Health Care and Hip Replacement

Over time your joints can age and movement can become painful, especially in your hips. Older men and women are more susceptible to this type of health difficulty. Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, you should consider information that can help you understand the benefits and limitations of total hip replacement.

 If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting, according to the American Academy of Orthopaedic Surgeons.

If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities. First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. More info can be found at the AAOS site: http://orthoinfo.aaos.org/topic.cfm?topic=a00377.

People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery, according to the National Institutes for Health. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery. According to the Centers for Disease Control and Prevention (CDC), 332,000 total hip replacements are performed in the United States each year.

In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.

Today, a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip.

People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes. More info can be found at this website: http://www.niams.nih.gov/Health_Info/Hip_Replacement/ .

According to John Hopkins Medicine, as with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

·         Bleeding

·         Infection

·         Blood clots in the legs or lungs

·         Dislocation

·         Need for revision or additional hip surgery

·         Nerve injury resulting in weakness or numbness

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure. A significant amount of information, including how to prepare for surgery, what happens during the surgery in the hospital, and recovery, can be found at this website: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/hip_replacement_surgery_procedure_92,P07674/ .

Some surgeons, however, are performing another type of hip surgery, according to the New York Times, called anterior hip replacement. The surgeon makes the incision at the front of the hip instead of through the buttocks or the side of the hip. This approach permits the doctor to reach the hip socket without cutting through major muscle groups.

 Proponents claim that the procedure results in less pain and fewer complications for patients than standard hip replacement. There is more and more data that patients recover quicker, discontinue use of a cane or walker sooner, and have a quicker return to a normal gait. Proponents note that because the operation spares muscles, patients don’t need to limit their movements during the recovery period.

Surgeons who perform the procedure also say the anterior position makes it easier for them to use fluoroscopy, a real-time X-ray technique that allows doctors to precisely position the implanted artificial hip. That, in turn, may allow artificial hips to last longer. And since the major muscle groups of the hip are left untouched, there appears to be a lower risk that the artificial joint might pop out, or dislocate. Conventional hip replacement techniques have a dislocation rate of about 1 percent. Preliminary studies suggest that the rate following anterior surgery may be less than one-third of that, according to the NY Times.

Yet reports of the benefits are mostly anecdotal, based on surgeons’ experience. No large randomized studies have been done comparing the outcome of anterior surgery with other approaches. And there are downsides. Anterior hip replacement often takes longer to perform and can result in more blood loss. Some patients experience temporary numbness in the thigh afterward.

Because the operation is tricky to perform, there is a steep learning curve for physicians, which partly explains why it hasn’t been taught as widely as other approaches in medical schools. Special operating tables have been designed that make the surgery easier to perform, but many medical centers don’t have them. Even surgeons who perform the new procedure are quick to say that it isn’t “minimally invasive,” the term often used in marketing materials. More info on this procedure can be found at this site: http://well.blogs.nytimes.com/2013/03/18/faster-recovery-from-hip-surgery/?_php=true&_type=blogs&_r=0 .

According to NPR, what patients really need is knowledge. The Internet is great for providing information, but it lacks a context in which to interpret that. How does a patient sift through all the information and make an informed decision? And, patients should investigate hip replacement information on a reputable website.

One key question to ask an orthopedic surgeon is about the number of times he or she performs this procedure in a year. Like most things in medicine, practice makes perfect. And being expert means performing a surgery at least 100 times a year. Once patients have found a doctor, they should talk the physician which technique is best, given the patient's history and preferences.

All techniques have improved over the years, with fewer complications and faster recovery times. Plus, all approaches to hip replacement have gotten less invasive over time because of medical practitioners’ understanding of anatomy, more sophisticated surgical tools and instruments that allow better access with a smaller incision. All the surgical approaches are less invasive than they were seven to 10 years ago. More info can be found at this site: http://www.npr.org/blogs/health/2013/07/15/200862227/new-anterior-approach-to-hip-replacement .  

Hip replacement surgery should not be taken lightly. Consult your doctor and any specialist recommended about your particular situation. You may or may not be a good candidate. Only a medical professional can guide you to make that decision. Do your research well. Once chosen, then remember to follow all the advice given for both pre-op and post-op recovery.

Until next time.