FAQ Category: Hip

The mini-posterior total hip replacement (THR) is done through a six- to nine centimeter long incision. That’s about two inches. Posterior means it is done from the backside. In other words, the large buttocks muscle (gluteus maximus) is split to reach the hip.

The hip capsule and external rotator muscles close to the hip are cut open and then repaired later. Patients like this method because the incision is behind and can’t be seen without a mirror. Some say they got better faster with this approach.

The two-incision operation is done with two incisions from the front of the hip. Both incisions leave scars that can be seen when bathing or changing clothes. Patients often feel annoyed by seeing these scars, but the scars don’t impair function or keep anyone from doing their daily activities.

A recent study compared these two methods on patients who had both hips replaced. One hip was done with the mini-posterior method. The other hip was replaced using the two-incision approach. There wasn’t any difference in how fast patients recovered from these two operations. About two-thirds preferred the mini-posterior approach because they couldn’t see the scar.

The two-incision THR is more technically demanding for the surgeon. Since there may be no advantage to this method, the mini-posterior may become the preferred method by patients and surgeons.

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.

Confusion or disorientation after surgery of any kind may be a neurologic problem called postoperative delirium. Agitation and disorganized thoughts are part of this problem. Women are not necessarily at greater risk for delirium. The most significant risk factor is older age. Since women outlive men two to one, older adults are more often women than men.

Other factors that put patients at risk include poor mental health or decreased physical fitness. The use of alcohol or other drugs is a greater problem among older adults than often realized. Withdrawal from alcohol and other drugs can also bring on periods of confusion and/or delirium.

Certain medications such as narcotic pain relievers and antidepressants may be another risk factor. Dehydration, lack of oxygen, and immobility are common risk factors for delirium among older adults.

Doctors are being encouraged to prevent postoperative neurologic symptoms like confusion and delirium. Assessing patients’ physical condition and mental status before surgery is an important part of reducing these problems.

Many patients getting a total hip or total knee replacement are older adults with other health problems. When a patient has more than one condition, disease, or illness, these additional problems are called comorbidities. High blood pressure, diabetes, or heart disease are just a few examples of comorbidities.

Physicians are encouraged to assess all surgical patients for current health concerns and risk factors that might become a problem after surgery. Comorbidities such as diabetes and heart disease are often risk factors.

The risk of heart attack after total hip replacement increases with age. Adults 80 years old or older have the highest risk. Other risk factors such as smoking, physical inactivity, and obesity should also be noted.

Matching potential complications with signs and symptoms experienced by the patient or observed by the family is important. There are many risk factors for heart attack. These may include smoking, high blood pressure, high cholesterol levels, physical inactivity, and obesity.

Postoperative complications after major joint replacement (hip or knee) are most likely to occur in the first 30 to 90 days. Patients and their families are usually given information after surgery about what to watch for. Doctors are especially concerned about local infection, pneumonia, and blood clots.

Under the stress of an upcoming surgical procedure, patients don’t always remember what they were told. And sometimes the symptoms of a heart attack are silent or so mild the patient doesn’t realize what’s happening.

Physical function is usually defined as your ability to move around and look after yourself. There are many standard tests of physical function used by rehabilitation specialists. The goal is to make sure patients are able to return home and complete their daily tasks safely.

Many patients overestimate their abilities when in fact, pain keeps them from moving as quickly or as smoothly as they think they can. After a joint replacement, pain is often better but movement is slower for many months. Various tests can be administered to measure pain, exertion, speed, distance, and time.

Some of these tests such as the 40-meter self-paced walk measure walking ability. Others such as the Stair Test assess stair climbing skills. More complete testing using something like the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is also possible.

And yes, there are specific driving tests that can be given. If you’re concerned about specific skills like driving, it may be a good idea to contact the person who is giving the test(s). Let them know your concerns and questions ahead of time so they can direct the testing to include as many of those areas as possible.

Only people with heart pacemakers are exempt from the security detection units (walk-through or handheld wand). They are, however, still required to be searched via a pat-down exam.

Carrying a surgeon’s certificate, card, or letter no longer gives you special privileges. Since 911, increased airport security requires that all passengers participate in routine airport screening. You may still want to carry this documentation for your own peace of mind.

No harm can be done to your implant from any airport metal detectors. These devices operate on the basis of a pulse induction eddy current generation and electromagnetic field distortion.

There’s a coiled wired in the detector. It generates short bursts of current forming a magnetic field used to detect metal. No change occurs to the metal object that is detected. Some types of implants are more likely to set off the alarm. That’s because the type of metal or the amount of metal makes it easier to magnetize and set off the alarm.

Talk to your surgeon if you still have any doubts or concerns. He or she can tell you what kind of implant materials you have and how likely they are to set off security alarms.

A fair number of people may need a revision of their hip joint replacement. Loosening and infection are the most common reasons for implant failure. Poor bone quality and decreased bone density are major factors in implant loosening.

When the implant is removed, the surgeon must be careful to take out all existing cement and fibrous tissue. Every effort is made to make sure the joint surface is smooth and clean. This will help new bone to form around the revision implant.

It sounds like you had a procedure called impaction grafting. Morselized bits of donor bone are placed in the hole or defect. A special surgical hammer is used to tamp down the bone and press it into the hole.

When the hole is filled and smooth again, the surgeon places a trial cup-shaped implant in place to check the hip and leg position. If all is well and everything lines up, then cement is injected into the bone graft to seal it all together. Finally, a new cup is inserted.

With more and more older adults experiencing arthritis and needing joint replacements, surgeons expect to see this problem increasing over time. Patients are living long enough to require one (or even more) revision operations. The number of people who need extra care because of bone deficiencies has already increased greatly.

The condition of bone grafts is difficult to assess from X-rays. Studies of X-ray findings compared with autopsies would be helpful in answering this question.

For example, if you had X-rays taken periodically throughout the rest of your life as a baseline, scientists could compare these tests with how the bone and hip actually look during autopsy after death. Such studies to report the fate of bone grafts just haven’t been done yet.

In the normal biology of bone grafting, we know that healing of the host tissue can begin as early as two days after implantation. New (native or natural) bone growth can be seen by four weeks. The rate of bone growth is often slower when donor bone from a bone bank is used for the graft.

PET scans can be used to assess blood flow to the graft site but this is costly and not used routinely with patients. X-rays may not show the condition of the graft but they do usually show any problems that may be developing. For this reason, X-rays are still the first choice for assessing graft condition.

Worldwide, total hip replacements (THRs) have been done for 30 years now. The success over time has been tracked using databases in several countries. Information has been collected comparing the U.S. to Sweden, Norway, and Australia.

Results of cemented versus uncemented implants in each of those countries is also reported. Revision rates are highest in the U.S. compared to these three other countries.

Revision rates in older adults (over 65 years old) is three times higher in the U.S. compared to Sweden. A second (revision) surgery is needed when patients develop infection, fracture, or loosening of the implant.

ccording to information provided by Norwegian researchers, they may have the best results. Long-term findings (15 years or more) were good in all age groups and for all problems.

Probably better! Long-term studies over a 30-year period of time show uncemented implants actually have less chance of loosening.

In one study of more than 6,500 total hip replacements (THRs), not one uncemented THR came loose. The cemented implants have a tendency to loosen during the second decade.

The increased survivorship for uncemented implants and improved durability have made it the new gold standad for THR.

The “everlasting hip” or “sport hip” are terms used to describe a new procedure called hip joint resurfacing. In this procedure, the surgeon smooths the joint surface and puts a protective or replacement metal cap over the bone at the top of the femur (thigh bone).

The idea is to provide younger patients with some options over the years. When used early on, the patient can still convert to a total hip replacement years later. You may be a good candidate. Check with your orthopedic surgeon about the possibility.

Joint resurfacing is not a reversible procedure. It doesn’t last forever. Although patients can be active, they are advised to limit or minimize some weight-bearing activities. This could include such things as impact sports, running, or sky-diving.

Good nutrition is always advised to maintain the best health possible before having surgery of any kind. Eliminating or reducing the use of tobacco products is known to improve wound healing after any operation.

In the case of hip fracture after joint resurfacing, there may be some biologic factors at play. A recent study in England showed a decreased amount of oxygen to the femoral head during the operation.

The change in oxygen level was observed when the surgeon cut the hip muscles and joint capsule. They do this before removing (dislocating) the femoral head. When the hip was relocated, the oxygen supply was not restored. The blood supply does eventually come back. It takes about 90 days.

Hip fracture is more likely during this three-month period without blood and oxygen, a condition called ischemia. The risk of osteonecrosis (death of bone) and fracture is also much greater during this time.

There isn’t anything you can do as a patient about the ischemia. More studies are needed to find ways to prevent this problem from occuring during this operation.

Thigh numbness after a total hip replacement (THR) can occur when the surgery is done from the front of the thigh. This approach is called an anterior THR. When two small incisions are made instead of one long one, it’s referred to as a minimally invasive (MI) approach.

There is a nerve to the leg along the front of the thigh that branches into several divisions. The exact location of the nerve and its branches isn’t always easy to predict. This means the surgeon can’t always avoid cutting it when making more than one incision. Every effort is made to keep this from happening but sometimes it’s unavoidable.

Some patients develop thigh numbness weeks or months after the operation. This can occur when scar tissue presses on the nerve or even wraps around the nerve. Over time and with the proper stretching exercises, this problem can go away.

When two-small incisions are made for a total hip replacement (THR), the operative technique is called minimally invasive (MI). Many studies have been done to see if there is any advantage to doing it this way.

Some studies show the long-term results aren’t really any better than with a larger incision. The MI method is much more difficult for the surgeon. Using the MI approach requires more training and practice on the part of the surgeon. Early cases in the surgeon’s training tend to have much higher complications and problems compared to patients treated much later.

There are a few conditions that may keep a patient from having a MI THR. The first is hip dysplasia. This is a deformity of the hip with a shallow acetabulum (hip socket). There’s a tendency for the head of the femur to slip up and out of the socket.

You may be excluded from having a MI THR if you already have plates, screws, or other hardware in the hip or pelvis. It may be necessary to remove these pieces before the THR can be done.

With minimal visibility, it’s more difficult for the surgeon to match the right size implant to the patient’s hip. It is also more challenging to insert the component parts with the correct angle and rotation. Extreme obesity may be a problem if the large abdomen hangs over the surgical site.

Otherwise the two-incision MI procedure can be done on most patients with degenerative hip disease needing a THR.

Age may be a factor in whether the surgeon uses cement or not, but the real issue is bone density. Older adults are more likely to have decreased bone mineral density. A cemented implant may be needed for patients with osteoporosis or brittle bones. The cement helps hold the implant in place when the bone grows around it is very slow.

Younger, active adults with good bone density do well with uncemented implants. In fact studies show that uncemented stems in the femoral component are less likely to loosen in the second decade. As a younger adult, the survival advantage of the uncemented total hip replacement will be to your advantage.

Osteoarthritis (OA) is classified or staged according to changes in the size of the hip joint space and condition of the bone. As the cartilage wears down, the joint space gets narrower. Bone spurs called osteophytes start to form around the edges of the bone.

These and other changes are seen on X-rays. Advanced OA is defined as narrowing of the joint space along with spots of radiolucency from bone erosion. Radiolucency means the image is dark because the X-rays have passed through where the bone has worn away.

Of the four stages of OA, advanced-stage is the third stage before the final end-stage arthritis. In end-stage disease, the joint space is absent and bone spur formation is severe.

Patients with advanced or end-stage disease are most likely to be considered for joint replacement. Younger patients with advanced stage disease may be able to have a procedure called joint resurfacing. Then later, if the joint wears out completely, a joint replacement is possible. Older patients (usually 65 years or older) are more likely to receive a total joint replacement.

Bone cysts of this type are an indication of uneven or excessive weight-bearing load. If you have hip dysplasia, the hip socket or acetabulum is probably shallow with shortened margins.

The head of the femur (thighbone) is round and normally fits inside the acetabulum. The curved socket forms a shelf or roof over the femoral head to keep it from dislocating. With hip dysplasia, the round head of the femur isn’t covered by the acetabulum. It can slip upward and even dislocate.

The cysts are a likely sign that there is uneven wear and load from the hip instability. The joint may be trying to cushion itself by forming cysts of this type.

In some patients, a procedure called a rotational acetabular osteotomy can be done for unstable hip dysplasia. The surgeon removes a wedge of bone and uses it to re-angle the joint. A small piece of bone is also used to improve the roof angle.

Studies show that cysts of the acetabulum or femoral head often disappear after this operation. Patients report decrease in pain and improved function.

According to a recent study from the Mayo Clinic in Rochester, Minnesota intraoperative acetabular fractures are rare. Out of 7,121 total hips done, only 21 patients had such a fracture. This is about a 0.4 per cent rate.

The Mayo study was able to identify the possible cause for this problem. They looked at the cup design used most often that fractured during the procedure. It looks like the elliptical shape and flare of the edges caused the most problem. Usually the shape of the opening for the cup didn’t match the shape of the cup.

Uncemented cups tend to fracture more often than cemented cups. This may be because more force is needed to set the cup up against the bone. If a fracture does happen, the surgeon checks to see if the hip is still stable. If it is, then bone chips are used to reinforce the fracture site. If it’s not, then the cup is taken out and a new one put in.

Your grandfather may have to wait a little longer to put his full weight on the leg. Otherwise, his rehab will continue as planned. He should be up and about fully in about six to eight weeks.

Intraoperative acetabular fractures don’t happen very often. In fact, a study from Mayo clinic found only 21 fractures out of more than 7,000 patients. Long-term studies of these patients aren’t available yet. The first results are short- or mid-term with follow-up from two to 10 years.

It appears that small or nondisplaced fractures do not affect the life of the cup. X-rays can show if your cup is stable, hasn’t moved, and isn’t showing signs of wear or loosening. If none of these problems occur, you can expect the standard 10 to 15 years of good use from your implant.

She may have what’s called a periprosthetic fracture of the femur. The femur is the thighbone. Periprosthetic means the fracture is in the bone next to the implant. The fracture is probably just below the implant and close enough to the hip to be generally referred to as a hip fracture.

Sometimes joint implants crack or fracture but these cases are usually referred to as implant failure rather than hip fracture. Fracture of the femur is not uncommon in patients with either a hip or a knee joint replacement.

Advancing age puts the older adult at risk for bone fracture. Many of the problems that come with aging are also risk factors for fracture. Other age-related risk factors include osteoporosis, diabetes, and arthritis. Anyone who is already experiencing problems with balance and falling is also at risk for bone fracture. Medications such as corticosteroids can weaken the muscles and bones putting patients at increased risk for falls as well.