FAQ Category: Hip

You mentioned arthroscopic surgery. In this operation, the doctor uses a special tool called an arthroscope that’s inserted into the joint. There’s a tiny TV camera on
the end of the arthroscope. This gives the doctor a view inside your hip joint. Special shaving and suction tools can also go through the scope into the joint.

The doctor uses three things to help in an operation like this. The arthroscope and special curved tools makes it possible to reach all around inside the hip joint. The scope can enter the joint from one of several places. This gives the doctor access to the hard to reach areas. The patient’s hip can also be put in a position that gives the doctor a better view.

Even if a patient doesn’t have stairs in the home, there may be other times when going up and down stairs is needed. Many times older adults avoid going out in public because they are afraid they can’t manage curbs, stairs, or uneven sidewalks.

Social isolation can lead to depression and other problems. Older adults who have lost balance and function can gain confidence with exercise programs that focus on function.

Climbing stairs improves strength and balance. Even without stairs at home, the by-products of this exercise can help with other activities.

There’s a lot of debate around this topic. We know that a small amount of weight through a broken leg actually helps the bone heal. Too much weight and the fracture healing gets
interrupted and delayed.

So depending on the location and type of leg fracture, patients may be told to put a small amount of weight on the foot. It also depends on what kind of fracture brace or cast is applied to the leg.

Hip replacements come in all sizes, shapes, and styles. In someone with good bone density, an uncemented implant is often used. The bone fills in around the implant sealing it in place. Cement is used for older adults with poor bone structure.

Some doctors tell patients not to put their full weight on an uncemented hip replacement. Partial weight bearing is sometimes advised. Too much weight too soon can cause the implant to sink too far into the bone.

Other doctors say full weight-bearing is okay if there are no post-operative problems. More research in this area is underway.

Heterotopic ossification is bone forming in the wrong place, usually between muscle fibers. It’s also called myositis ossificans. Indomethacin is an anti-inflammatory drug. It’s been used the longest to prevent HO.

Newer studies show that another anti-inflammatory (naproxen) may work better with fewer problems. Treatment is usually started the day after surgery. It’s often used for about six weeks. A study in 1998 showed that one week is all that’s really needed to prevent
HO.

Check with your father’s doctor about his need for an anti-inflammatory. If it’s been long enough since the operation with no sign of HO, he may be able to stop taking the drug. Don’t stop this medication without his doctor’s approval first.

Good point. Doctors know that with today’s current implant materials, the hip replacement may only last 10 to 15 years. It may be less if you are highly active in sports and other physical activities.

This means you’ll likely need another hip replacement when you are only 65 years old and maybe a third before your 75th birthday. You’ll lose some bone and height with each operation. There are many other problems that come with revision operations.

On the other hand, pain and disability are hard to live with. If you wait too long, you may not gain back what you’ve lost in terms of strength, function, and physical ability. The patient’s symptoms and ability to tolerate pain for a long time should be considered.

Exercise is a key ingredient to improving balance, strength, function, and overall health. A recent study from the University of South Wales showed the value of exercise up to four months after hip fracture.

They compared three groups: one group did weight-bearing exercises (WBE); one group did exercises without standing up, and a third group didn’t exercise. They found the WBE group did the best and any exercise was better than none.

A physical therapist can come to your uncle’s home and prescribe an exercise program for him. Even better, if he can come to a clinic he’ll get a chance to exercise and interact with other people of all ages. This may help motivate him to continue exercising.

I don’t really have a question as much as I’d like to post a comment. I had a total hip replacement three months ago. Before the operation the doctor sent me to a physical therapist. She told me what to expect for pain and movement after the surgery.

Knowing ahead of time that I might need a walker helped me accept it and use it properly when the time actually came. Best of all, I know it was probably only temporary so I didn’t think twice about it.

I left the hospital and went to a step-down unit where I stayed less that a week. Everyone there said the patients who get therapy before joint replacement move along faster and go home sooner. I highly recommend it!

Predicting results after any surgery is a little like having a baby. Everyone has a different experience. What happens to one patient doesn’t happen to everyone. Doctors and other health care workers don’t want patients to worry by giving them warnings and predictions that might not come true.

Even so, you make a good point and one that’s backed up by a recent study. Researchers in England report a shorter hospital stay, less cost, and greater satisfaction in patients
who received advice before their total hip replacement.

There are many possible reasons for the difference. You didn’t mention how long it’s been since your surgery compared to your sisters’ operations. Many patients expect results too soon. Total hip replacement is a major operation. It takes weeks to months for bone to grow around the implant and help seal it in place. Some of the hip muscles are cut during the operation and must knit back together, too.

The type of implant and method used to put it in place can vary too. Both of these factors can make a difference. Rehab and a home exercise program must be followed carefully for a good result.

Tell your doctor about your concerns at your next follow-up visit. It may just be too early to know what your final outcome will be.

Your mother’s orthopedic surgeon will help you with this decision. It depends on the type of fracture and condition of the bone. Some areas of the bone have less blood supply and won’t heal easily. Thin or osteoporotic bone may not heal either. A pin or plate to hold
the bone until the fracture heals may not work.

An X-ray will show the doctor if the hip joint is stable. The key is to see if the head of the femur (thigh bone) is secure inside the hip socket. If it isn’t, then the joint is considered unstable. There’s a much greater chance for a poor result pinning an
unstable joint. In such cases hip joint replacement is needed.

The decision to have a joint replacement is complex. It involves real and imagined fears. Often older adults have heard “horror” stories from friends after their surgery. Many patients don’t see the advantages of a joint replacement. The best approach may be to
offer as much information as possible.

Ask her doctor for pamphlets, brochures, or videos on this subject. Don’t hesitate to contact the Arthritis Foundation for more information (http://www.arthritis.org. You can call them at 800-283-7800). There’s also another good resource on-line with information just on joint replacements. It’s http://www.jointreplacement.com.

And be prepared to let her make her own decision. Some people see joint replacement as an elective operation. This means it’s their choice and not absolutely needed. They may see the costs as too high for the benefits. This is especially true in their “sunset years.” Costs refer to the financial cost as well as the need for help after the operation.

Joint replacement is an accepted treatment for arthritis. It has been shown to be safe and effective for the majority of patients. Even so, research shows that only 10 percent of patients with arthritis are willing to do it. The patients had all been evaluated as needing a joint replacement.

There are many reasons why patients hold off on this decision. Some do not have accurate information to rely on. They depend on their friends and peers’ results to make decisions for themselves. They may have been told paralysis is likely or that the pain doesn’t go away with the new implant. These fears keep them from taking advantage of this treatment.

Talk to your doctor about the risks and benefits of joint replacement for yourself. Make sure you are a good candidate. Then use accurate medical information to make an informed decision. Don’t rush into it until you are “ready to jump in.”

The standard opening for hip joint replacement is still between five and 10 inches. Not all surgeons use the mini-incision for this operation. Some patients are too large for the mini-approach.

Sometimes the skin is too tight and a longer incision is needed. In other cases, the surgeon needs to see more of the joint so a bigger opening is needed.

Chances are you got the standard incision if you didn’t ask for a small incision before the operation. If you ever have the other hip replaced, be sure and talk with your surgeon about this option.

Many studies show decreases in muscle strength around the replaced hip even two years after the operation. With an exercise program, muscle strength improves from before to after the operation. An even better measure is to compare muscle strength from side to
side before and after the hip replacement.

The joint implant can come loose when muscles are weak or when they function poorly. Muscle weakness leaves the joint unstable and unprotected. A supervised exercise program is advised for as long as possible even up to two years after the operation. This will protect the joint and improve function.

Doing the same exercises may not be best. A recent study showed exercises given early after hip replacement should be advanced to weight-bearing exercises. The best time to move on to this phase is four months after the operation. The patient must be able to stand on one leg without pain. The leg shouldn’t give way or collapse.

Several studies show problems can continue after a total hip replacement (THR). This is true even when pain is reduced or relieved. The reason for this can be decreased muscle strength or a lack of stability on the side operated on.

Patients report reduced walking speed and difficulty climbing stairs even when there’s no pain. Part of the problem may come from weakness and deconditioning. These were present before the operation. Pain and inactivity result in this weak state.

A recent study at Texas Women’s University in Dallas, Texas, showed that exercise even as late as a year after THR can make a difference. Check with your doctor about getting back into a rehab program.

You should get clearance from your doctor before taking up Tai Chi again. Weight-bearing and standing balance exercises are usually permitted. You can add these activities once the tissues are healed and standing on one leg doesn’t hurt.

This may take about four to six months after the operation. Researchers at the Texas Women’s University report exercises balanced on one leg with slow motion movements like Tai Chi works very well. They advise doing this later in the rehab program for total hip replacements.

Patients report less pain, more motion, and better function after doing this kind of exercise program.

Improved cosmetic appearance may be the only real advantage so far. According to a study from the Nebraska Joint Replacement Center, there are no other differences. Researchers
compared two groups with 42 patients in each group.

All patients had the same operation. Group one had the standard incision (five to 10 inches long). Group two had a mini-incision about two inches long. Both groups had about the same amount of blood loss and time in the operating room. Total hospital stay was the
same for both groups.

There were no deaths caused by the operation. One patient in the standard group had a hip dislocation. All other hips (both groups) were in good alignment and without problems.

The authors concluded that cosmetic appeal was the only real benefit of the mini-approach to total hip replacement. Patients who are overweight may not be able to have the less invasive method. Some types of hips require a broader view during the operation. The
mini-incision isn’t for everyone.

You’re wondering about the bias in such a study. It’s a valid and fair question. And one that researchers must ask themselves when setting up the study. There are ways to avoid this kind of problem.

For example, your study is being done after the operation is over. This is called a cohort or retrospective study. This type of study helps limit patient bias. The study takes place after you’ve finished your treatment. The results aren’t biased by what you expect to happen.

The doctor may choose to compare your results with the final X-rays of the hip joint. In these cases, the X-rays are read by a doctor who didn’t do the operation. The radiologist doesn’t know by looking at the X-ray which patients had a small incision and which ones had the mini-incision.

Finally, scientists think that independent researchers reduce bias. These are studies done by people who weren’t the first ones to try something. They aren’t trying to prove something works. They are just looking at the results of using the method developed by someone else.

The small incision is a fairly new method for hip joint replacement. It’s called a mini-incision. Many studies are being done to compare the mini-incision method with the standard way to replace the hip joint.

Right now doctors choose patients who aren’t overweight. Compared to the standard-incision group the mini-incision group is more likely to be male, taller, and thinner. In fact, the standard-incision group is six times more likely to be obese than the mini-incision patients. The mini-group also has fewer problems in general after surgery.

Researchers are working to find out what type of patients is best suited for each method. That information will help doctors guide their patients in choosing the right operation for each one.

There’s always a certain learning curve with any new skill. This is true for doctors, too. Some information is reported about this. Studies show that doctors using the mini-incision method have the same number of problems whether they are in training or not.

A recent study from Stanford Hospital in California reports no difference between doctors with special training and doctors without extra training. They suggest this means the safety of the operation doesn’t depend on the skill of the doctor. It’s more likely the things that aren’t under the doctor’s control make the difference.

If this is true then you are just as safe at home with your regular doctor as you would be traveling to a special center.