Hip replacement surgery for arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

When arthritis progresses to a certain point, the pain becomes debilitating.

The decision to proceed with surgery is usually decided by the severity of the disease, the degree of patient handicap and the extent of movements possible. Medical treatment for hip replacement includes analgesic and anti-inflammatory drugs, exercises, rest, injections, and physical therapy. Using a cane may help alleviate some pain and allow more comfortable walking.

Hip replacement is not done until daily activities are severely affected or pain is intolerable.

The indications for surgery include severe pain, loss of movements and inability to perform activities of daily living. The contraindications of the surgery also need to be discussed in detail. Hip replacement surgery can be done using general spinal or epidural anesthesia. The surgery can be done using the traditional approach of ten to twelve inches cut or the recent technique of minimally invasive procedure with a three to four inch incision. The surgery lasts for approximately one hour. The postoperative care and exercises are very important in the final outcome of the hip replacement.

The patient will need to spend time with a physical therapist who will be managing the rehabilitation after surgery. The therapist will begin the teaching process before the surgery.

A patient may be asked to donate blood before the operation. This blood can be donated once a week beginning about three to five weeks before the surgery. This is the blood that will be given back to the patient if needed during surgery.

Implants are made of various materials depending on the purpose reserved for the artificial implant. Polyethylene is used to make the acetabular socket. Most implants utilize this material for acetabulum component because of its strength and flexibility. Metals such as chromium, cobalt and titanium are currently used for making implants. Ceramic hip implant material is wear resistant and long lasting.

The hip replacement implant fixation can be cemented, non-cemented or hybrid. The cemented type fixation uses a material that enters the small pores in the bone. The non cemented types implant have microporous components in which the natural bone tissue can grow in. The hybrid type includes both types of fixation methods.

A note about complications... Nerves in the area of the total joint replacement may be damaged during the total replacement surgery. This is more likely to occur when the surgery involves correction of major joint deformity or lengthening of a shortened limb due to an arthritic deformity.

Blood clots result from decreased mobility causing sluggish movement of the blood through leg veins. This leads to thrombophlebitis. Blood clots may be suspected if pain and swelling develop in the calf or thigh. Several measures may be used to reduce the possibility of blood clots, including:

• blood thinning medications (anticoagulants)
• elastic stockings
• exercises to increase blood flow in the leg muscles
• inflatable plastic boots to compress the muscles in the legs

Despite the use of these preventive measures, blood clots may still occur.

Infection may occur. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Urinary tract infection may also occur. Any infection in the body can spread to the joint replacement. Prophylactic antibiotics are needed for certain procedures if a patient has had a hip replacement.

Loosening of the prosthesis within the bone may occur after a total joint replacement. If the loosening is significant, a revision of the joint replacement may be needed.

Occasionally, after total hip replacement the ball can dislocate from the socket. In most cases, the hip can be relocated without surgery. A brace may be worn for a period of time if a dislocation occurs. Most commonly, dislocations are more frequent after complex revision surgery. Excessive wear may contribute to loosening and may require surgery to repair the artificial hip. Breakage of the metal or plastic joint replacement is unusual but may occur.

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