Total Hip Replacement
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If you have arthritis which has not responded to conservative treatment, you may be a candidate for total hip replacement surgery.
Hip replacement has become necessary for your arthritic hip: this is one of the most effective operations known and should give you many years of freedom from pain.
Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons. When the articular cartilage wears out, the bone ends rub on one another and cause pain. In general, but not always, it affects people as they get older (osteoarthritis).
Other causes include
- Childhood disorders such as congenital dislocation of the hip, Perthe’s disease, slipped epiphysis, etc.
- Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
- Trauma or fractures
- Increased stress such as overuse, obesity, etc.
- Avascular necrosis (loss of blood supply)
- Connective tissue disorders
- Obesity, since additional weight puts extra force through your joints which can lead to arthritis over a period of time
- Inflammation such as rheumatoid arthritis
In an Arthritic Hip
- The cartilage lining is thinner than normal or completely absent
- The degree of cartilage damage and inflammation varies with the type and stage of arthritis
- The capsule of the arthritic hip is swollen
- The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
- Bone spurs or excessive bone can also build up around the edges of the joint
- The combinations of these factors make the arthritic hip stiff and can limit activities due to pain or fatigue
The diagnosis of osteoarthritis is made on history, physical examination, and X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).
Total hip replacement is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatment.
You should consider a total hip replacement when you have
- Arthritis confirmed by X-ray
- Pain which does not respond to analgesics or anti-inflammatories
- Limitations of activities of daily living including your leisure activities, sport or work
- Pain keeping you awake at night
- Stiffness in the hip making mobility difficult
Prior to surgery you will usually have tried conservative treatments such as analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes or physical therapy.
The decision to proceed with total hip replacement surgery is a cooperative one between you, your surgeon, your family, and your primary care physician.
Benefits of surgery include
- The reduction or elimination of hip pain
- Increased mobility and movement
- Correction of deformity
- Equalization of leg length
- Increased leg strength
- Improved quality of life and the ability to return to normal activities
- Elimination of pain at rest allowing you to sleep without pain
- Your surgeon will send you for routine blood tests and any other tests or studies required prior to your surgery
- You will be asked to have a general medical check-up with your primary care physician
- You should have any other medical, surgical, or dental problems attended to prior to your joint replacement surgery
- Make arrangements around the house prior to surgery
- Stop aspirin or anti-inflammatory medications 7days prior to surgery as they can cause bleeding
- Stop any naturopathic or herbal medications 10 days before surgery
- Stop smoking as long as possible prior to surgery
The Day of Your Surgery
- You will be admitted to the hospital usually on the day of your surgery
- Further tests may be required on admission
- You will meet the nurses and answer some questions for the hospital record
- You will meet your anesthesiologist, who will answer all of your questions about anesthesia
- You will be given hospital clothes to change into prior to surgery
- The operation site will be initialed with a marker by your surgeon
- Your surgical site may be shaved if needed
- Approximately 15 minutes prior to surgery, you will be transferred to the operating room
Post –Operative Care
You will wake up in the recovery room with a number of monitors to record your vitals. (Blood pressure, heart rate, oxygen saturation, temperature, etc.) You will have a dressing on your hip and a small drain.
Post-operative X-rays will be performed in the recovery room.
After waking up in the recovery room, you will be taken to your room.
You will have an IV in your arm for fluid and pain relief. This will be explained to you by your anesthesiologist.
On the day following surgery, your drain will be removed and you will get out of bed to walk. You will be able to put all your weight on your hip and your physical therapist will help you with the post-op hip exercises.
Discomfort is normal but if you are in significant pain, please inform your nurse.
You will be discharged to go home or to a rehabilitation hospital on the second day depending on your progress.
A post-operative visit will be arranged prior to your discharge.
You will be advised to walk with crutches for two weeks following surgery and then walking aids for another four to six weeks.
Remember this is an artificial hip and must be treated with care.
Avoid the combined movement of flexing your hip and turning your foot inwards. This can cause dislocation. Other recommendations for post-operative care are:
- Sleep with a pillow between your legs for 6 weeks.
- Avoid crossing your legs and bending your hip past a right angle.
- Avoid sitting in low chairs.
- Avoid bending over to pick things up. Use a grabber.
- Use a long shoe horn and consider getting slip-on shoes.
- Elevated toilet seats are recommended.
- You may shower once the wound has healed.
- You may apply Vitamin E or moisturizing cream into the wound once the wound has completely healed.
- If you have increasing redness or swelling at the incision, or a fever over 100.5°, you should call your surgeon.
- If you are having any procedure such as dental work, you should take antibiotics before the procedure to help prevent infection. Please ask your surgeon for details.