Hip joint replacement Health Article

Indications

Hip joint replacement is primarily done in people age 60 and older. The operation is usually not recommended for younger people because of the strain they can put on the artificial hip, causing it to fail prematurely.

The reasons for replacing the hip joint include:

• Severe pain from arthritis in the hip that limits an individuals' ability to do the things they want to do
• Fractures in the elderly of the neck of the femur (usually requires a hemi-arthroplasty)
• Hip joint tumors

This surgery is usually not recommended for:

• Very young patients
• Current hip infection
• People with poor skin coverage around the hip
• Paralyzed quadriceps muscles
• Nerve disease affecting the hip
• Patients with severely limiting mental dysfunction
• Serious physical disease (terminal disease, such as metastatic cancer)
• Extreme obesity (weight over 300 pounds)

Risks

• Blood clots in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolus)
• Pneumonia
• Infection that requires removal of the prosthesis
• Prosthesis dislocation
• Heterotopic bone formation (extra bone growth that can cause stiffness)

Expectations after surgery

The results of hip prosthesis surgery are usually excellent. The operation relieves pain and stiffness, and most patients (over 80%) need no help walking.

With time -- sometimes as long as 20 years -- the artificial joint will loosen and revision surgery will become necessary. Younger people may wear out the lining of their new cup and need it replaced before the prosthesis loosens.

Convalescence

You will remain in the hospital for 3 to 5 days after surgery. However, some people may need to stay temporarily at a rehabilitation unit or long-tern care center until mobility has improved and they are safely able to live independently. These centers will provide intensive physical therapy to assist you in regaining muscle strength and flexibility in the joint.

Be careful after surgery that you don't dislocate the prosthesis. The new hip will not have the same range of movement of the original joint, although you should eventually be able to return to your previous level of activity. While you should avoid vigorous sports such skiing, or contact sports, many people go on to play tennis and golf quite successfully.

The use of crutches or a walker may be necessary for as long as 3 months, although most people who did not use them before are able to walk without them in several weeks.

Many surgeons place their patients on blood thinners for several weeks after surgery to help prevent blood clots. These may be taken in the form of pills (either Coumadin or aspirin) or injections.

SPECIAL PRECAUTIONS

The new joint has a limited range of movement. You will need to take special precautions to avoid displacing the joint, including:

• Avoid crossing your legs or ankles even when sitting, standing, or lying.
• When sitting, keep you feet about 6 inches apart.
• When sitting, keep your knees below the level of your hips. Avoid chairs that are too low. You may sit on a pillow to keep your hips higher than your knees.
• When getting up from a chair, slide toward the edge of the chair and then use your walker or crutches for support.
• Avoid bending over at the waist. You may consider purchasing a long-handled shoehorn or a sock aid to help you put on and take off your shoes and socks without bending over. Also, an extension "reacher" or "grabber" may be helpful for picking up objects that are too low for you to reach.
• When lying in bed, place a pillow between your legs to keep the joint in proper alignment.
• A special abductor pillow or splint may be used to keep the hip in correct alignment.
• An elevated toilet seat may be necessary to keep the knees lower than the hips when sitting on the toilet.