Arthritis is the gradual loss of cartilage over the hip joint surfaces. It can be caused by osteoarthritis, which is more common, and rheumatoid arthritis. Numerous other conditions can lead to the formation of osteoarthritis (avascular necrosis, trauma, developmental deformation)
Once the surfaces are irregular, inflammation, pain, stiffness, and grinding result to cause gradual decrease in strength and function.
The early management of hip arthritis would include anti-inflammatory medication. Over the counter medicines like Ibuprofen and Naproxen can be quite effective. Other prescription medications such as Celebrex andVioxx can also be used and may have less risks of gastrointestinal side affects. Plain Tylenol can also relieve pain, but does not relieve inflammation.
On rare occasion, a short course of physical therapy may have a role in the non-surgical management of arthritis. Mechanical factors such as the use of a cane in the opposite hand or a walker can help relieve stress on the affected hip.
There are more than 300,000 total hip replacements performed in the United States each year. 90 to 95 % of patients have good results with nearly complete pain relief. Improved hip motion often results with gradual recovery of strength, walking, and other recreational activities.
The hip joint is made up of a "ball and socket" type joint. The socket is called the "acetabulum." The ball becomes part of the femoral component. Materials now used include newer generation, highly crossed linked polyethylene, metal, titanium, chrome cobalt, or ceramic. The components can be anchored to the bone using a textured, bone ingrowth surface, or a cementing process, (polymethylmethacrylate, or PMMA). Various factors are taken into consideration when choosing the combination of component parts and materials that best fit the individual. These include age, bone quality, activity level, job requirements, recreational desires, general health and daily activity requirements.
Prior to surgery, existing health problems should be evaluated and stabilized. This process includes evaluation by the internist or family physician prior to surgery. Routine blood test, chest x-ray and EKG are often necessary. A preoperative session with physical therapy for evaluation and counseling is quite beneficial.
Various types of anesthetic options can be considered for this procedure. These include general anesthetic, epidural anesthetic, or a spinal anesthetic. Sedation medicine is usually given when regional anesthetics are used to maximize patient comfort. The duration of surgery is usually one and one half, to two hours.
Various approaches can be used to access the hip joint; these include anterior, lateral or posterior. Some patients are also candidates for minimal incision surgery, (MIS). The "Mini-Incision" total hip procedure is becoming more commonly used. Certain body types can be candidates for doing this surgical approach. Several types of variations on mini-incision surgery are used including the "single incision" versus the "two incision" technique.
Pain medications will be ordered to maximize patient comfort after surgery. This may include the patient controlled analgesia computer machine, (PCA) or postoperative epidural anesthetic medication. After two days these methods will be converted to oral pain medications, which is typically quite sufficient.
Emphasis will be placed on rehabilitation, with a rapid return to strength, mobility with the building of endurance. The postoperative regimen of weight bearing will vary depending on factors such as, the type of implant used, patient’s strength, quality of bone, and the specific desires of the treating physician.
The typical hospital stay would be 1-3 days. If patients qualify, the surgery can even be done as an outpatient. At this time, patients can go either home, or to a rehab facility until they gain additional strength and endurance. This will be determined by the patient’s age, general health, strength, and home living environment.
A total joint replacement is a major operation. Complications are not common, but occasionally occur, and sometimes maybe serious. These include:
- Deep vein thrombosis, (blood clot).
- Pulmonary embolus, (clot to the lung).
- Nerve injury.
- Arterial injury.
- Wound healing problems.
- Wearing or breaking of parts.
- Loosening over time which may require re-operation.
- Fracture of the bone on insertion.
- Dislocation of hip components.
- Leg length inequality.
Overall, a total hip replacement is one of the most reliable, beneficial and predictable operations that medicine has to offer.