Hip replacement is surgery for people with severe hip damage. The most common cause of damage is osteoarthritis.Osteoarthritis causes pain, swelling, and reduced motion in your joints. It can interfere with your daily activities. If other treatments such as physical therapy, pain medicines, and exercise haven't helped, hip replacement surgery might be an option for you.
During a hip replacement operation, the surgeon removes damaged cartilage and bone from your hip joint and replaces them with new, man-made parts.
A hip replacement can
- Relieve pain
- Help your hip joint work better
- Improve walking and other movements
The most common problem after surgery is hip dislocation. Because a man-made hip is smaller than the original joint, the ball can come out of its socket. The surgery can also cause blood clots and infections. With a hip replacement, you might need to avoid certain activities, such as jogging and high-impact sports.
Indications for surgery
Pain is the principal indication for hip replacement and is reliably relieved as early as one week after surgery.Pain from an arthritic hip is classically located in the groin and buttock. Radiation into the thigh may occur and at times pain may present in, or even below the knee. The pain is usually described as a dull ache that is difficult to localise. Activity aggravates the pain while rest relieves it. Increased activity during the day may be followed by pain extending into the evening. Night pain is particularly distressing to patients and an important surgical indication.
In osteoarthritis functional limitations are usually associated with pain but are rarely an indication for hip replacement in isolation. Walking and particularly stair climbing become difficult, with start up pain a particular feature. Capsular contractions and joint deformity cause a decreased range of motion in the hip, which typically leads to patients complaining of problems with pedicure and putting on shoes and socks or stockings. Functional limitations are usually more severe in patients with inflammatory arthritis reflecting the systemic nature of their disease. Functional improvements can be confidently predicted in patients with osteoarthritis and rheumatoid arthritis after total hip replacement.
There are certain patient subgroups in which joint stiffness without hip pain is an indication for surgery. In ankylosing spondylitis hip stiffness, or even ankylosis, can leave patients with tremendous functional disability in the absence of pain. Hips commonly fuse in flexion, which in combination with a stiff thoracolumbar spine contributes to a stooped posture. These patients may become bed bound and if mobile often require walking aids. Hip replacement in this group leads to dramatic improvement in function allowing bedridden patients to ambulate and most patients to discard walking aids.
Patients who have had previous hip fusion, either spontaneous, usually from childhood infection, or surgical may also present with disability in the absence of hip pain. Disability in this group can be caused by back pain, pain in the knees or the opposite hip, as well as the disability imposed by the stiff hip. Although a hip replacement in this group of patients is technically demanding and associated with a higher complication rate than normal a moderately good range of movement can be achieved. Furthermore some surgeons feel that an arthrodesis should be taken down before another affected joint is replaced so as to minimise the risk of failure of the arthroplasty.
While most hip replacements are performed in patients between 60 and 80 years of age, older or younger age is not a contraindication to surgery. Hip replacement is occasionally performed in patients in their teens and early twenties. In this age group its most successful indication has been in relieving pain and improving function in patients with debilitating childhood inflammatory arthritis. In one study of patients 21 years or younger over 90% implant survival was seen at 10 years in patients with juvenile arthritis. This severely affected group of patients enjoyed a greatly improved quality of life over this period. Twenty five per cent of North American surgeons in one survey considered a patient’s age over 80 as a factor against total hip arthroplasty.We do not agree that older age should preclude a patient from total hip replacement and we do not think there is an upper chronological age beyond which patients should not be considered for total hip replacement. Elderly patients undergoing elective hip replacement for either osteoarthritis or rheumatoid arthritis have a greater life expectancy than average probably reflecting less co-morbidity in patients considered fit for elective surgery.
The severity of the radiographic changes of arthritis within the hip joint usually but not always reflects the severity of the patients’ disability. However the decision to perform surgery is made on the severity of the symptoms not the severity of the radiographic changes. At times, particularly in osteoarthritis associated with a more pronounced inflammatory response, radiographic changes can be mild in association with severe symptoms. It is important to appreciate that mild radiographic signs of disease should not exclude a patient from consideration for total hip replacement. Occasionally, in the presence of mild radiographic changes, it is not possible to be certain that the hip is the source of pain. In this situation we find that an injection of local anaesthetic into the hip, performed under radiographic control, is a very useful diagnostic test.
Factors considered as poor prognostic indications for total hip replacement are significant medical disease where the risk of surgery outweighs the expected benefit, psychiatric disease, dementia, or systemic infections. Though obesity and in particular morbid obesity are considered relative contraindications to hip replacement studies have shown that these patient groups can undergo hip replacement with low complication rates, with significant improvements in functional level, and at least in the short-term no increased risk of implant loosening.Local considerations against hip replacement include poor vascular supply, poor soft tissue cover, ulcers, and neuropathic disease of the hip.
Treatment of Hip Replacement
Treatment of hip arthritis should begin with the most basic options and progress to the more involved, which may include surgery. Not all treatments are appropriate for every patient.
Hip replacement is generally reserved for patients who have tried all of the other treatments and are still left with significant pain during normal activities. Patients who have occasional pain, are able to participate in athletic activities, or have not tried non-operative treatments are probably not ready for a hip replacement. Non-operative treatment options include:
- Weight Loss
- Activity Modifications
- Anti-Inflammatory Medications
- Joint Supplements
Reasons of Hip Replacement
There are two main conditions that can end up with you needing a hip replacement:
If you have arthritis in your hip:
- Arthritis means inflammation of a joint.
- Osteoarthritis is the most common cause of arthritis in the hip and the most common reason for needing a hip replacement.
- Rheumatoid arthritis is a less common cause. About one person out of every 21 who has a hip replacement has rheumatoid arthritis.
- There are other causes of arthritis that may lead you to needing a hip replacement.
If you break your hip (hip fracture):
- A hip fracture is a fracture of the top part of the thighbone (femur). The fracture can be of the head, of the neck or below the neck.
- Usually a hip fracture is treated by an operation to screw the broken ends back together again. However, if it is the head of the femur that has broken, this is often treated by replacing the broken head of the femur with an artificial head of the femur (prosthesis).
This is particularly the case if the broken bits have moved away from each other or if you already have arthritis in that hip joint.
Symptoms of Hip Replacement
It may seem obvious, but the most important and debilitating indication that you may require hip replacement surgery is pain: pain around the hip, groin or even radiating down to the knee. No two hip pains are the same. Your hip pain may be made worse by exercise or by being at rest. It may be worse in the morning or in the evening. It may be calmed down with simple pain killers or strong prescribed pain relief may have no effect.
Reduced flexibility and movement in your hip joint will turn otherwise simple tasks into a chore. Getting up and down from chairs may be difficult and more complex manoeuvres such as getting into and out of car seats may become prohibitive.
Reduced mobility and quality of life
Taken together, hip pain and stiffness can amount to reduced mobility and consequently have a detrimental effect on your quality of life. Problems with your hip may make it difficult to function at your usual level: your ability to sleep, to enjoy your hobbies, family and socialising as well as your ability to carry out your normal daily activities. Your mood may even be affected.