Your hip joint replacement guide

Transcription

1 Your hip joint replacement guide Ready to consider hip joint replacement? You're not alone If arthritis (or injury) has damaged your hip, and different treatments for your pain haven't helped you get through your everyday activities comfortably, you may be ready to consider hip replacement surgery. First performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years. It has amply fulfilled its promise of restoring many people to the lives they knew before their hip pain worsened. Understanding how hips work By understanding how a normal, healthy hip works, it will be easier for you to understand the way a hip joint prosthesis, or artificial hip joint, works -- and the difference it may make in your life. A joint is formed by the ends of 2 or more bones that are connected by thick bands of tissue called ligaments. The hip -- which, like the knee joint, must bear the full force of your weight -- consists of two main parts: A ball (femoral head) at the top of your thigh bone (femur). A rounded socket (acetabulum) in your pelvis. The ball (femoral head) on the thigh bone fits into the rounded socket (acetabulum) in the pelvis. Ligaments, which are bands of tissue, connect the ball to the socket and help keep the ball and socket steady. The surfaces of the ball and socket are covered by a smooth, tough material called articular cartilage, which cushions the bones and lets them move easily. All the rest of the surfaces of the hip joint are covered by a thin, smooth tissue liner called synovial membrane, which makes a small amount of fluid that acts as a lubricant so that the bones in the hip joint will not rub against each other.

2 What causes hip joint pain? One of the most common causes of joint pain is arthritis. The most common types of arthritis are: Osteoarthritis (OA) -- sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older, and frequently in individuals with a family history of osteoarthritis. Rheumatoid Arthritis (RA) -- produces chemical changes in the synovium that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men, and may affect other organs of the body. Post-traumatic Arthritis -- may develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth, and these irregularities lead to more wear on the joint surfaces. Other causes of joint pain include avascular necrosis, which can result when bone is deprived of its normal blood supply (for example, after organ transplantation or long-term cortisone treatment), and deformity or direct injury to the joint. In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move. What's causing your hip joint pain? Is getting relief through joint replacement an option for you? These are just some of the answers that an orthopedic surgeon can provide. But first, it's a good idea to be sure you have information about joint replacement that will help you understand what the surgeon tells you.

3 Learning what you should know about hip joint replacement "Joint replacement" (the term orthopaedic surgeons use) is usually reserved for patients who have severe arthritic conditions. Most patients who have artificial hip joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology. Circumstances vary, but generally patients are considered for total joint replacement if: Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living. Pain is not relieved by more conservative methods of treatment -- such as medications or physical therapy -- by the use of a cane, and/or by restricting activities. Stiffness in the joint is significant. X-rays show advanced arthritis or other problems. "I had to give up dancing, and I just love to dance! And I thought, I was too young to have to give that up." What is total joint replacement? Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a hip joint, are removed and replaced with a plastic or metal device called a prosthesis, or artificial joint. The artificial joint is designed to move just like a normal, healthy joint. Hip replacement involves replacing the femur (head of the thigh bone) and the acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong metal or ceramic, and the artificial socket is made of polyethylene (a durable, wearresistant plastic) or metal backed with a plastic liner. The artificial joint may be cemented in position or held securely in the bone without cement.

4 "I was at the point where I couldn't walk anymore. The pain was so bad. We went shopping. I sat in the car with a library book... I decided there's got to be a better way." Possible complications of surgery As with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications, the vast majority of which can be successfully avoided and/or treated. In fact, the complication rate following joint replacement surgery is very low : Serious complications, such as joint infection, occur in less than 2% of patients. (Besides infection, possible complications include blood clots and lung congestion, or pneumonia.) Will an artificial hip joint last forever? As successful as most of these procedures are, over the years, an artificial joint can become loose and unstable or wear out, requiring a revision (repeat) surgery. These issues -- together with the fact that increasing numbers of younger and more active patients are receiving total joint replacement, and patients are living longer -- have challenged the orthopaedic industry to try to extend the life cycle of total joint replacements. Recent improvements in surgical techniques and instrumentation will help to further the success of your treatment. The availability of advanced materials, such as titanium and ceramic, and new plastic joint liners provides orthopaedic surgeons with options that may help to increase the longevity of the artificial joint. Having an orthopaedic evaluation If you're ready to consider having hip joint replacement, the next important step is to talk with an orthopaedic surgeon. The medical management of arthritis and joint degeneration may be handled by a family doctor, an internist, or a rheumatologist. However, when medical management is not effective, an orthopaedic surgeon should be consulted to determine if surgery is an option. In some cases, the orthopaedic surgeon may be the first physician to see a patient and make the diagnosis of arthritis. "I would recommend asking questions and writing them down." While every orthopaedic evaluation is different, there are many commonly used tests that an orthopaedic surgeon may consider in evaluating a patient's condition. In general, the orthopaedic evaluation usually consists of: A thorough review of your medical history A physical examination X-rays Additional tests as needed The information that the orthopaedic surgeon gathers during the medical history usually suggests the possibility of several different diagnoses (causes). After the medical history is taken, the orthopaedic surgeon conducts a physical examination: If you are experiencing pain in your hip joint, your back may be examined, because hip pain may actually be the result of problems in the lower spine.

5 After the physical examination, X-ray evaluation is usually the next step in making the diagnosis. The X-rays help show how much joint damage or deformity exists. An abnormal X-ray may reveal: Narrowing of the joint space Cysts in the bone Spurs on the edge of the bone Areas of bony thickening called sclerosis Deformity or incorrect alignment Other abnormalities Additional tests may include laboratory testing of blood, urine, or joint fluid and/or magnetic resonance imaging or a bone scan of the joint and surrounding soft tissue. Treatment Options Following the orthopaedic evaluation, the orthopaedic surgeon will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include: Medication Physical therapy Hip joint fluid supplements (injections that provide temporary pain relief) Total hip joint replacement If you and your orthopaedic surgeon decide that hip joint replacement surgery is an option to relieve your pain, the orthopaedic surgeon will provide the specific-to-you details of which type of artificial joint he or she will use, what you need to know to prepare for the surgery, how the surgery will be performed, and what results you can expect once you're up and moving again. Next steps: adjusting to life with less hip joint pain The vast majority of individuals who have joint replacement surgery experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living. Keep in mind, however, that joint replacement surgery will not allow you to do more than you could before joint problems developed. After joint replacement, a good rule of thumb is that acceptable physical activities should: Not cause pain, including pain felt later. Not jar the joint, as happens with running or jumping. Not place the joint in the extremes of its range of motion It is also important for an individual with a joint replacement to keep his or her body weight as close to normal as possible. Joint wear and loosening increase with weight increase. When fully recovered, most patients can return to work, although some types of work -- such as construction work, certain types of carpentry, and occupations that involve repeated or high climbing -- may not be advisable for individuals with a joint replacement. Also, athletic activities that place excessive stress on the joint replacement should be avoided. Stryker, 2004