Should You Have Hip Replacement Surgery?
Do you have hip arthritis? Is your ability to walk deteriorating? Have you lost motion in your hip? Are treatments like physical therapy, medications and injections not helping? Is your ability to perform your job affected? Is your quality of life being compromised? If the answer to many of these questions is yes, then total hip replacement surgery is something that you may want to consider.
Total hip replacement has been called the “operation of the century” because it has revolutionized the treatment of disabling arthritis of the hip. Osteoarthritis of the hip is commonly referred to as “wear and tear” arthritis. It is a common condition that many people develop during middle age and older. About 27 million American adults have osteoarthritis, according to a 2013 study published in Osteoarthritis and Cartilage.
Hip Osteoarthritis Risk Factors and Symptoms
Osteoarthritis has no specific cause. It is thought to be multifactorial. Common risk factors for osteoarthritis include:
- Increasing age
- Family history
- Previous injury to the hip
- Hip dysplasia or improper formation of the hip at birth
The most common symptom of hip osteoarthritis is pain around the hip joint. The pain typically increases over time. The next most common symptom is stiffness or loss of motion of the hip. Other symptoms include:
- A grinding sensation with movement of the hip
- Groin pain, which can radiate to the thigh, knee or buttock
- Loss of hip motion, difficulty putting on a shoe or stocking
- Pain with weight-bearing activities
- Walking with a limp
What to Expect From an Orthopedic Surgeon
Your orthopedist will ask you about your hip symptoms during your evaluation. The hip will be examined for tenderness and loss of motion. Your walking will be assessed. The surgeon will ask you about what treatments you have tried in the past: what worked, what didn’t work and what no longer works.
Hip X-rays are taken to evaluate the hip for characteristic signs of osteoarthritis. These include:
- Bone spurs around the hip
- Deformity of the ball (femoral head) of the hip
- Hip joint space narrowing
A magnetic resonance imaging (MRI) scan can be ordered to further evaluate the hip cartilage, bone or soft tissue (tendons, muscles) around the hip.
Hip Osteoarthritis Treatment Options
There is no cure for hip osteoarthritis. There are, however, many nonsurgical and surgical treatments to improve mobility and treat hip pain.
Early treatment of hip osteoarthritis is non-surgical. Lifestyle modification including weight loss and limiting impact activities such as running and jumping can reduce pain. Switching to nonimpact exercise such as swimming and cycling can help reduce stress on the hip. Physical therapy can help improve strength and mobility of the hip. A cane, crutches or a walker can improve mobility and independence. These devices can help to keep pressure off the hip.
Medications can help when other treatments are not controlling the hip pain. Acetaminophen or Tylenol can be effective. NSAIDs (nonsteroidal anti-inflammatory drugs) can also be effective. Over-the-counter medications like ibuprofen or prescription NSAIDs are typically recommended. Cortisone injections at the hip joint can also provide excellent short-term pain relief.
Hip replacement surgery
Surgical treatment is recommended when nonsurgical treatment is not controlling the hip pain. In total hip replacement surgery, the affected components of your hip joint are removed and replaced. The worn out or damaged cup (acetabulum) is replaced with a metal shell and plastic liner. The damaged ball (femoral head) of the hip is replaced with either a metal or ceramic head. A metal femoral component is implanted into the femur (thigh bone) to support the femoral head implant.
Hip replacement surgery can be performed under spinal or general anesthesia. The procedure frequently requires a hospital stay for 24 to 48 hours. Some patients may be able to go home the same day as the procedure.
There is no restriction to weight bearing after total hip replacement. Patients are frequently walking the day of surgery with the assistance of a walker or crutches. Physical therapy is started immediately after surgery. Pain is controlled with medication. Narcotic pain medication is usually not required for a prolonged period after the procedure.
A successful total hip replacement can be expected to last more than twenty years with appropriate activity precautions.
Risks of Hip Replacement
Though hip surgery is safe, complications are possible with any surgery. Your surgeon will do everything possible to minimize your risk. According to the American Academy of Orthopedic Surgeons, serious complications occur in less than 2 percent of total hip replacements. The most common risks of hip replacement surgery include:
- Blood clots
- Damage to blood vessels or nerves
- Excessive bleeding
- Hip dislocation
- Leg length inequality
Hip Replacement Recovery
There is a period of recovery after hip surgery. Recovery time is needed to regain motion and strength of the hip. Physical therapy is frequently recommended after the surgery to help in the rehabilitation process. The use of a cane, crutches or walker is frequently needed for a short time after surgery.
Most patients can expect to be back to light work activities and drive a car within six weeks of surgery. Minimally invasive hip procedures can decrease this time.
The vast majority of patients with osteoarthritis who are candidates for hip replacement surgery can look forward to significant improvements in their mobility, pain levels and quality of life. If you believe that it might be time for you to consider hip replacement surgery, please schedule an appointment to see me or one of my colleagues at Summit Medical Group Orthopedics for a consultation and evaluation. I look forward to discussing the procedure and your joint health with you.