Hip

Hip Replacement


Steven R. Wardell MD
Chief of Joint Reconstruction and Replacement
Parkview Musculoskeletal Institute

What is Hip Replacement?

When a hip joint has worn out to the point where conservative treatments are unsuccessful, total joint replacement is indicated. Total joint replacement, also called joint arthroplasty reconstructs and recreates normal joint function and motion utilizing prosthetic materials. Hip replacement involves replacing the ball and the socket with prosthetic materials or implants, which are well tolerated by the body. These implants are made out of metal and plastic and there are many differing sizes available so that each joint replacement can be customized to the patient's own anatomy and size. One size does not fit all.

The implants are secured to a patient's bone utilizing both cemented and cementless implant designs. Both types have worked very well our time. Cemented implants rely on "bone cement" to allow the prosthesis to be firmly fixed to the bone and are generally utilized in older patients who might have weaker bone secondary to osteoporosis. Cementless implants rely on bone to grow into the implant over time through special implant surfaces and are generally utilized in younger patients.

What are the benefits of Hip Replacement?

The benefits of hip replacement include pain relief, restoration of mobility and function, and improved quality of life. Hip replacement can also correct deformity, equalize leg lengths, get rid of a limp and walking aids, such as a cane. In addition, hip replacement can allow a patient to decrease if not stop the use of arthritis medication.

What are the potential complications of Hip Replacement?

Complications after hip replacement can include infection, prosthetic wear, hip dislocation, leg length discrepancy, nerve injury, incomplete relief of pain, fracture of bone, and heterotopic bone or extra bone formation. An experienced hip replacement surgeon can utilize special X-rays that will allow proper implant selection and size for your own hip problem to minimize a majority of these problems. Medical complications after surgery can include blood clots (both deep venous thrombosis and pulmonary emboli), heart, lung, and urinary tract complications.

The complications of hip replacement can largely be avoided with a thorough evaluation before surgery by both an experienced orthopaedic surgeon and internist or family physician. Problems identified prior to surgery need to be corrected or optimized before surgery is performed. Correction of dental or urinary tract infections before surgery with antibiotics can significantly reduce the risk of infection.

How does a person become a candidate for Hip Replacement?

A person is a candidate for hip replacement when they have failed conservative treatment and have a condition of the hip that produces severe pain and disability. Furthermore, preoperative evaluation by a patient's family physician is required to make sure there are no medical problems that would preclude them from being a surgical candidate, such as severe heart disease.

Preoperative Testing Requirements:

A thorough history and physical examination with a family physician or internist is required before surgery. In addition, several routine blood tests, chest x-ray, and EKG (heart rhythm evaluation) are needed preoperatively. Special X-rays or other radiologic tests are sometimes required to provide your orthopedic surgeon with a more detailed evaluation of the anatomy of the hip so that proper implants may be available at your surgery.

Blood donation can be required depending on the complexity of the procedure required for your hip. Since hip replacement is an elective procedure, a patient is generally asked to donate two units of blood prior to hip surgery, if they are deemed a candidate for blood donation. When both the patient and Dr. Wardell decide upon joint replacement as the best treatment option, our nursing staff will check your blood counts in the office via a simple finger stick test. If a patient does not have a low blood count, blood donation is recommended. If a patient has a low blood count or is anemic, then Dr. Wardell will recommend the use of a medication that stimulates blood cell production called Procrit. Procrit, or erythropoietin, has been around for a while and has been utilized in oncology and bone marrow transplant patients to reverse anemia. Anemia can cause fatigue, heart problems, shortness of breath, and lightheadedness. Both procedures are meant to decrease the need or requirement for blood from the blood bank. Blood bank blood can carry a small risk of patient exposure to hepatitis and HIV. Procrit has just recently been utilized in patients who are undergoing elective orthopaedic procedures where potential blood loss is expected. Dr. Wardell has utilized Procrit in over a hundred patients and has noted a significant decrease in the need for blood transfusion in joint replacement surgery.

How long am I in the Hospital and what happens?

Patients are generally in the hospital for 3 to 4 days after surgery. A patient as admitted the morning of surgery and physical therapy is initiated immediately after surgery. Spinal or epidural anesthesia is utilized in a majority of patients with sedative medications given during the operation. A patient is therefore sleeping but breathing on their own during the operation. This makes recovery easier and allows good pain control after the operation.

What happens after my Hospitalization?

After the hospitalization for hip replacement, a patient is either discharged home or transferred to a rehabilitation facility. Most patients can be discharged home after hip replacement. Physical therapy and a visiting nurse come to the home to follow a patient's progress after joint replacement. A prescription for pain medications and iron supplements by mouth are given to the patient just prior to hospital discharge. Walking aids, such as a walker or cane, is generally provided. A rehabilitation facility is generally utilized for patients that live alone or have limited family support in the area.

How long does it take for me to recover after hip replacement?

Recovery after hip replacement is most rapid during the first 4-6 weeks after surgery. However, most patient's recovery takes approximately 3 months. At that point, patients who are laborers can generally return to work. A patient who has a more sedentary job can generally return to work earlier. Return to driving is generally 6 weeks after surgery. Maximal recovery can take up to a year dependent upon the procedure and the patient's age.

What are my restrictions after hip replacement?

Most patients have significant improvements in motion after surgery; however, there are motion restrictions that need to be followed after the operation so that the prosthetic joint does not dislocate. Certain positions of the hip, such as crossing the legs, bending over to tie shoes from a standing position, are not recommended. Avoidance of certain positions of the hip is most important during the first 3 months so that the soft tissues of the hip can heal. Running is not advised after hip replacement and can increase the degree of implant wear and decrease the longevity of the implant.

What can I do after hip replacement?

Knowing the recommended positions to avoid, patients can return to an active lifestyle and participate in walking, golfing, swimming, biking, and bowling.

How long will my hip replacement last?

Hip replacement will last ten to fifteen years under average wear conditions. Conditions that can accelerate wear can be obesity, younger age and increased patient activity. Currently, there is no material utilized in joint replacement that lasts forever and does not wear. The prosthetic material does wear with time and at different rates in different people. Current research in joint replacement has focused on the modification of implant surfaces and materials to improve implant longevity. Ceramic on ceramic and newer durable plastics have shown promise but more research is needed before any conclusions can be made.

Is revision or repeat surgery required after my hip replacement?

As time passes after joint replacement, wearing of the joint replacement surfaces can occur. When wear has progressed to a point where the prosthesis has loosened or a patient is having pain; revision joint replacement can be required. Revision joint replacement is a much more complicated procedure than the initial procedure and can require complex implants and bone graft to reconstruct the hip joint. Yearly office visits or follow-up is generally requested so the prosthetic implants are assessed for wear and position. In general, once a patient starts to have pain around an implant that was functioning well, significant prosthetic and bony changes have occurred that can easily be determined by a physical exam and x-rays.

What happens in the future after my hip replacement?

After hip replacement, yearly office visits or follow-up with x-ray evaluation of the implants are required. This allows your surgeon to diagnose and treat a problem earlier before loosening or prosthetic wear becomes catastrophic. Furthermore, Dr. Wardell has several patient outcome studies in progress and closely follows the outcome and results of all his patients.

How do I make an appointment with Dr. Wardell?

Dr. Wardell sees patients in the office on Monday, Wednesday, and Friday. To schedule an appointment with Dr. Wardell, please call (708) 361-0600 or (708) 361-2271.