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Cascade Orthopaedics Practice Newsletter |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website |
Total Hip Replacement - Part I
Hip arthritis is an increasingly common problem in the population of active baby boomers.
This month's newsletter (July 2013) will address:
- How a normal hip works
- Common causes of hip pain
- What is hip replacement surgery?
Next month (August 2013), we will address:
- How to Prepare for Hip Replacement Surgery
- What to expect during the hospital stay
- Potential Complications and How to Avoid Them
- Exercises and activities to help restore mobility and strength, in order to return to everyday activities.
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The hip joint can be damaged by arthritis, a fracture, or other conditions such as infection.
If so, common activities such as walking or getting in and out of a chair may become increasingly difficult. Your hip may become stiff. It may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 285,000 total hip replacements are performed each year in the United States.
Anatomy
 The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum (or hip cup,) which is part of the large pelvis bone. The ball is formed by the femoral head, which is the upper end of the femur (thighbone). The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily. A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement. Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint. AAOS Topic Link
Common Causes of Hip Pain
The number one cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
 Osteoarthritis. The most common form of arthritis, Osteoarthritis is a wear and tear condition that destroys joint cartilage, and it typically develops after years of constant motion and pressure in the joints. As the cartilage continues to wear away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis.
Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
 Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis. The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis as can exposures such as excessive alcohol or steroid use.
Childhood hip disease. Some infants and children have hip problems at the time of birth. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected. AAOS Topic Link |
What is a Hip Replacement?
- In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
 The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone.- A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
- A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
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Is Hip Replacement Surgery for You?
The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. There are no absolutes in this decision process; each individual may decide to proceed with a hip replacement for different reasons and at different levels of disability. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation.
Candidates for Surgery
There are no absolute age or weight restrictions for total hip replacements however, there is a significant increase in complications of the surgery with obesity, and the complication rate does increase with the severity of the obesity.
Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate each patient as an individual. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
When Surgery Is Recommended
There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
- Hip pain that limits everyday activities, such as walking or bending
- Hip pain that continues while resting, either day or night
- Stiffness in a hip that limits the ability to move or lift the leg
Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports.
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The Orthopaedic Evaluation
An evaluation with an orthopaedic surgeon consists of several components.
- Medical history. Your orthopaedic surgeon will gather information about your general health and ask questions about the extent of your hip pain and how it affects your ability to perform everyday activities.
- Physical examination. This will assess hip mobility, strength, and alignment.
- X-rays. These images help to determine the extent of damage or deformity in your hip.
- Other tests. Rarely, and usually only in the setting of Avascular Necrosis, will an MRI of the hip be indicated prior to hip replacement surgery. In the vast majority of evaluations, regular X-rays provide sufficient diagnostic and planning information. More commonly, an MRI of the back may be indicated to rule out nerve impingement at the spine as a primary cause of hip or thigh pain.
(Left) In this x-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This x-ray of an arthritic hip shows severe loss of joint space and bone spurs. AAOS Topic Link
Deciding to Have Hip Replacement Surgery
Talk With Your Doctor
Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options - such as medications, nutritional supplementation, weight loss, physical therapy, or other types of surgery - also may be considered.
In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.
Realistic Expectations
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, hip replacements can last for many years.
Next Month: Total Hip Replacement - Part II
If you have questions or wish to schedule an evaluation by one of Cascade Orthopaedics' specialists, please call us at (253) 833-7750.
This material presented is for educational and informational purposes only. You should consult a physician or health care provider for actual evaluation, diagnosis, and individual treatment recommendations or advice. |
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