Procedures

Hip replacement

Reproduced with permission from Your Orthopaedic Connection. ©American Academy of Orthopaedic Surgeons.

Hip replacement is a procedure that is done for the severely arthritic joint, and only after other forms of treatment, such as medication and physical therapy, no longer have any benefit.

The hip is a "ball-and-socket" joint. It connects the trunk of the body to the legs through the pelvis. The hip, a major weight-bearing joint, is surrounded and held together by muscles, ligaments and other soft tissues. Cartilage is the material that "cushions" the ball and socket and allows the joint to move in a smooth and free manner.

Hip with arthritis

As the arthritic process develops, the cartilage wears out, and the nerve endings that lie beneath the surface become irritated and produce the symptoms of pain. As the joint becomes more and more damaged, the soft tissues offer less and less support. At that point, it may be time to consider surgical replacement.

The surgical procedure

The surgical procedure involves removing the damaged portions of the joint and replacing them with new parts. A new socket is placed within the worn-out socket of the pelvis and a new ball and stem are inserted into the femur (thighbone). The new components are fitted together, and since the painful diseased cartilage (cushioning) has been removed, there is generally a very quick relief of pain, an outstanding feature of this procedure.

The surgical procedure for total hip replacement usually takes about two to three hours. The new joint is often immediately solid. However, strengthening the weakened muscles and soft tissue surrounding and supporting the joint requires a longer-term program of exercise and physical therapy. Although many patients see and feel immediate benefits, they must continue the rehabilitation process for several months to get the total benefit.

Prior to my surgery I had been experiencing pain in my hip for over a year...Now I can walk without pain. I am back to exercising and lifting weights. If I had known it was going to be this easy, I would have had the surgery done a long time ago!” More

Anesthesia

Anesthesiology has come a long way in the last twenty-five years. There are newer, more stable drugs, and more accurate and more complete monitoring.

There are, however, some risks involved that are largely related to the severity and amount of underlying diseases, such as heart disease, atherosclerosis (hardening of the arteries) or lung problems. With an increase in the severity of these conditions, there is, naturally, an increase in the risk. Nevertheless, the safety record of anesthesia today is very high.

It is essential that patients tell their surgeon and anesthesiologist all of the medical conditions they have, as well as all the medicines that they are taking.

Hospital stay

Before surgery

Most patients are admitted to the hospital the day of surgery. Prior to surgery the hip that is being replaced will be thoroughly cleaned with an antibacterial surgical sponge.

After surgery

During the first few days after surgery there is naturally some pain. However, pain can be adequately controlled by medication.

In spite of any discomfort, it is important that patients make the effort to do the deep breathing and physical therapy exercises as instructed. Patients who breathe well and work at strengthening their muscles improve their lung capacities, and circulation, and tend to get well faster.

There are also certain restrictions that may be placed on patients early in the postoperative period in order to avoid unusual strains on the joint that could result in dislocation of the joint or disruption of the sutures. The nurses and therapists are familiar with the procedures and give instructions that can be easily understood and implemented.

Reproduced with permission from Your Orthopaedic Connection. ©American Academy of Orthopaedic Surgeons.

Exercise and physical therapy

One of the most frequently asked questions is, "When can I start walking again?"

Patients will often sit on the side of the bed and possibly stand in the hours following their surgery. While patients are often encouraged to stand and sit (with assistance) during this period after surgery, walking is approached gradually and in a guided manner, so as to avoid injury and complications. Therefore, it is not until the next day that they will begin walking and working with a physical therapist to regain mobility. It is very important to rebuild and strengthen the muscles through isometric exercises.

Social services

Many patients, especially those who live alone, are concerned about whether or not they will be able to manage for themselves in the first few weeks after they leave the hospital. In addition, if they should need assistance, they are concerned about who will pay for it.

Insurance coverage for home care is generally limited, but there are agencies available that can provide some help. Someone can visit the home and show patients how to adapt everyday activities to accommodate joint limitations during the healing process. A home health care agency can assist with needs like bathing and dressing. The hospital Social Services Department can direct patients to these agencies.

Mid Coast Hospital's care coordinators will work with the patient to ensure that the transition from the hospital to home is as seamless as possible.

Patients sometimes benefit from going to a rehabilitation facility after they are discharged from the hospital. The decision about whether to go to a rehab facility or directly home is made by the patient, but the orthopedic care team will make their recommendation based on the progress that a patient makes in the first several days after surgery.

Patient involvement and commitment

With hip replacement, the surgeon replaces the diseased hip joint, and, along with the physical therapist, occupational therapist and nursing staff, guides the patient through the recovery process. However, rehabilitation is up to the patient. The patient must participate fully in the rebuilding and strengthening of the weakened muscles. To get the total benefit of hip replacement, the patient must make a serious commitment to doing the prescribed exercises and developing and maintaining an active life-style.