Our hips bear much of the load of the human body. And when you have a damaged or deteriorating hip, some of the most seemingly simple movements can become an exercise in torture. Walking around the block or getting up from a chair can involve shooting pain. Sleeping on your bad hip becomes almost impossible.
When the pain and lack of mobility really starts to impact your life, it’s time to consider hip replacement with the team at Orthopedic Associates of Long Island. Our patients have great success with these surgeries, enabling them to get back on their feet and back to normal.
WHAT IS A HIP REPLACEMENT?
The hips are involved in all of our movements when we are upright, and a damaged hip can make many of life’s simple pleasures, things like walking on the beach, excruciatingly painful, if not at the time then hours afterward. Things you may have taken for granted your entire life, such as getting out of a chair, now are painful. Sleep can be difficult, as your bad hip is loaded when on your side. The damage is usually simply a result of long-term use. This can be especially true if you’ve participated in activities or sports with a lot of impact, such as running or gymnastics. You’ve likely damaged the cartilage in the hip socket or maybe the cartilage has mostly worn away.
The goal becomes simply stopping the pain. People opt for cortisone injections or hip resurfacing procedures that “clean out” the torn or frayed cartilage. They stop participating in certain sports or activities they love.
But when the pain continues, as it will when the damage is within the hip socket, it could be time to consider a total hip replacement with the experienced team at Orthopedic Associates of Long Island. Hip replacement is one of the most successful operations performed in the medical world. As we age as a population, the need is growing all the time. Hip replacement can make a real difference in the life of the patient, in effect allowing the person to return to a pain-free life once again.
Hip replacement involves addressing both the bone and the socket. The damaged ball of the thighbone is replaced with a metal ball; the socket is ground clean of damage and a metal socket is inserted into it for the new metal ball to pivot within.
CONDITIONS THAT LEAD TO HIP REPLACEMENT
The most common cause of chronic hip pain and damage is arthritis, in this case, osteoarthritis, rheumatoid arthritis, and traumatic arthritis.
- Osteoarthritis — As we age, basically everyone has some degree of this “wear-and-tear” arthritis. In the hips, osteoarthritis damages the slick cartilage that covers the ends of the femur and the inside of the hip socket.
- Rheumatoid arthritis — Rheumatoid arthritis creates inflammation that erodes cartilage and bone in the hips.
- Post-traumatic arthritis — If you’ve had a serious hip injury or fracture, the cartilage could have been damaged, leading to pain and stiffness over time.
- Osteonecrosis — Sometimes a hip dislocation or fracture can limit the blood supply to the femoral head, which causes the surface of the bone to collapse. If you were a fan of football/baseball legend Bo Jackson, this was his cause for immediate hip replacement.
- Childhood hip disease — In rare cases, children have hips that didn’t develop normally. Even if the hips were successfully treated during childhood, these conditions will often lead to arthritis later in life.
HOW WILL I KNOW IF I NEED A HIP REPLACEMENT?
There is no “this is the day” threshold with hip replacement. The question usually comes down to how much your damaged hip is impacting your daily life. There isn’t a typical age threshold, but most of our Orthopedic Associates of Long Island hip replacement patients are between the ages of 50 and 80.
People considering hip replacement surgery usually have been dealing with the pain for a long time, possibly decades. The question is — how badly is the pain affecting your life? Our entire team helps walk you through the decision to move forward with replacement. These are some of the common issues people have when considering hip replacement:
- Hip pain is limiting activities such as walking or bending.
- Hip pain is impacting sleep.
- Hip pain continues even when resting.
- There is stiffness in the hip that limits movement.
- Other avenues to address the pain have not been effective — physical therapy, band-aid procedures such as hip resurfacing, cortisone injections, and other options are not stopping the pain.
BENEFITS OF HIP REPLACEMENT SURGERY
What is the benefit of being able to walk around the block without pain? What’s the benefit of being able to return to sports you love, such as snow skiing, without pain? And who wouldn’t welcome actually sleeping on your bad hip?
These are quality of life issues. When people postpone these surgeries they are basically postponing living life, and that’s a shame because these surgeries are so successful.
WHAT IS THE AVERAGE AGE FOR HIP REPLACEMENT?
As mentioned above, there isn’t a predominant age or point where a person needs hip replacement. At Orthopedic Associates of Long Island we’ve had teenagers with juvenile arthritis have hip replacement. Still, it is generally a condition of advancing age. If you were to average out this procedure, you would see patients between the ages of 40 and 80.
PREPARING FOR HIP REPLACEMENT SURGERY
Once you’ve made the decision to go ahead with hip replacement, it will be very helpful to do a few things prior to the procedure.
- Do your research — Become knowledgeable about what to expect. Ask all the questions you have of your doctor. Know what to expect.
- Plan for work — You’ll have to miss some work, so plan accordingly.
- Become stronger — If you are stronger at the time of your surgery, you’ll fare better in recovery. Lose some weight, if you need to. Get stronger in your upper body, which will make crutches and walkers easier to manage.
- Meet with your physical therapist — We’ll line you up with a physical therapist for your recovery. He or she will give you a series of exercises that are key to your recovery. It helps if you understand them and are comfortable with how to do them prior to your surgery.
- Get a feel for your crutches or walker — We’ll let you borrow crutches so you can get comfortable with them prior to your surgery.
- Bring in reinforcements — This is not time to be the Lone Ranger; recovering from hip replacement requires help. It can be family or a friend. If you don’t have a network, you may want to stay in a rehab center after your procedure.
- Get your home ready — You’ll want to sleep downstairs if your bedroom is upstairs. Prepare your recovery area where you’ll spend most of your time. Get your computer, remote controls, books, phone charger, pillows, blankets. Keep everything within arm’s reach. Go around the house and remove any things you could trip over, such as throw rugs.
HOW IS A TOTAL HIP REPLACEMENT DONE?
The procedure begins with an incision on the upper outer thigh to allow access to the bones of the hip joint. Next, damaged cartilage and bone are removed from the acetabulum, the cup-shaped hollow in the pelvic bone. The damage was the result of bone on bone contact as the cartilage was worn down and frayed. A tool called a reamer removes any cartilage and bone spurs and prepares the socket for the placement of the acetabular component (the cup that will accept the artificial femur ball). The acetabular component consists of two parts, an outer metal cup that will fit directly into the socket and an inner plastic part that will accept the ball of the thighbone. The outside portion of the metal cup is usually rough to allow the patient’s bone to grow into the exterior, making it a part of the hip socket.
Now it’s time to address the femur. First, the ball-shaped head is removed and the femur is prepared for the placement of the stem portion of the component. Once the stem is inserted into the femur a metal ball is attached to the end. This ball precisely fits into the plastic socket, mimicking the similar arrangement in the natural hip.
After this is done, the surgeon checks the range of motion and closes the incision.
HIP REPLACEMENT RECOVERY
The first part of your recovery isn’t necessarily about your new hip; it’s about preventing blood clots. To address this, you may be encouraged to sit up and even walk with crutches on the same day as your surgery. This surprises patients, but it really helps prevent potential clots. You’ll also likely wear a compression stocking to exert pressure on your leg; this keeps blood from pooling in the leg veins, reducing the chances of a clot forming. You’ll also be on blood-thinning medication.
Usually, on your first day, you will meet with your physical therapist who will walk you through minor exercises you can do immediately, along with the longer-term plan for your rehabilitation.
Once you leave the hospital and return home, being diligent about your exercises will be critical to a successful recovery. You will likely be able to return to most normal light activities in your life within three to six weeks after your surgery. Total return to normal with your new hip will take about six months.
HOW SOON AFTER MY SURGERY WILL I HAVE RELIEF FROM MY HIP PAIN?
Your pain that was the cause of needing replacement surgery will be gone. For instance, the torn cartilage in the joint has been replaced. Your pain now is simply involved with your recovery and your body adapting to the new prostheses.
HOW LONG BEFORE I CAN WALK NORMALLY AFTER HIP REPLACEMENT?
It depends what you deem “normal,” but most patients can begin to walk without the aid of crutches or a walker at a point from 2 to 6 weeks after surgery. You probably wouldn’t consider this “normal” walking at this point, but you won’t need support. By 10-12 weeks, you should be able to walk without anyone knowing you’re using a new hip to do so. That’s pretty amazing when you think about it.
WHAT WILL THE SCARRING BE LIKE AFTER THIS SURGERY?
This is major surgery and you will have a scar. The scar length will be dictated by the approach used. Here are some general numbers. With an anterior approach, the incision runs down the front of the thigh starting at the pelvic bone and will be approximately 3-6 inches. With a posterior hip replacement, the incision tends to be behind the hip, down the outer buttocks. If this can be done with a minimally invasive technique, the incision will be from 3-5 inches. If a traditional posterior method is used, the scar will be longer, from 8-10 inches. It will fade with time, but there will be a scar. Still, considering you’ll be pain-free, most patients are thrilled with the tradeoff of a scar.
RISKS OF HIP REPLACEMENT SURGERY
As with any surgery, there is a risk of infection and blood clots. Infections can be especially difficult, as something like an infection in a tooth can spread bacteria that then lodge around your prostheses.
Here are other risks.
- Leg-length inequality — Sometimes after a hip replacement, one leg may be longer than the other. While the surgeon makes every effort to keep your leg lengths equal, sometimes it may be necessary to shorten or lengthen the leg slightly in order to maximize the stability and biomechanics of the hip. A shoe lift can rectify this down the road.
- Dislocation — Dislocation of the hip joint is not common, but the greatest risk of it occurring is during the first few weeks after your surgery while the tissues are healing and strengthening.
- Loosening and wear — Over time, the hip prosthesis may wear out or loosen. This can simply be the result of everyday impacts from normal activity, but you can exacerbate the process with high-impact activity. Tissue may also grow between the components and the bone, leading to loosening.
- Metal sensitivity — As you live with your artificial hip, tiny bits of the surface of the new hip joint wear off as the ball and socket pieces rub against each other. Some people are sensitive to this metal.