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Total Hip Replacement Surgery for Patients from Cary, Garner, Raleigh, Chapel Hill and the Triangle

The history of total hip replacement surgery dates back to the 1940'a and continues to be refined constantly. The goal of the hip replacement surgery is to completely replace the arthritic head of the femur (ball) and the acetabulum (socket) with a man made device (prosthesis). The femoral (leg component) is fastened into the femoral canal and has a ball attached to the top. The acetabular (hip component) is fastened into the socket of the pelvis and a liner is inserted into this component

These devices may be combinations of metal and plastic or ceramic. They are fixed to the bone either using bone cement or by using a prosthesis with a roughened surface onto which your natural bone grows and creates the long term stability.

Total hip replacement is not always a onetime complete solution to the problem. Hip components may wear or loosen with time or excessive activity. The optimal choice of prosthesis will depend on bone quality, anatomy and surgeon preference.

How Is The Diagnosis Made for Hip Replacement Surgery?

In normal instances to consider hip replacement surgery, your orthopaedic physician will perform a physical exam which will include history of illness, physical examination and X-Rays. Blood tests are not indicated for diagnosing normal wear and tear osteoarthritis.

When Is an Artificial Hip Implant Indicated?

If your physician has diagnosed you with osteoarthritis based on the full physical and clinical exam, and this correlates with pain and stiffness from your hip joint you may be a candidate for the artificial hip implant. Diagnosis with minimal symptoms does not make a patient a candidate for artificial hip implant automatically, however. Below is a listing of specific instances in which one would be considered for Total Hip Replacement Surgery:

Failure of conservative treatment such as pain medicine, anti-inflammatories, weight loss, physical therapy and assistive ambulation devices such as crutches or a cane. Severe disability such as:

• Hindrance in ability to perform job duties
• Interference or cessation of with your recreational activities.
• Interference with normal dressing or hygiene functions
• Limitation with your walking or functional mobility.
• Awakens you at night despite taking analgesic or anti-inflammatory medications.

The patient should be keenly aware that undergoing hip replacement surgery should not be taken lightly, is elective in nature and there are always risks vs. benefits that should be considered.

What Are The Benefits of Hip Replacement Implant Options?

The primary benefit of an artificial hip implant is significant, if not total pain relief from the arthritic condition. Arthritis at this joint does not have to be something you have to live with. This surgery not only provides relief from the pain but also helps to restore more normal mobility and function to your daily life.

Hip replacement surgery replaces the worn out arthritic joint surfaces with artificial joint surfaces that do not sense pressure or pain. Of course there is pain related directly to the artificial hip implant, but this pain should cease considerably within the first few weeks or month. Additional benefits such as pain free sleep, increased ability to perform activities of daily living and light exercises without pain while providing years of reliable results.

What Are The Preoperative Procedures?

Prior to surgery you will be involved in a "Total Joint Class" in which you will learn about the condition and the procedure as well as the normal post operative course and information about your rehabilitation and recovery. Shortly before surgery, you will be required to undergo special tests to insure that you are medically ready and able to undergo the procedure. These tests will be conducted at the hospital facility at which you will be undergoing surgery. You will undergo the following test procedures at this time:

Blood tests will be conducted to insure normal blood count and no other medical problems. ECG (Echocardiogram) - A test that analyzes the electrical activity of your heart will insure no hidden cardiac abnormalities. Urine Sample - Urine samples are taken to rule out any urinary tract infection that would need to be treated prior to surgery using simple antibiotics. General information provided and questions answered by the hospital staff on what do do both pre-operatively and what to expect post-operatively.

Other Recommendations:
Stop smoking or use of any tobacco products for a long a period as possible prior to surgery

Discontinue the use of aspirin and anti-inflammatory medications (ibuprofen,celebrex, etc) up to 10 days prior to surgery as they can cause thinning of the blood. Discontinue use of any non-prescribed homeopathic or herbal medications 10 days before surgery as these can also cause bleeding.

Continue with all other medications unless otherwise specified.

Notify your surgeon in the event you sustain any skin disturbances such as a rash, abrasion,cut, pimple or boil in the area around the hip.

Just Prior To The Procedure

You will meet with the anaesthesiologist prior to your procedure.He/she will discuss with you the anesthetic procedure and effects to expect post-operatively, as well as risks. You will then be taken to the operating room.

A urinary catheter will be placed in your bladder to measure your fluid balance during and after surgery.

The Surgical Procedure

An incision will be made through the skin and underlying tissues to expose the hip joint.

The joint is then dislocated and the femoral head (ball) is removed.

Special instrumentation is utilized to ensure very accurate cuts in the bone to fit the prosthesis.

Your surgeon will then use trial components first to make sure everything all parts of the system fit correctly.The exposed bone is cleaned with all excess debris removed and the permanent components are put in place.

Drains are placed in and around the joint followed by incision closure one layer of tissue at a time. A dressing is then applied and you are escorted to the recovery room.
 

Special Precautions

After surgery, the hip will be covered with dressings and pads to absorb bleeding and provide some local protection and compression at the incision site. The nursing staff will place a pillow between your legs.

Your fluid levels, both input and output are measured carefully. A IV drip in the arm will be used for infusion of fluids, bloods or antibiotic medications.

Expect some pain as a normal course and result of the operation. If you experience severe pain that is not reduced over time take care to inform the nursing staff. You may receive additional pain medication that can be injected intramuscularly or by IV directly into the blood stream.

Patient Controlled Analgesia (PCA) allows you to control your own pain medication. When you push a button pain medication is pumped through an IV line.The amount of pain medication delivered is regulated and you can be assured that safety features are built in for protective measures.

The drains, catheter and IV drips can be removed at 24 hours after surgery.

Blood samples will be taken 24 to 48 hours after the operation to check your hemoglobin and blood chemistry.

Light physical therapy will be instituted as soon as you are able and will continue to progress during and after your hospital stay. Your Physical Therapist will direct that care and supervise your progression.

Discharge from the hospital usually is at 5-7 days post surgery and will depend on both your physical and medical progress. At your physicians discretion, and in most cases, you will be sent to an in-patient rehabilitation hospital before you go home to undergo more directed and intense physical therapy to increase strength, endurance and function.

Special precautions

Hip replacement surgery necessitates certain precautions. One of the primary precautions is to limit hip flexion or bending. With your newly replaced hip, you should not flex it beyond 90 degrees which is a right angle relative to your body. Rotating the knee inwards with a flexed hip should be avoided. You should avoid crossing your legs and ankles when standing, sitting,or lying down. As part of your post operative course, you will be additionally educated and informed of additional functional and positional precautions to take.
 

Know The Risks And Complications

Complications of Surgery

Infection
A risk of any surgery, including total hip replacement is infection. Infection occurs in approximately 1 % of the cases. These infections may either be superficial at the skin or incision site, or deep in the joint around the prosthetic joint. In the event an infection occurs, you will receive aggressive, antibiotic medication. In the event the infection occurs deep in the joint it may be necessary to clean out the infection and surrounding tissues and rarely it may be necessary to replace the hip prosthesis once the infection has cleared.

Wound Irritation or Breakdown
The operative scar will always result in numbness in the skin around the incision. Eventually this numb feeling improves slightly and does not worry most people. Occasionally, you may experience a burning or hypersensitive sensation instead of numbness and usually settles down over many months but occasionally can be long term and troublesome.

Wound/skin breakdown does occur in rare instances that may require surgery to alleviate it. Suture reaction causing a stitch abscess may appear as a small pimple on your scar. These abscesses can usually be treated with an antiseptic dressing but occasionally will entail using a short course of antibiotics.

Fracture (break) of the Femur or Pelvis
Occasionally during the surgical procedure the bone may fracture and not be recognized. If recognized, it may require additional surgery during initial operation and occasionally re-operation a few days later.

Nerve or Blood Vessel Damage
The surrounding nerves or blood vessels may be damaged during the operation. Normally this is recognized and may be repaired at the time of the procedure if recognized but may require a second operation to repair any damage. In normal instances a damaged nerve will recover on its own. If a damaged nerve does not recover it can lead to dysfunction of the leg below the surgical site, such as a foot that does function properly as a result of weakness or loss of sensation.

Dislocation of the Hip Joint
Postoperatively, the new hip may dislocate. In this instance, the ball pops out of the socket. This typically occurs during the time when the capsule around the replaced hip and muscles are in a weakened,state, usually in the first 6 to 8 weeks. The instance of hip dislocation is low, in the 2-4 % range. Hip dislocations can be reduced under general anaesthesia normally without needing any additional surgery.If, in rare instances, the hip continues to dislocate, further surgery may be required to make adjustments to the components. There are other surgical techniques that can also be performed to add to the stability of the joint.

Deep Venous Thrombosis (DVT) or Pulmonary Embolus
Surgical procedures can occasionally result in blood clots in the calf muscles and they can eventually travel to the lung. These clots can be serious and even life threatening. Blood clots, once documented, will be treated immediately. Every precaution is taken to avoid blood clot formation.

Trochanteric Bursitis
Inflammation of the bursa sac is not uncommon after total hip replacement. This bursa sac is located where the muscles pass over the muscular insertion site called the trochanter. This condition usually improves over time as your hip strength and endurance improves and the quality of your gait normalizes. In the event that the condition persists, steroid injection can be used to reduct the pain and inflammation. For further information, see Trochanteric Bursitis.

Leg Length Discrepancy
Stability and leg length equality are two important issues that are addressed during the total hip replacement procedure.

Obtaining symmetrical leg length is an important factor to address when performing the replacement. Stability of the joint however, should not be sacrificed to obtain this leg length equality. It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg will need to be lengthened intentionally to create the needed hip joint stability. Dislocation of the hip is a much more serious disability than a leg length inequality. Keep in mind that 30% of the normal population has a 1cm leg length inequality without having had any surgery or disease. Typically, post-operatively, most patients (80%) have equal leg lengths. Occasionally, due to other extraneous, related factors such as arthritis or deformity of the other leg it becomes impossible to perfectly match leg lengths.

Limp
Postoperative limping is a normal occurrence, is expected initially and is expected to improve during the first year after surgery. Limping is usually a result of muscle weakness. Gait deviation can persist if you have had a limp for an extended time period prior to surgery or if you have a developed major anatomical problems associated with or causing your arthritis, for example, congenital dislocation of the hip.

Wear
Total joint replacement components are not designed or intended to last indefinitely. The long-term complication of total hip replacement is wearing of the ball and socket. The natural as well as the replaced hip take a great deal of stress over time with impact activities and other work activities such as heavy, manual labor. Excessive weight plays a part in hip joint wear.

There are many factors that affect long term hip replacement survival rate. Most hip replacements (80-90 %) will last approximately 15 years.

Technology, research and development are constantly improving and refining techniques and design of these procedures and components. Over time, we would expect these procedures to last an even greater period of time. There is really no way to know the longevity of the current hip replacements of today until we have experienced time with these newly replaced hips

It is recommended that you continue to follow up with your surgeon over time to assess the wear of your new hip. In the event you experience any unusual symptoms you would want to contact the practice sooner than later.

Breakage of The Implant
Although rare, in the event breakage of the implant were to occur, another surgery would be required to remove and replace the broken implant.

Osteolysis
This complication is an instance where a portion of the bone is reabsorbed or disappears. This can occur as a result of small wear particles setting up a reaction in the body causing this resorption. It may be recommended you have a procedure to change the liner (weight bearing surface) or bone graft these defects before they worsen.

Other
Not all complications from this major orthopaedic surgical procedure are discussed in this section.

Pre-existing medical conditions may predispose you to incur any type of medical complication. These complications include stroke, heart attack, kidney failure, pneumonia, bowel or bladder obstruction, bladder infection, etc. Serious medical problems can lead to ongoing prolonged hospitalization, health concerns, and rarely death.

What Activities Can I Plan To Return To?

It is recommended that you avoid pounding activities such as running and basketball, which induce a great deal of stress on the joint. Walking and swimming in a pool is good.

Tennis (Doubles) is allowable but more aggressive singles tennis, which requires much more pounding, twisting and turning, will lead to premature wear of the joint. Contact sports are forbidden.

You may ski if you are accomplished at it, providing that you stay on groomed slopes. You should be aware of the significant damage that can occur from a fall. Golf and bowling should not be a problem once you have fully healed and recovered from the hip replacement.

The Total Hip Joint Replacement Procedure has proven to be one of the most cost effective and beneficial operations in the field of orthopaedic surgery. Results have shown that a large majority of people are very happy with their joint replacement. Before proceeding with this operation it is very important that you make an informed decision. Although there is a lot of information, it is important to read it all. You should proceed only when you are confident that you understand the procedure, the rehabilitation and expectations and particularly the complications. Although every effort has been made to explain the complications there will be complications that may not have been specifically mentioned because they are extremely rare. You may access a wealth of sources on the internet as well as other patients and your surgeon or family practice physician.

The Hip Replacement Procedure | A Caregiver's Guide for the Joint Replacement Patient at Home