Total knee replacement surgery resurfaces the degenerating (problem) knee joint with an artificial knee joint or prosthesis. Through an organized recovery process and strength building program, the prosthetic knee will allow you to regain the pain-free movement you have lost.

What Is a Hip Replacement?

 

Hip replacement, or arthroplasty, is a surgical procedure in which the diseased part of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery are to improve mobility by relieving pain and improve function of the hip joint.

 

Who Should Have Hip Replacement Surgery?

 

The most common reason that people have hip replacement surgery is the wearing down of the hip joint that results from Osteoarthritis. Other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), avascular necrosis (loss of bone caused by insufficient blood supply), injury, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

Before suggesting hip replacement surgery, the Doctor is likely to try walking aids such as a cane, or non-surgical therapies such as medication and physical therapy. These therapies are not always effective in relieving pain and improving the function of the hip joint. Hip replacement may be an option if persistent pain and disability interfere with daily activities. Before a doctor recommends hip replacement, joint damage should be detectable on x-rays.

In the past, hip replacement surgery was an option primarily for people over 60 years of age.

Typically, older people are less active and put less strain on the artificial hip than do younger, more active people. In recent years, however doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts allowing them to withstand more stress and strain. A more important factor than age in determining the success of hip replacement is the overall health and activity level of the patient.

For some people who would otherwise qualify, hip replacement may be problematic. For example, people who suffer from severe muscle weakness of Parkinson's disease are more likely than healthy people to damage or dislocate an artificial hip. Because people who are high risk for infections or in poor health are less likely to recover successfully, doctors may not recommend hip replacement for these patients.

 

What are Alternatives to Total Hip Replacement?

 

Before considering a total hip replacement, the doctor may try other methods of treatment, such as an exercise program and medication. An exercise program can strengthen the muscles in the hip joint and sometimes improve positioning of the hip and relieve pain.

The doctor also may treat inflammation in the hip with nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen. Many of these medications are available without a prescription, although a doctor also can prescribe NSAIDs in stronger doses.

In a small number of cases, the doctor may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteriods reduce joint inflammation and are frequently used to treat rheumatic diseases such as rheumatoid arthritis. Corticosteroids are not always a treatment option because they can cause further damage to the bones in the joint. Some people experience side effects from corticosteroids such as increased appetite, weight gain, and lower resistance to infections. A doctor must prescribe and monitor corticosteroid treatment. Because corticosteroids alter body's natural hormone production, patients should not stop taking them suddenly and should follow the doctor's instructions for discontinuing treatment.

If physical therapy and medication do not relieve pain and improve joint function, the doctor may suggest corrective surgery that is less complex than a hip replacement such as osteotomy. Osteotomy is surgical repositioning of the joint. The surgeon cuts away damaged bone and tissue and restores the joint to its proper position. The goal of this surgery is to restore the joint to its correct position, which helps to distribute weight evenly in the joint. For some people, an osteotomy relieves pain. Recovery from an osteotomy takes 6 to 12 months. After an osteotomy, the function of the hip joint may continue to worsen and the patient may need additional treatment. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure.

 

What Does Hip Replacement Surgery Involved?

 

The hip joint is located where the upper end of the femur meets the acetabulum. The femur or thighbone looks like a long stem with a ball on the end. The acetabulum is a socket or cup-like structure in the pelvis, or hipbone. This "ball and socket" arrangement allows a wide range of motion, including sitting, standing, walking, and other daily activities.

During hip replacement, the surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural, gliding motion of the joint. Hip replacement surgery usually lasts 2 to 3 hours.

Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a "cemented" procedure. In an uncemented procedure, the artificial parts are made of porous material that allows the patient's own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a "hybrid" replacement, which consists of a cemented femur part and an uncemented acetabular part.

 

Is a Cemented or Uncemented Prosthesis Better?

 

Cemented prostheses were developed 40 years ago. Uncemented prostheses were developed about 20 years ago to try to avoid the possibility of loosening parts and the breaking off of cement particles, which sometimes happen in the cemented replacement. Because each person's condition is unique, the doctor and patient must weigh the advantages and disadvantages to decide which type of prosthesis is better.

For some people, an uncemented prosthesis may last longer than cemented replacements because there is no cement that can break away. And, if the patient needs an additional hip replacement (which is likely in younger people), also known as a revision, the surgery sometimes is easier if the person has an uncemented prosthesis.

The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it tales a long time for the natural bone to grow and attach to the prosthesis, people with uncemented replacements must limit activities for up to 3 months to protect the hip joint. The process of natural bone growth also can cause thigh pain for several months after the surgery.

Research has proven the effectiveness of cemented prostheses to reduce pain and increase joint mobility. These results usually noticeable immediately after surgery. Cemented replacements are more frequently used than cementless ones for older, less active people and people with weak bones, such as those who have osteoporosis.

 

What Can Be Expected Immediately After Surgery?

 

Patients are allowed only limited movement immediately after hip replacement surgery. When the patient is in bed, the hip usually is braced with pillows or a special device that holds the hip in the correct position. The patient may receive fluids through intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid and a tube (catheter) may be used to drain urine until the patient is able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.