FAQ Category: Hip

Bead shedding means the implant has come loose. The hip joint may be replaced with a variety of material, including metal, polyethylene, and ceramic. With metal implants, tiny pieces of metal come loose from the surface of the implant. Bead shedding has also been reported with other types of implants.

Bead shedding causes abnormal motion and then pain occurs. It’s the most common cause of joint replacement failures requiring revision. Scientists aren’t sure how to keep the problem from happening a first or second time. They are actively studying the problem by trying different materials with and without cement to hold the implant in place.

Ask your mother’s doctor if there is any way to tell what caused her problem. Be sure and mention your concern about the problem occurring again. Her doctor may already have a plan in mind for preventing this from happening.

The scour test is usually done when a patient has hip pain of unknown cause. The examiner bends the patient’s leg up so the knee is pointing to the shoulder. The examiner moves (scours) the hip in an arc of motion while putting pressure down through the leg
into the hip joint.

The object is to look for any “catches” or bumps in the joint movement. Pain or apprehension on the part of the client are also positive findings during the scour test. This tells the doctor or therapist that the problem is coming from the hip joint and not some other source.

It’s not a given that if you have arthritis in the knee, you’ll get it in the hip. But there does seem to be a link between the two. Perhaps hip problems start when knee pain
results in a limp or altered way of walking.

Problems above or below the impaired joint are common. Change in weight shift, weight-bearing, and balance can lead to a change in the hip or ankle joint. The hip is especially prone to end up with decreased function.

Physical therapists are actively researching ways to prevent this from happening. Finding hip problems early may be a start. If you are having pain and stiffness from knee arthritis, ask your doctor or therapist to check the hip on the same side and the knee
and hip on the opposite side.

A recent study from Mayo Clinic reports on advice given patients by surgeons after total hip replacement (THR). Doctors were shown 12 positions used during sexual activity and asked to mark each one as acceptable or unacceptable. They did this for both male and female patients with a THR.

Five positions for men and three for women were agreed upon by 90 percent of the doctors. The best position is standing with the male partner behind the female. The woman is supported by a pillow against a firm object or piece of furniture. Both partners are bending forward but with less than 90 degrees of hip flexion.

Avoiding extreme positions of hip flexion, internal rotation, and adduction (crossing the midline) is still advised. Pillows can be used to help support the body in acceptable positions.

Doctors vary in their advice on this point. Those who do more operations suggest the same amount of time for healing before resuming sexual activity. Others say a longer time is needed for the patient who has had a revision.

With more time after a revision surgery, the tissue around the joint and the muscles can heal fully. These tissues are often disrupted more during revision compared to the first implant operation. Revised hips have a slightly higher rate of instability compared to first (primary) hips. A longer period of protection might be best.

Check with your surgeon first. When resuming sexual activity, avoid positions with full hip flexion. Don’t torque or twist the hip inward. Keep the thigh in line with the body, and don’t bring it across the midline of the body.

Yes! Total hip replacements (THRs) can be done with much smaller incisions now. This is called minimally invasive arthroplasty. The same implants are still used with this method, but new devices are being developed that will change how the surgery is done.

Cutting tools and surgical instruments are also changing. New computer technology will make it possible for surgeons to put the implant into a much smaller space. A smaller incision can be made and less damage to the soft tissues around the joint.

It’s not clear yet if patients getting THRs this new way have the same outcomes as the more traditional approach. Studies are underway to compare the two methods. It may not be worth it to get a patient up and going sooner if the implant fails in the end.

Several countries such as Sweden, Australia, and Canada, have a National Joint Registry (NJR). They keep track of results for hip and knee replacements. They use the data to measure long-term results of these implants. This kind of monitoring helps doctors find out quickly about any problems with joint replacements.

The NJR adds up the number of implant failures. It can sort out which implants have the highest failure rate and which are most successful. Information from a national registry can also help doctors find out what risk factors are likely to cause implant failure. A NJR also helps monitor how well each hospital performs in this area of health care.

The American Academy of Orthopaedic Surgeons (AAOS) has started a pilot joint registry program. It will last 18-months and involves 10 hospitals. About 1,250 patients were started in January 2004. Collecting data will start in April and go for 12 months. By June 2005, the results of this trial run will be known. Then the AAOS Board will decide whether to start a national program.

Yes it’s true according to a new study just released by McGill University in Canada. They compared 940 Canadian and 739 American patients. All received a total hip replacement (THR). Costs were recorded. Canadian costs were converted into U.S. dollars for comparison.

The researchers found the total cost of a THR in the U.S. is twice as much as the same operation done in Canada. It appears there are two major factors behind this difference. One is the cost of the joint implant itself. Prices can vary as much as 700 percent from one hospital to another.

The second factor is the type of health care system. Canada has a national health system funded by the government. Services are rationed out. Follow-up and rehab after THR are not included as part of the services offered. Even though Canadians stay in the hospital longer, without these added services, the total cost is less.

The first thing to do is meet with the hospital or surgical center where you’ll have the operation done. Let them know your concerns and ask them to work with you to find creative ways to reduce your costs. Even something as simple as making your own cold packs or using your own supplies can make a difference.

Let your doctor know your situation. Health care professionals can give patients a discount. A recent report from McGill University showed extreme variations in the cost of the joint implant from one hospital to another in the United States.

Ask your doctor for a price quote on different types of implants. He or she may be able to get a discount from the supplier as well.

Finally, follow all of your doctor’s advice carefully. This can help you avoid costly complications. You may be able to go home early if you have good family support. Even one day of hospital expenses saved can add up in terms of costs.

Korea doesn’t have any home-based supplier of joint implants. For this reason, they rely on five United States-based firms. There are other suppliers in Europe, but the United
States supplies about 70 percent of the market for hips and 90 percent for the knee.

Korea is only one country that relies completely on an imported supply of artificial joints. However this may be changing as these countries are preparing for their own production of joint implants.

The demand for joint replacements is expected to go up even more. In Korea knee replacements are at an all time high. This may be because Koreans squat, which puts increased pressure on the knees. Korean women over age 60 with arthritis are a growing group in need of joint replacement.

According to a large study of patients with hip fractures, the average age was 82.4 years. Patients ranged in age from 65 to 118 years old. More than three-fourths of the hip fractures were in women.

Besides age, the biggest risk factor for hip fracture is a condition called
osteoporosis. Bone loss called demineralizationis common with osteoporosis. Bones weakened by osteoporosis are more likely to fracture.

Other risk factors include the use of some medications and poor health. Conditions like high blood pressure, cancer, and congestive heart failure put a patient at increased risk of falls and fractures. Chronic asthma, chronic emphysema, and diabetes are other health
issues that increase the risk of fracture.

There are many ways to prevent falls. Drugs to improve bone strength are now available. Talk to your grandmother about your concerns. You may want to go with her to her next doctor’s appointment.

Adopting a team approach to this potential problem is best. Involve a physical therapistas well. The therapist can test your grandmother’s balance, strength, and coordination. A home program of exercise can be designed to help prevent falls. The therapist can also help your grandmother modify her home to remove any obstacles or hazards that can contribute to falls.

Scientists aren’t entirely sure. It may be that the injury itself leads to death. It’s more likely a sign that the person is in poor health or has frail bones. These factors can lead to falling and bone fractures.

To put this in perspective, studies show that death is rare after orthopedic operations. About one percent of all patients die after bone or joint surgery. Three percent of patients with a hip fracture die after surgery to repair the hip.

The biggest risk factor is age over 70 years. The second biggest risk factor is congestive heart failure.

The answer to this question lies more in the fact that a fracture on the weekend may not get treated until Monday at the earliest. Often the surgery schedules are full for Monday and the patient must wait until Tuesday.

Surgical delays caused by low staffing on weekends are the real culprit, not the fact that the break occurred on a Sunday. A recent study of over 18,000 patients with hip fracture showed a much higher chance of dying in patients whose surgery was delayed two
days or more.

Some doctors say you can engage in sexual activity as early as four weeks after a hip replacement. Most advise between one and three months. The longer you wait the better your chances are for good wound healing and recovery of the muscles and other soft tissues.

Most tissue is healed within six to eight weeks although age, poor nutrition, and smoking can delay healing time. Healing can also take longer if you have other health problems
such as diabetes or heart disease. Pain and stiffness from arthritis affecting other joints can also make a return to sexual activity more difficult.

Don’t be afraid to ask your doctor to give you some guidelines. Ask him and her how long to wait and what positions are best at this point in your recovery.

Several studies have shown that physical therapy helps people regain function faster after hip fracture. The advantage is that with improved strength and motion, the person can return to regular daily activities sooner. This improves quality of life and psychologic function.

A post-fracture physical therapy program also helps restore balance and coordination. These skills help prevent future falls that could result in another hip fracture or other injuries.

As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”

First make an appointment with the hospital social worker and/or case manager assigned to your father’s case. They will help you find out what’s available in your area.

There are usually several options. Finding the right fit for your father and the family is the goal. Finances usually play a key role in the decision, too.

Sometimes there’s a rehab or extended care facility linked with the hospital. Your father may be able to transfer there for additional services before going home. It’s also possible to have a home-based program. A nurse and a physical therapist will come in several times a week to assist him.

Many people are able to function better in the comfort and familiarity of their own home. With a little in-home help they regain their function faster than you might imagine.

First of all, the new hip joint is likely to reduce your pain and improve your function. It’s up to you to now increase your activity level.

If you can keep your intake of calories the same while increasing your activity, then you might be able to lose some weight. At the very least, you should work toward not gaining any more weight.

Studies do show that obese patients put increased loads on their joints. Grossly obese people may reduce their activity enough to balance out load on the joint.

A recent study was done looking at body mass index (BMI) and hip motion and function after hip replacement. Hip function was less as body weight increased but overall the change was minimal.

Tobacco use and previous history of thromboembolism (blood clots) top the list of concerns. These two combined with any of the following increase your risk of surgical complications:

Most doctors are using body mass index (BMI) to decide if/when a patient is at increased risk from obesity. The BMI corrects the weight of the patient for their height.

BMI is calculated from the weight divided by the square of the height. A score of 20 to 24 kg/m² is the ideal weight. From 25 to 29.9 kg/m² is considered overweight. Obese is listed as 30 to 39.9 kg/m². Anything 40 kg/m² or more is morbidly obese. Morbid means “dangerous” or life threatening.

Most likely if you fall into the last two groups your risk of complications or problems is much greater during or after surgery. Since the doctors have suggested a 100-pound weight loss it’s likely you are in one of these two categories.

You raise a good point. Some doctors have their patients see a physical therapist before the operation. During this session you will learn how to do the exercises after the
operation. The therapist will go over what to expect and how to walk with crutches.

You’ll still need someone to walk with you the first few times after the operation. The therapist will remind you how to use the crutches. It’s easier to remember how to walk with the crutches afterwards if you’ve practiced before.

Pain medications can make walking more difficult. The nursing and physical therapy staff will watch your vital signs. A safety belt is used until you are steady and able to walk alone.