Hip Surgery - Pain, Resurfacing, Replacement & Recovery
By Dr. Stuart Gold, M.D., Orthopedic Surgeon & Author
The human hip is one of the most important joints in the body. It is the primary junction between the femur (the thighbone) and the pelvis and trunk. It plays a crucial part in standing, walking, running and even in keeping the trunk upright when sitting. If damaged by injury or disease, excessive pain and decreased mobility can result.
The hip is a "ball-and-socket" type of joint. The rounded end of the femur fits inside at the pelvis in the acetabulum, which cups it in place. Both surfaces are coating with a layer of cartilage. Synovial fluid (the joints natural oil) provides lubrication for movement. Five ligaments provide strength and reinforcement for the joint. Movement is furnished by muscles acting on the bones to generate movement forward and back, left and right, and in combinations.
Hip Replacement Surgery Overview
When hip surgery is required, it is most often a total arthroplasty or hip replacement. The surgeon removes the diseased or damaged joint and replaces it with a prosthesis or artificial joint. Modern replacement joints typically consist of a ceramic or metal ball and ceramic, metal or plastic socket. After making an incision, the damaged cartilage and joint are removed, and as much of the healthy bone as possible is left intact. The artificial socket is attached to the pelvic side, and the replacement ball is attached to the femur.
After the surgery is complete, patients will be monitored for vital signs and pain level. Steps will be taken to avoid potential complications, which may include compression cuffs or stockings applied to the lower legs and the administration of blood thinners. These steps are taken to help prevent blood clots from forming in the legs. Patients may be asked to walk with aid as soon as the day following surgery to further bolsters the circulation.
Physical Therapy After Hip Replacement Surgery
Patients who undergo a total hip replacement should expect a period of physical therapy following the surgery. Exercise and activity suitable for the patient's age and condition should become a part of the patient's routine. Failure to follow the therapist's recommendations can prolong recovery and delay regaining strength and mobility. Most patients can resume normal or near-normal activities within six to eight weeks following surgery.
Common Surgical Outcomes of Hip Replacement Surgery
Hip replacement surgery is successful more than 90 percent of the time. It is generally regarded as a safe procedure, but like any surgical treatment certain risks can apply. The most common and serious of these is the risk of blood clots forming in the legs. Infection, either around the incision or internally around the replacement hip, can occur but can usually be diminished through the use of antibiotics. The surgeon may have to repair fractures that occur in healthy bones during the surgery.
After the incision heals, there is a danger of damaging the artificial hip. The ball can become dislocated, sometimes due to over-extending its capacity. With time, the joint can loosen or in rare instances, break. Both situations might require surgery to correct. Additional small shoe lifts may be needed if the surgery results in the leg being shorter or longer than the other. Occasionally medications may be required to prevent ossification, or a hardening of the surrounding soft tissues. Finally, younger patients may eventually need another prosthesis, since it will eventually deteriorate from normal wear and tear.
About Hip Resurfacing Surgery
A relatively recent alternative to a total hip replacement is hip resurfacing. The procedure is not ideal for all patients, and the consulting orthopedic surgeon best determines suitability. In general, however, patients are typically younger, not obese, and meet the qualifications for normal hip replacement surgery. Patients who are small-boned, thin or tall, those with rheumatoid arthritis, or those with major bone loss are often considered unsuitable candidates for resurfacing.
Hip resurfacing has some potential advantages. Less bone must be removed, leaving more available should a total arthroplasty be required in the future. Dislocations are lower, since the femoral head is typically larger. However, the incidence of fractures in the femoral neck increases by as much as four percent.
Resurfacing may be the choice of active patients who wish to return to the more strenuous lifestyle practiced previously. A total replacement may carry with it limitations on exercises such as running or impact sports, but further studies need to be carried out. While there is no guarantee that such activities could be resumed after resurfacing, time will tell if it is the better option for those patients.
Candidates for resurfacing should evaluate not only the proficiency of their surgeons but also the type of devise that is to be used. Certain systems, including some by major medical manufacturers, have proven to be failures when placed in actual use. Since the choice of device determines the amount of bone that will be lost, it is also important to select a surgeon with experience in the exact method chosen by the patient.