FAQ Category: Hip

Major orthopedic surgery such as a total hip or total knee replacement does put patients at an increased risk for blood clots. These clots are also known as deep vein thrombosis or DVT.

During and after hip replacement surgery, the circulation of your blood slows down. This is due to your immobility or decreased movements. The blood tends to coagulate or pool. Sluggish or slow moving blood can result in the formation of clots.

Anticoagulants or blood thinners like heparin don’t really change the thickness of your blood. These drugs work by interrupting the clotting cascade or steps needed to form a clot. Once you become more active again, you’ll be able to stop taking the drugs without any side effects.

High versus low-volume hospitals refers to the number of procedures done at that facility. A low-volume hospital for total hip replacements (THRs) probably refers to a hospital where one to 10 THRs are done each year. High-volume refers to facilities where 100 or more procedures are completed on an annual basis.

Some studies show there is a connection between volume and outcomes. The more surgeries of one type done, the better the chances are for a good result. But other studies fail to show any major link between hospital volume and patient outcomes.

It may be that finding a high-volume surgeon is more important than a high-volume hospital. There are some studies that support the idea that hospital-volume effect is important, but it’s the surgeons who perform the most number of a specific operation who have the best results.

A large survey recently conducted by the Agency for Healthcare Research and Quality (AHRQ) also reported that hip replacements done in smaller hospitals on older, sicker patients were likely to have higher complication rates. The surgery was usually unplanned because of an emergency. This result was reported when compared to total hip replacements performed on an elective (or planned) basis.

You are observing the lack of a skill called automaticity. This is the ability to do two things at once. In this case, your father can’t combine a motor task (walking) with a cognitive task (talking).

Experts refer to the interruption of one task while doing another as dual-task interference. Attention-demanding activities such as talking can interfere with tasks that are usually automatic. Decline in these skills can affect activities of daily living. You’ve already noticed this with your father.

Some older adults may be able to talk while walking but when they do so, the speed of their gait slows down quite a bit. Automaticity is influenced by how complex or demanding the tasks are. Sometimes a hearing loss affects automaticity.

Reduced or absent automaticity is a risk factor for falls among older adults. You may want to think about having your father tested for hearing loss. A cognitive assessment might be a good idea, too. Early identification and treatment can prevent many other problems from occurring.

It isn’t always possible to make a perfect decision during an emergency. You did the right thing to call an ambulance. Without having a plan worked out ahead in case anything happened to your grandmother, you followed what the EMTs advised at the time. This is perfectly acceptable.

Hip fractures aren’t as likely to be life-threatening compared to heart attacks or strokes. But a break in the bone can cause a fat embolus or blood clot to travel to the lungs or brain, so getting medical care quickly is still important.

It’s possible that smaller hospitals have fewer cases than a large, regional, medical center. But being close to home is important for many older adults. And a smaller facility may be able to offer closer follow-up when needed.

Late complications of hip replacements have been reported. Swelling in the upper leg or thigh could be caused by your hip implant. Imaging studies with X-rays and/or CT scans may be needed to find out what’s going on.

You’ll need to see an orthopedic surgeon for an exam and testing. There have been rare cases of a fluid-filled mass in the thigh from debris wear after hip replacement.

Wear and tear on the polyethylene (plastic) liner or metal component parts can cause microscopic particles to build up in the joint or nearby soft tissues. Sometimes the patient reports pain or develops a limp, but there may not be any painful symptoms, just a mass such as you describe.

The physician will also rule out the possibility of a soft tissue or bone tumor, infection, fracture, or loose implant.

Hip and knee replacements certainly out number shoulder replacement surgery. For example, a review of one East Coast state’s hospital discharge records showed 994 shoulder replacements. This was compared to 15,414 hip and 34,471 knee replacements during the same time period.

So you’re right that the hip and knee replacements far out pace the same operation for the shoulder. However, those hospital records were also compared for hospital length of stay, complication rate, and costs. They found the shoulder replacement surgeries had a lower complication rate with a shorter hospital stay. Costs were less, too.

It appears that shoulder replacement surgery is as safe as the more common hip and knee replacements.

More and more older and even sicker adults are having surgery and other procedures of this type. Advances in the medical field have made it possible to give an 89-year old a new hip. Longer life expectancy and desire for improved quality of life are two reasons this happens.

Studies show that sick and frail adults do very well after joint replacement. Sometimes being able to get up and move about again without pain gives them a renewed lease on life. The risk of life-threatening complications in this age group such as pneumonia or urinary tract infections goes down when they can move around and especially if they can walk again.

With the new minimally invasive orthopedic operations, there’s less blood loss, less pain, and faster recovery. Some people are in and out of the hospital in 23 hours but most stay two to four days.

Problems can still occur with early discharge. If you are in the same area with your grandmother, you can be a big part of helping reduce the cost of post-operative care. Check in with her as often as you can. If her doctor has approved walking and activities, encourage her to walk with you. Report any suspicious symptoms right away. Early diagnosis and treatment can prevent some problems from getting worse.

Total hip replacement remains one of the safest and most effective orthopedic surgeries available today. But problems can occur and they can be serious. Heart attacks and other cardiac complications top the list of major complications possible.

Same-day discharge is being used in some centers where minimally invasive surgery is performed. Other surgeons prefer to keep the patient overnight for observation. Many patients remain in the hospital for two to four days.

According to a recent study, patients with a minimally invasive procedure may need just as much postoperative care as those getting a standard hip replacement. There are two reasons for this.

First, both patients still had general anesthesia during the operation with possible complications from that. Second, the same bone cuts are made increasing the risk of bone or fat from inside the bone breaking off and traveling to the heart, lungs, or brain.

When your wife comes home, you will be given a list of post-operative instructions to follow. There should be a list of precautions and symptoms to watch out for. Most patients have an excellent recovery if they follow all the instructions. Family support is very important in this process. In the meantime, don’t hesitate to call the doctor if you have any special concerns.

Studies show that your pre-operative status has a lot to say about your post-operative progress. Your level of physical fitness before a hip or knee replacement is often able to predict your recovery after surgery.

The fact that you were active and a leader of a hiking group is very much in your favor. After six months it is reasonable to expect to resume many of your former activities. But if you had some hip muscle weakness before the hip replacement (and it’s likely you did), then you may need a more specific rehab program for this particular activity.

We can suggest two things for you: 1) See a physical therapist for an updated exam and exercise program. Let him or her know your goals, so the program can prepare you for the level of activity you are interested in. 2) Use a walking stick or pole.

Research shows that trekking poles reduce the load, increase stability, and decrease soreness associated with hiking. In fact, a simple walking stick may even decrease your risk for injury and allow you to maintain your active lifestyle for much longer.

Although there may be a genetic link to joint problems like arthritis, obesity remains the biggest risk factor for hip and knee osteoarthritis (OA). Aging with the degenerative changes that come with aging is the second biggest risk factor.

Women seem to be affected by knee OA more often than men. Although you can’t do much about your age or your gender, risk factors like body weight, activity level, and hibitual positions can be modified.

A recent study of sitting positions while on the floor linked bent-knee floor activities with an increased risk of knee OA. Daily use of the lotus position, squatting, and side-knee bending does put increased stress on the knee joint leading to cartilage break down and arthritis. Kneeling does not seem to have the same effect.

Monitoring your weight and avoiding too much knee flexion for long periods of time are two risk factors within your control. Other risk factors such as knee alignment can be evaluated, too.

Your daughter may have a common condition called snapping hip syndrome. It’s seen most often in ballet dancers who over train their hip flexor muscles. The tendon flips back and forth over a bump on the bone causing a snap or pop that can be heard and/or felt.

Sometimes this problem occurs in response to true hip joint problems. There could be a hip fracture, tear of the hip cartilage, or fragment of tissue or bone caught inside the joint. Usually this type of problem is much more painful than the tendon snapping over bone.

Ballet dancers seem to have this problem more than any other group of individuals or athletes. They may have hip pain that will only go away when the hip is moved in such a way that a snap or pop occurs. Or they may be pain free but feel and hear the snap whenever the leg is lifted or flexed more than 90 degrees.

It may not be normal, but it is a typical response to the specific activity of repetitive hip flexion.

More and more young people are having joint problems. Hip pain affects one out of every 12 patients under the age of 40. There are many possible reasons for this symptom. Arthritis is only one consideration. A medical doctor must make the diagnosis.

A proper workup for hip pain will include a patient history and exam. Depending on the results, the physician may order X-rays or some other type of imaging study. Although less common, conditions affecting other parts of the body can cause hip pain and must be considered.

For example, appendicitis, Crohn’s disease, ulcerative colitis, and diverticulitis are gastrointestinal problems that can refer pain to the hip. In young women, pelvic inflammatory disease, ectopic pregnancy, and endometriosis are possibilities. In men, prostate or testicular conditions must be ruled out.

If this problem persists, don’t hesitate to make an appointment for a medical evaluation. Early diagnosis and treatment can often make a difference for many conditions. You may have a simple problem that can be solved with change in posture, stretching, or exercise.

Improved diagnostic imaging may be what has changed the most. The use of thin-cut CT scans gives a 3-D view of the hip joint. Combined with magnetic resonance arthrography (MRA) and X-ray, surgeons can better see what is the problem. Understanding the cause of painful symptoms helps the surgeon plan a more effective treatment.

By the way, MRA is the injection of a contrast agent (dye) directly into the joint space. then MRI pictures are taken. The technique helps show the shape and depth of the joint space. The dye will seep into any areas where the cartilage is torn or pulled away.

There are two main reasons why young adults have hip pain. Abnormal loading and pinching called impingement can result in pain and loss of motion. A shallow hip socket called dysplasia can do the same thing. In many cases, the surgeon may be able to repair and realign the hip.

It may be time to go back for a second look or a second opinion about your particular situation. New advances in the diagnosis and treatment of hip pain in young adults may put a different spin on your case.

You’re right on with your description of the labrum. This extra cartilage is present in both the hip and the shoulder. It deepens the socket just a bit and helps hold the round head of the bone inside the socket.

A tear of the labrum can be very painful. Surgery to repair the problem is often needed. Sometimes the surgeon can stitch it back in place using an arthroscope. The arthrocope is a tool that makes it possible to go inside the joint without an large, open incision. In other cases, the scope is used to shave off and smooth down the torn cartilage.

It’s always important to identify the cause of the tear. A faulty position of the hip or shallow socket could result in more problems later on if not taken care of now.

Sometimes the angle of the hip in the socket or even the tilt of the socket itself can be the source of the problem. Open hip surgery may be needed then to realign the hip and prevent the same labral damage from occurring a second time.

The surgeon will use X-rays and CT scans and/or MRIs to help plan the right procedure. A videotape of the operation is often made and given to the patient afterwards. You may be able to actually see for yourself what is done step-by-step!

Today’s total hip replacements are indeed done in an average time of 75 to 90 minutes. The typical range is anywhere from 45 minutes to 120 minutes. The time factor depends on the type of problem (fracture versus arthritis) and type of implant.

Some patients may only have a partial hip replacement called a hemiarthroplasty. Others have a total hip replacement (THR). The method or technique used can make a difference. In a minimally invasive (MI) procedure, the surgeon makes a much smaller incision compared to an open incision. MI hip replacement operations can actually take longer than a THR with an open incision.

Hip dislocation is a potential complication after THR. It doesn’t happen very often. When it does occur so early after the operation, it’s likely due to a fall or poor positioning.

Patients are given strict instructions on motions and positions to avoid. Sometimes they forget and cross their legs or bend the hip too far. Dislocation can also occur when turning in bed if the patient isn’t careful.

It’s very unlikely that there is any link between the operative time and post-operative dislocation. You should talk with the surgeon and get his or her impression of the cause of the dislocation. The cause may be unknown or there may be a simple explanation.

Age of the patient, condition of the bone, type of fracture, and mental capacity are just a few factors the surgeon takes into consideration. Adults less than 60 years of age who need surgery for a broken hip usually have a pin and/or metal plate to hold the bones together. This is called internal fixation.

If there is severe arthritic disease, bone cancer, or severe osteoporosis, then a total hip replacement may be needed. Depending on the fracture type, the patient may end up with a hemiarthroplasty. The hemiarthroplasty replaces the head and neck of the femur (thighbone) but leave the patient’s own acetabulum (socket) in place.

Total hip replacement (THR) is more common in older adults. There are benefits and disadvantages for each type of surgery. Hemiarthroplasty only replaces the broken side but can result in bone erosion and a painful hip. This is more likely to happen in a younger, active adult.

THR is subject to hip dislocations. There’s also a limited life to a THR. In younger adults, a THR may have to be replaced again 10 to 15 years later. This can mean more bone loss, more scarring, and decreased function for some patients.

After the operation and while your husband is still in recovery, the surgeon will come out to the waiting area and tell you what was done. Use that opportunity to ask any questions you may have about what was done and why.

Return to work, sports, driving, or other activities varies based on several factors. Your age and general health and fitness can make a difference. Your recovery can be delayed if you are an older adult or if you have other health problems such as diabetes or heart disease.

The type of surgery you have can also make a difference. The newer minimally invasive surgery (MIS) uses smaller incisions with less blood loss. Usually, there is a shorter hospital stay and a faster recovery.

Several studies have been done to track return to function. The average patient used a cane for two weeks. The average time to go up and down stairs without assistance was three weeks. Walking half a mile took place six weeks later.

Patients can actually go without a walker or cane whenever they feel comfortable doing so. Driving may be more dependent on the use of pain medications. You should not drive while still taking narcotic-based drugs used for pain after surgery.

Driving probably isn’t the only issue for you. Most OTR truckers are driving (sitting) for long hours. Getting in and out of the cab can be a challenge at first. The job often requires heavy lifting or handling heavy materials. Your decision to return to work will be based on all the variables mentioned.

Talk to your surgeon about your particular situation. Find out what type of surgery will be done and what you might be able to expect in a best-case/worst case scenario. Plan on something in between as your likely timeframe.

Implant designers are looking for ways to get a good solid implantation without problems such as implant loosening, fracture, or bone loss. Research tells us that the stiffer the implant, the greater the amount of bone loss.

In an effort to reduce this bone loss, companies are designing and doctors are trying different implant designs. The first wave of studies compared implants made of different materials such as chromium or titanium.

The second series of studies looked at the coating painted onto the implants. The thought was that bone responded differently to various kinds of coatings. This research is ongoing but so far has not been conclusive.

Geometric angles, width of implants, and now slots or flutes in the bottom have all been examined. The clothes-pin design you saw splits the bottom part of the stem in an effort to reduce implant ridigity. So far studies have not shown a significant difference with this feature.

Now researchers have reason to believe the shape, size, and design at the top of the implant may be more important than the bottom tip. More studies are needed before the perfect implant design is invented. Until then, a wide variety of sizes, shapes, and materials will be tried.

Certainly you should talk with your surgeon again to find out what her thinking is on this subject. Some surgeons are skeptical about hip resurfacing these days. Even though it’s been around for 30 years, there are enough problems to approach it cautiously.

Recent improvements in the design and fixation of the component parts has brought this technique back into the news. But there are some problems that haven’t been addressed yet. You could end up with a failed hip resurfacing and need a total hip replacement (THR) after all.

Femoral fracture and leg length difference are two of these unresolved issues. Reports of femoral neck narrowing from stress shielding are common. Stress shielding is the resorption of bone near the implant. It’s caused by a shift of load from the bone to the metal replacement parts.

Bone needs stress and load to keep forming new, stronger bone. Load will shift to wherever the stiffest, strongest force is present. In the case of joint resurfacing, that turns out to be the metal cap placed over the round head of the femur. X-rays show the neck of the femur shrivelling away to a thin stalk. Fracture of the femoral neck is a natural consequence of stress shielding in this area.

Resurfacing doesn’t allow the surgeon to adjust the leg length as much as a THR does. Restoration of leg length is more accurate with THR. All things considered, your surgeon may not think you are a good candidate for joint resurfacing.

Anytime a rigid implant such as a total hip replacement (THR) is put into a bone, there can be bone loss. Bone is a living tissue that needs physical stress to keep it strong and active. Moving about on two legs usually gives it just the right amount of stress needed to stay healthy.

When a piece of metal such as the femoral stem component of the THR is put inside the bone, there’s a mismatch of materials, load, and strength. The body reacts to this in a protective fashion. Any time two materials are joined, the stiffer material bears most of the load. The result is loss of bone density where the stiffer implant takes over.

X-rays don’t show early changes in bone density. In fact, the bone can lose up to 30 per cent of its density before it can be seen on X-ray. Newer DEXA scanning is more sensitive but isn’t used routinely. Future medical practice may suggest the need to use DEXA to assess implant condition after total hip replacement.

New drugs to help strengthen bone after THR may be another strategy to combat the loss of bone density. Meanwhile, researchers continue to make changes in the implants to help prevent bone resorption.