FAQ Category: Hip

Doctors and nurses will both tell you and your sister the importance of taking pain meds early on. The sooner your sister gets up and moving, the faster she’ll recover. Pain pills will help her work harder and rest better.

Narcotics like Oxy Contin or Percocet are often used for moderate to severe pain after major surgery. Physical dependency on drugs of this type occurs with long-term use. Most patients after hip replacement only need this kind of pain control in the first week to 10 days. The idea is to get control of the pain before it controls the patient.

Encourage your sister to take the drugs as they were intended to be used: on a short-term basis to control the pain and allow early movement. Hopefully she will see the common sense of this approach. Ask the nurse and doctor to keep explaining it to her. With a team approach she may be more willing to yield on this issue.

Even with today’s modern imaging devices, bone fractures simply don’t always show up during or after the operation. Most surgeons are very careful to take postoperative X-rays before the patient even leaves the operating room.

A hairline fracture may not show up until the patient puts enough weight on the leg to further stress the bone. Pain on weight-bearing is a classic sign of a fracture. It’s good the diagnosis was made before she walked enough to displace the bone.

Studies show that most fractures related to hip joint replacement occur in older, obese women. Sometimes the size of the implant stem isn’t a good match for the patient and a fracture can occur. Sizing implants can be very difficult, made worse by the patient who is osteoporotic.

Pain control after major orthopedic surgery has really come a long way. General anesthesia (putting the patient to sleep) was the standard way to operate for years. But there were serious problems with blood loss and blood clots.

Over time doctors have been able to narrow the anesthesia down to the specific area being operated on. This is the use of nerve blocks called regional anesthesia. The risk of blood clots is much less. Patients are also less likely to have nausea, vomiting, fever, and breathing problems.

Postoperative pain is still a problem. The latest effort to control pain after a hip replacement is the continuous use of nerve blocks. The doctor keeps the leg from feeling any pain for hours to days after the surgery. The hope is to find a drug that will do the same thing but still allow the patient to go home.

For now, a combination of anesthesia and narcotics seems to work well. Each patient is different so it’s never clear what dose of each drug is ideal. Doctors and nurses must adjust both to find the optimal treatment for each person.

Many studies have been done comparing these two types of anesthesia. With general anesthesia, the patient is put to sleep for the entire operation. The advantage is the patient doesn’t feel anything or remember anything. However, there are various problems possible with general anesthesia. Blood loss and blood clots head the list.

Regional anesthesia puts the local area like an arm or leg to sleep so it is insensate or “nonfeeling.” There are fewer complications with a regional anesthesia. The patient must still be sedated but the anesthesiologist controls how much drug is needed for each person.

The regional anesthesia doesn’t wear off right away so the patient has a longer pain free period of time after the operation. This helps the patient get up and get moving again without fear of pain. Motion is lotion and can help speed up recovery.

Actually, they can keep your leg numb but then you can’t walk on it and movement is important. The same peripheral nerve block used during the operation can be used afterwards as well.

The problem is there’s no way to separate out the sensory from the motor portion of the nerve. The patient’s leg is both numb and unable to move under voluntary control. Injury from an insensate leg is a real concern. And there is a risk for toxicity from the anesthesia to persist.

Patients must be selected carefully for this kind of treatment. Patient education is very important. For patients to go home with continuous nerve blocks there must be close supervision to prevent accidents and injuries.

Studies are underway to find drugs that can do exactly what you suggest. With a time-released capsule, patients could go home under their own steam but with far less pain. Nerve blocking drugs that last 48 to 96 hours would be very helpful.

Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) are very similar tools. MRA is basically MRI for the joints. It is more accurate in detecting joint problems. MRI can confirm there’s a problem in the joint. MRA shows exactly what is the abnormality.

CT scans work well for bone lesions around the hip. CT scan shows places where the bone might have a tumor, abnormal anatomy, or necrosis (dead cells).

If you ever need surgery on the hip, advanced imaging studies of this type are very important. The more details the surgeon can see ahead of time, the better the surgical plan with no (or very few) last minute surprises.

Playing soccer may not be the issue. Studies show it’s the sports injuries players get that increase the risk of osteoarthritis. Ankle and knee injuries are common among soccer players. Since these two joints are in a direct line-up with the hip, it makes sense that such injuries can lead to arthritis later.

Another risk factor for injury and thus arthritis is left-leg dominance. At this point we know more about what isn’t a risk than what is. In studies of soccer players ages 12 to 18, there was no apparent increase in risk of injury linked with body size or type, balance, strength, or flexibility. Preseason play didn’t seem to make a difference either.

Thigh pain after total hip replacement (THR) has been reported by patients. As few as two percent and as many as 40 percent of THR patients have said they have thigh pain. There aren’t a lot of studies on the problem.

According to a recent report patients with thigh pain have trouble with daily activities. They say it doesn’t affect their overall quality of life any more than someone with a THR without thigh pain.

There may be a problem that can be fixed. Make an appointment with your orthopaedic surgeon to make sure the pain is coming from the implant. It could be caused by a low back or sacroiliac problem. If it is the implant, then revision surgery may be all that’s needed to get you back on your feet and going at your regular speed.

You may want to ask your doctor about having both hips done at the same time. If you are in good health and qualify, this may be the best option for you. Without the stiffness and pain on the nonoperative side after a single replacement, you can move along faster in rehab, too!

There’s also a cost savings. Even though you’ll be in the hospital longer than if only one hip was done at a time, the overall number of days is less when both hips are done together.

You can have bilateral hip replacements in one of three ways. First, they can both be done in the same surgery. Second, you could do one and finish rehab before having the second one done. There’s usually at least six to eight weeks between operations. Some people wait longer. Third, you could have one hip done and wait five to seven days. If your health is stable and you’re up for it then have the second one done. With this third method, you don’t leave the hospital between operations.

If you still opt for one hip replacement at a time, then a physical therapist will help you. Your home may need to be adapted to make toileting, bathing, sleeping, and household chores easier. You will likely need a family member or live-in assistant for a few days to weeks, depending on the speed of your recovery.

Depending on when your father had his hip replacement, we may have good news for you. Preventing blood clots after orthopedic surgery has been a concern of surgeons for a long time.

Back in the 1970s and 1980s aspirin was used most often as a blood thinner and anticoagulant. The aspirin reduces the number of platelets in the blood making it more difficult to form a blood clot.

Later Coumadin (also known as warfarin) was developed. It has a different way to interfere with blood clotting. Today newer low-molecular-weight heparins are used with much better results.

Blood clots can still form and deaths occur as a result. The death rate after a single hip replacement is very low (less than one percent). More up-to-date rehab programs are also credited for better results.

Talk with your surgeon about this concern. You may find that his or her mortality rate is even lower than the average. Some studies report no deaths related to blood clot formation after this operation.

Many people with osteoporosis have had total hip replacements. Often the hip breaks and it can’t be repaired because of the osteoporosis. Doctors have special ways of handling such cases.

They use cement to hold the implant in place. They can choose implants that don’t need the inside of the femur (thigh bone) to be drilled out. They are more likely to use an open method of surgery instead of the newer mini-incisions.

Ask your doctor for his or her opinion. A decision can be made based on your X-rays and bone mineral density studies. Your overall health is a factor and whether you smoke. Tobacco-use delays wound healing and increases your risk of a fracture. If everything checks out, you could be a good candidate for a hip replacement.

The answer to your questions really depends on the surgeon. If the mini-incision method is fairly new to the surgeon, the operation itself can take longer. If all things are equal (the doctor has done the same number of both operations: open and mini), then the time is about the same.

Length of hospital stay also varies. The hope is that the newer mini-incision method will mean a shorter hospital stay. But hospitalization may be longer if there are any complications during or after the operation. For example, fractures and dislocations may happen more often when a surgeon is learning a new technique.

A recent study from the University of Missouri reports on this. An experienced surgeon had an overall rate of 42 percent for problems after a two-incision mini-invasive hip replacement. That was compared with six percent for the single-incision method. The surgeon also reported a 25 percent rate of nerve injuries. Any of these (or other) problems can extend a patient’s stay in the hospital.

The smaller incisions for the mini-incision joint replacements definitely mean it’s harder for the surgeon to see all the anatomy. They do use a special X-ray called fluoroscopy that allows them to see inside the joint. It’s not quite the same as the standard open method.

The nerves can get cut when the surgeon replaces the hip from the front or anterior approach. The lateral femoral cutaneous nerve is one cut most often. Numbness in the thigh is the most common complaint. Itching, burning, and tingling are also possible. The symptoms can be mild to severe.

The problem usually goes away gradually over time. It can take up to a full year or longer. Occasionally there is permanent nerve damage.

Many possible disadvantages have been reported. Most have to do with the small visual field. Some relate to learning a new method. Surgeons often have better results the more times they do the operation. Early attempts may have poorer results or more complications.

Sometimes one factor leads to another and another. For example, it might take longer to do a surgery that’s new to the surgeon. Longer operating time means longer exposure to anesthesia. Longer surgery time also leads to higher risk for blood clot or infection.

Overall not being able to see clearly inside and around the joint is the surgeon’s biggest drawback. Finding the anatomy to guide each incision makes a difference. Implant placement and function depends on finding the landmarks and vital structures.

The quick and easy answer to your question is “about a month.” But that varies from patient to patient. Return of function can take longer if there are serious health issues or problems after surgery.

This timeframe is based on a large study of 1,000 patients having a minimally invasive total hip replacement. One surgeon did all the operations. Patients were seen after the operation at six weeks, three months, one year, and then once a year.

Everyone was asked to report on when they were able to get back to their normal routine. The patients reported on the time it took to get back to work, drive, do their household chores, and get back to any recreational activities.

The average length of time to recovery was 4.2 weeks. There was a range from one to 11 weeks. This means that some patients were able to get back to their normal activities within a week. Other took much longer than the average person.

You ask a very good question. Perhaps only a surgeon can really appreciate the difference between the two operations. A total hip replacement is invasive no matter how it’s done. A better way to look at it is to say it “minimizes the invasiveness”. From a patient’s point of view, it certainly does sound invasive.

The first difference and reason why it’s called “minimally invasive” (MI) is the length of the scar. MI means the incision is about two inches long. A full incision can be up to eight or 10 inches long.

During the operation fewer muscles are cut. New tools allow the surgeon to gently move structures out of the way to get to the hip. Anything that is cut is carefully repaired and put back in place.

More and more surgeons are getting trained in this new technique. We can expect it to improve even more over the next few years.

Total hip replacement (THR) is used more and more now for patients with arthritis and other hip problems. There have been many changes over the past 10 years in how this operation is done.

The type of incision used depends on a couple of things. The first is surgeon’s preference. Some of that comes from how he or she was trained. The type of implant used can make a difference in the kind of surgery the patient has done.

The most recent advance in THR is the new, minimally invasive surgery. Only one small incision is made. It could be in the front, along the side, or in the back. Research shows there’s no advantage of one placement over another. It usually depends on what the surgeon prefers.

Longer scars suggest the person had the standard open-incision method of hip replacement. A small scar occurs with the minimally invasive approach.

Good question! Sometimes the patient’s symptoms don’t match the underlying pathology. So you can end up with pain, stiffness, loss of motion and function, and still only have a “mild case.”

First, let’s review heterotopic ossification. Literally, this is the growth of bone in the wrong place. Most often, islands of bone form inbetween the fibers of muscle. It’s not a tumor, so it won’t cause death. However, it can be painful enough to make you wish for death!

Grade zero means there’s no heterotopic bone formation present. Grade one is the presence of islands of bone within the soft tissues. If bone spurs occur, but the joint space is
still good, then it’s given a grade two. Grade three is with bone spurs and a narrow joint gap (<one cm). In grade four, the bone grows across the joint. The higher the grade, usually the greater the symptoms.

Fortunately, it can be treated even when it’s a “mild grade.” Ask your doctor what are your treatment options and what he or she recommends.

Heterotopic ossification (HO) or the overgrowth of bone is not uncommon after any trauma to the hip area. Total hip replacement tops the list. Doctors hope to find ways to
tell who might get HO and how to prevent it. This would be much better than trying to treat it after it occurs.

Right now, radiation therapy can be used to treat HO. Patients are understandably
concerned about the possible side effects of radiation. Also the cost of this treatment can add up. Another option is the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

There are many different kinds of NSAIDs. Researchers are trying to find out which one(s) work best. The newer NSAIDs have fewer side effects on the gut, a common problem with aspirin and other anti-inflammatory drugs. These newer NSAIDs are called COX-1 and
COX-2 inhibitors.

It’s not clear how COX-1 and 2 inhibitors work to prevent HO. Maybe they suppress bone formation by stopping early stages of inflammation that occur with bone growth. Or maybe
there’s a direct effect of the inhibitors on the base cells that form bone cells.

In some cases surgery is needed to cut the bone fragments out. This can damage the nearby muscle tissue and must be done carefully. Even with the best surgeon, problems can occur. Treatment often depends on how severe the problem is and how much it’s bothering the
patient. Check with your doctor about your case and see what’s advised.

Doctors want to predict and prevent blood clots after surgery. Knowing a patient’s risk factors is the first step in that process. Having a previous blood clot puts you at increased risk, but it doesn’t guarantee another blood clot. Make sure your spine surgeon
knows about your previous history.

Scientists think the risk of blood clots is greater after surgery to the legs compared with surgery to the spine. But the statistics aren’t all in for spine surgery yet, so this is a little unclear. Other risk factors include being overweight, a long period of
immobility or bedrest, and heart problems.

For a long time, doctors thought drugs to thin the blood and prevent blood clots from forming was the best way to go. More recent studies have called this into question. The problem of bleeding too much from taking blood thinners during spine surgery concerns
doctors, too.

Until more is known about this issue, keep the lines of communication open with your doctor. Tell him or her your concerns and find out what steps will be taken to prevent and treat blood clots.