Hip Replacement

Anatomy of the hip joint

Hip prothesis

The hip joint, surrounding muscles and tissue are important structures in carrying out day to day activities.

The hip joint is a ball and socket formed between the large thigh bone called the femur and the pelvis. The main muscles spanning the hip joint include the hip flexor, extensor, abductor and adductor muscles which help to rotate the hip joint nearly all directions. Movement and support of the hip joint is assisted by the other joints of the leg and pelvis as well as the muscles of the entire lower limb and body’s trunk or core.

There are a number of mechanisms that can cause the hip joint to become damaged or weakened, ultimately leading to arthritis. Arthritis is damage to the boney surfaces that form the joint. It causes pain, stiffness and deformity. Arthritis of the hip makes it difficult walk, get up from a chair, climb stairs,get in and out of bed and tie your shoes, among other activities. As it worsens, arthritis can even cause pain at rest or at night. Arthritis can be hereditary or caused by injury or obesity, however its affects can be lessened by a healthy and active lifestyle.

Hip replacement involves removing the damaged surfaces of the hip joint and replacing them with artificial components called prostheses. With the aid of rehabilitation, a hip replacement can result in reduced pain, improved mobility, strength and function resulting in a better quality of life.

esearch has shown that joint replacement is very effective at achieving these outcomes in most people. For persons who are physically and emotionally ready for Joint Replacement, there is roughly a 90% chance of being satisfied with the outcomes of surgery. For the remaining 10% there are some known and many unknown reasons for less than ideal results.

Complications such as infection or blood clots do occur in less than 1% of patients and can lead to less than ideal surgical outcomes and prolonged recovery. Other important factors such as realistic expectations and sufficient recovery of function are also very important.

It is important to understand your particular risk level for surgical complications and what you can expect after surgery along with the efforts you will undertake to restore your quality of life. Talk to your surgeon about your risk levels, expectations and rehabilitation as it will assist with your decision making for surgery.

There are a variety of non-surgical treatment options that should be considered before proceeding with a joint replacement.

Weight Loss

For both the hip and the knee, the forces acting across the joint are a combination of body weight pressing down on the joint and the muscles pulling up to stabilize the joint. As these values combine, the hip and knee experience 3-4 times the body weight in pressure with each step. Loosing excess weight reduces the pressure on damaged joints and can relieve pain.

Physical Therapy

By stretching, strengthening and re-balancing the muscle- forces across the joint, the movement and control of the joint can be improve. Pain can also be improved with therapy in addition to the mobility of the joint.

Acetaminophen

Acetaminophen (Tylenol) containing products can be very useful analgesics in arthritis. Given its low cost and good side effect profile, it is a good first-line drug for treating arthritis. It should be avoided in some patients with a history of liver disease and care should be taken not to exceed the total daily dose of 4gm per day. This is especially true when a patient takes multiple different medications that contain acetaminophen.

NSAIDs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications that block the COX receptors on cells and reduce inflammation which can play a significant role in both osteoarthritis as well as other inflammatory arthridities such and rheumatoid arthritis and lupus. Different versions of this type of drug have different side-effect profiles, but, in general, NSAIDS, when taken for extended periods, can play a role in stomach irritation, ulcers, and bleeding and kidney problems with elevated blood pressure. While these can be very helpful medications, their prolonged use should be done under the guidance of a physician.

Steroid Injections

Steroid injection (often referred to as a “cortisone shot”) is generally performed with a depot version of a corticosteroid that remains within the joint. Once in the joint, the steroid blunts the inflammation within the joint and can reduce the pain of the arthritis. This effect can last from a few days to 6 months. There is a small risk of infection with an injection which can be very debilitating and destructive if it were to happen. The risk of infection is less than 1%. There is no agreed upon number as to how many times an injection can be repeated if the most recent injection had benefit for multiple months. Most agree that multiple injections can be offered, the whether a limit should exist or how high the limit may be is unknown.

Unloader Bracing

As arthritis progresses in the knee and joint space is lost, the leg becomes more bow-legged or knock-kneed. As this collapse occurs, increased load is applied to the already diseased and damaged section of the joint. By applying and unloader brace, the leg can be straightened and the load shifted back onto the more healthy area of cartilage remaining. This can reduce pain and suffering during activities such as walking, shopping and yard-work.

Viscosupplement Injection

Viscosupplement injections inject a purified, viscous fluid into the joint. The injection frequently includes components of normal healthy joint fluid known to be reduced in arthritis. While the exact mechanism of benefit is not known, many patients, especially with early arthritis, can benefit from these injections for a variable period of time.

Walking Aid

Many patients find the use of a cane, walking stick or walker to reduce their pain. By transferring weight to the walking aid, the effected joint can be off-loaded reducing the pain experienced and improving the distance that a patient can walk.

Hip Replacement

Patients

Walking Is Man's Best Medicine

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