can reduce the life of the artificial hip. The extreme hardness of alumina ceramic is the hardest material next to diamond. It is also known to be biocompatible (tolerated well in the body), has excellent lubrication characteristics and improved wear properties.

Your orthopaedic surgeon may consider ceramic-on-ceramic hip replacement appropriate for younger, active patients. The best type of replacement-hip surface for you depends on your medical condition, activity level, and age. Ask your orthopaedic surgeon to discuss your options with you.

Potential Benefits

The goals of artificial hip replacement include relief of pain, restoration of function, and correction of deformity. Ceramic-on-ceramic, however, demonstrates significantly lower wear versus conventional metal-on-plastic components in laboratory testing4. Therefore, it is anticipated that these improved wear characteristics will result in a longer lasting implant.

Potential Risks

Any artificial hip replacement may be associated with serious complications. These include: dislocation, loosening, implant breakage, bone fracture, reaction to the implant’s materials, bone loss, change in the length of the treated leg, pain, hip stiffness, excessive bleeding, hip joint fusion, nerve damage, allergic reaction to medical and/or blood transfusion, infection, reactions to pain-relieving drugs, blood clots in the legs and/or lungs, amputation, heart attack, pneumonia, excessive wear of the implant’s components, decrease of bone mass, and audible sounds during motion.

With this ceramic-on-ceramic system, sudden breakage of ceramic components resulting from excessive forces is possible; however, no ceramic component broke during the clinical study. Corrosion (eroding) between the insert and shell may be possible; however, this event was not demonstrated in the clinical study, and laboratory tests have shown the potential to be minimal.

Any of the above-cited complications may require medical intervention, including additional surgery. In rare instances, complications may lead to death. Please ask your surgeon to discuss with you any of these complications that are not familiar to you.

Patient Instruction

Call your doctor if you experience any of the following symptoms:

  • Redness, burning, swelling, or drainage from your operated area
  • Fever of 100 degrees or higher
  • Pain that does not lessen with rest
  • Acute, severe pain in the hip associated with twisting, turning or injury

Consult your doctor regarding considerations before surgery, rehabilitation after surgery, and expectations for surgery. It is important to begin planning for your return home from the hospital before your surgical procedure. Your surgeon may suggest tips to prepare your home for after surgery. For example, get an apron or belt with pockets to carry things while you are on crutches, buy or borrow a cordless phone, remove scatter rugs and other obstacles, safe transport using crutches, have high chair and commode accessories available. Above all, during this time, treat yourself well, eat balanced meals, get plenty of rest, and if requested by your surgeon, donate your own blood in advance so it can be transfused during and after surgery.

After surgery you will need to rest your hip to allow proper healing. Your activity will be restricted during this healing period. During the first weeks after surgery, you may be advised to put a pillow between your legs when turning over in bed, wear elastic stockings, use raised toilet seat, take showers rather than baths, restrict activities such as sudden twisting or turning, crossing legs, exposing the scar to sunlight, and driving. Carefully follow your doctor’s instructions regarding progression to normal weight bearing and resumption of normal physical activity. Individual results will vary and all patients will experience different activity levels post-surgery.

Even after the healing period, excessive loads placed on the implants through sudden trauma or high impact activities, such as running and jumping, can damage the artificial joint. While the expected life of an artificial hip replacement system is difficult to estimate, it is finite. The components are made of foreign materials that will not indefinitely withstand the activity level and loads of normal, healthy bone. The hip joint may have to be replaced at some time in the future.

Alternative Treatments

Other options may include use of a conventional hip replacement system, other surgical procedures that do not replace the hip joint, or non-surgical treatments based on pain management and activity restriction. Your doctor can explain these alternatives, and help you decide which treatment is best for your condition.

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