FAQ Category: Hip

No one has really answered the question which came first: the broken bone or the fall?

Older adults with brittle or osteoporotic bones are at increased risk for hip fractures. In theory, the forces applied to the bones during a hip joint replacement could cause a fracture. If a patient has extremely weak bones, he or she usually isn’t a good candidate for a joint replacement.

minimally invasive total hip replacement means the opening or incision is very small (about 2 to 2 1/2 inches long). The surgeon can’t really see inside the joint using this method. X-rays are taken to see the placement of the implant. The X-rays also show the condition of the bone. A fracture would have been noticed at the time of the operation.

You may want to ask the physician to review the X-rays with you to satisfy your concerns about this point.

You’ll need to ask your surgeon this question to know for sure. Every patient and every scar is slightly different. Sometimes the anatomy determines where and how an opening is made. Before cutting the patient open, X-rays are taken and the surgeon uses his or her hands to feel where each muscle, tendon, and bone is located.

A curved incision is often used to help the surgeon remove the diseased joint. The capsule around the joint must be cut and the hip dislocated first before removal. A curved incision helps with this process. If the head of the femur is larger than expected, the incision may have to be made longer to get it out.

Sometimes the size of the surgeon’s hands makes a difference. Doctors joke about finding a surgeon with small, but strong hands. There is some truth to this idea!

Doctors and researchers are studying the pros and cons of the minimally invasive (MI) operation. Right now it’s being used to replace hip and knee joints. They are comparing how long it takes patients to recover. Other results are measured by how much blood loss occurs, how long the operation takes, and how soon patients leave the hospital.

Some doctors point out that “minimally invasive” doesn’t always means minimally disruptive. It’s not minimally invasive if the tendons and muscles are cut and moved out of the way no matter how small the skin incision is.

Making a small opening makes it harder for surgeons to find the true margin of the hip socket. The skin along either side of the MI is more likely to tear. This is most likely to happen when the diseased joint is taken out and the edges of the bone are filed smooth.

Many doctors are taking a “wait-and-see” approach. Until more studies are done to compare the standard method to the minimally invasive surgery, doctors will continue to use the traditional incision.

Doctors at the Mercy Hospital Orthopedic Institute in Miami, Florida noticed the same thing. They did a study to find out if the difference is linked to insurance. What they found was insurance coverage is important, but not as important as race or ethnic background.

By the time blacks and Hispanics come in for a hip replacement, they have more severe disease. They are also in poorer health in general compared to whites. Poor health status may be linked to race/ethnicity. It’s not clear if this is a factor of cultural beliefs, language barriers, or genetic differences.

It could be minorities delay seeking help until their arthritis is severe. It could be arthritis is milder in patients of black or Hispanic background. More study is needed to answer these questions.

The labrum is a thin rim of fibrous cartilage around the hip socket. It helps hold the head of the femur in the shallow socket. It gives the hip stability. New studies suggest that labral tears can’t heal without surgery. There isn’t enough blood supply to the edge of the labrum.

Sometimes a piece of cartilage breaks off after the labrum is torn. This forms a loose body in the joint. Over time the loose body gets hard or calcifies. It can cause the hip to lock or catch during certain movements. The loose body can cause more damage to the joint so it must be removed at the same time the labral tear is repaired.

You mentioned “chronic” pain, which suggests you’ve had this problem for some time. The ongoing nature of your condition supports the idea that surgery is needed. If it was going to heal on its own, it would have happened by now.

A displaced fracture of the femur (thigh bone) means the bone broke and the two ends either separated or shifted. In other words, the broken pieces of the bone don’t line up anymore.

Femoral fractures are very common in the United States, especially with the aging of America. The type of fracture you’re describing can cause quite a bit of disability for the patient. Some patients are unable to get back to their former level of function. They may have to give up independent living. They may go from being able to walk to being confined to a wheelchair.

he goal of treatment is always to get the patient back to a prefracture level of function. Treatment is usually an operation to repair or replace the bone. Repair may be done using screws to hold the two ends of bone together until healing takes place. This is called internal fixation. It may be necessary to replace part or all of the hip joint.

There are many factors to consider when choosing the right treatment. The patient’s age, bone density, mental status, and other health issues are important. Most likely the doctors are meeting to confer on which treatment would give your father the best chance for recovery based on his individual factors.

You didn’t mention your age or bone status, two important points in making these choices. Older patients (65 years old and older) with poor bone density may not be able to grow enough new bone to heal a fracture that’s pinned. The hip replacement may be the best option.

Is the fracture stable (fracture line hasn’t moved), separated (bone has drifted apart) or impacted (one side of the fracture is pushed into the other side)? A stable fracture that hasn’t moved or shifted is often treated by internal fixation. This means screws are used to hold the bone together until it heals.

If the fracture can’t be pinned together or if there are serious arthritic changes in and around the bone and joint, then a joint replacement may be needed. According to the results of a recent study, older adults have better results with a total hip replacement.

Hip fractures are common in the aging adult population. Even so, it isn’t clear what the best treatment is for this problem. Most often, surgery of some kind is done. They may pin the broken bones together until healing takes place. Or they may give the patient a joint replacement. Sometimes only part of the joint needs to be replaced.

Older adults who aren’t in pain and who don’t walk may be treated differently. Surgery may be too risky because of age and health issues. It’s the one time nonoperative treatment is considered a reasonable treatment option.

If her bones are fragile enough to break just moving in bed, the doctor may be thinking she won’t tolerate major surgery to repair the break. You (or some family member) may want to make an appointment to discuss this more with her doctor.

A recent report on 851 cases of total hip replacement included information on patient demographics. This refers to data about the patients’ ages, gender, diagnosis, and body mass index (BMI).

BMI is calculated based on height and weight. It helps show how much body fat you have. Healthy risks from carrying too much weight include heart disease, diabetes, and arthritis.

A BMI in the “healthy” range does not always mean the person is fit and healthy. Poor diet and genetics can put an average person at risk for health concerns. Keep in mind the BMI does not take into account body frame. A muscular, large-framed person’s BMI could indicate obesity, but this may not be the case.

The Centers for Disease Control and Prevention (CDC) offer a website with easy calculations of your BMI. You can do this by going to:

http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

Once you’ve found your BMI ask your doctor about a reasonable weight loss plan. Studies show results after a hip replacement are best in patients with a BMI of 30 or less.

You are probably referring to the minimally invasive method of hip joint replacement. The doctor uses special tools and updated X-ray technology to guide the operation with just a small opening.

Surgery of any kind always runs a broad range of risks from minor infection to death. Infection can be a minor skin problem or a deep infection of the joint. This could lead to a failed operation or a second operation. With a joint replacement, fracture,
dislocation, and nerve injury are also possible.

Don’t be afraid to ask your doctor to go over the list of possible problems. Find out if you have any risk factors to be concerned about.

This is a very real concern for some patients. Actually, doctors wonder the same thing. Researchers have been collecting data to help sort out some answers. A recent report of
159 doctors presents the results of 851 total hip replacements (THRs) using this method.

Minimally invasive surgery uses new technology that allows the doctor to make smaller openings into the body. Special tools and X-ray imaging called fluoroscopy
guide the surgeon.

Each surgeon in this study reported on the first 10 patients to get a THR using the MI approach. It turns out surgeons who do more than 50 THRs every year have the best
results. They don’t necessarily get better at the MI method. Their overall experience improves their skills. The only thing that changes as they do more THRs by MI is the amount of time it takes to do the operation and to use the fluoroscopy.

The operation you had is called a minimally invasive total hip replacement (THR). Two small incisions are made: one in the front of the hip and one to the side. Besides the small cuts, there are other important differences from the standard THR.

No muscles or tendons are cut in a minimally invasive THR. The joint capsule is cut, but not removed. The joint itself is removed in several pieces. No cement is used to hold the new implant in place.

Overall, less trauma to the soft tissues and joint mean less pain and a faster recovery time. Patients can stop taking pain killers and get back to normal function faster. In fact most patients are able to put weight on the operated leg the same day as the surgery. Many go home in the first 24 hours.

This is a question many younger family members face as older family members have major surgery such as a joint replacement. The decision is based on many factors. Did the person have a safe driving record before the surgery? Is he taking any narcotics? Anyone taking narcotic pain relievers should not drive.

What type of total hip replacement (THR) did your father have? The standard THR with a full incision usually requires four to eight weeks rehab and recovery before driving. Some patients must wait up to three months.

The newer, minimally invasive operation has a much shorter recovery time. Patients have been reported driving within six days of the operation. In this case, the use of narcotic medication is the only thing holding patients back from driving earlier.

You may be experiencing some loss of strength. This happens in many patients one to two years after recovery from a total hip replacement (THR). Sometimes an exercise program is all you need.

Your muscles can be tested and a specific program of exercises given for any weakness. A regular program of walking 30 minutes at your own pace each day has also been shown to help. Patients do best when they combine an exercise program with daily walking.

It’s a good idea to have your doctor check you over for any medical causes of this change in your function. If you get the all-clear signal make an appointment with a physical therapist for muscle testing and an exercise program. Most programs of this type can be done on your own at home.

It’s likely that your mother was given a printed copy of her exercises. Look around for some handouts with pictures and descriptions of the exercises. If you can’t find it, contact the physical therapist who gave her the exercises. Some of these programs are standard and you can get another copy. They may have a copy of her program in her file.

Studies show that walking every day helps patients with a total hip replacement (THR) to
do other things like going up and down stairs or getting in and out of a chair. If you can, set up a time to walk together at least three times each week. Walking can improve her muscle strength. It also improves posture and overall health, which can help prevent
other problems.

Keep a record of some sort, either a calendar or journal where you write down what she did each day. This can help older folks remember if they did the exercises and what they did. It can also be motivational as the person sees what he or she has accomplished.

Sometimes family support can make all the difference in the world. Studies show that a walking speed of 72 meters per minute is needed to cross the street safely at a traffic light. That’s about 90 yards or the length of a football field.

It might be helpful to see how far he can walk and how long it takes him to go 90 yards. If he can walk that distance within 60 seconds he shouldn’t have any trouble crossing an intersection.

You may want to take him on a trial run. Having someone to walk with who can help navigate the intersection can be very helpful. Some people carry a cane with them when walking alone. Even if they don’t need it, oncoming traffic will slow down when they see a person using a cane.

Ask him about his daily exercise program. Is he still doing the exercises he was given during rehab? Research is showing patients with hip replacements do better if they continue their exercises up to two years after the surgery.

You’re right. Vitamins and herbal supplements can have dangerous interactions with prescribed drugs. They must be reported. Sometimes these products are called
nutraceuticals. Nutraceuticals refers to any food, supplement, or dietary substance that improves health or offers medical benefit.

This can include herbs like ginkgo biloba, ginseng, Echinacea, and St. John’s wort. Antioxidants such as lycopene, Vitamins E, A, and C, and supplements like calcium are also included.

Anyone planning surgery of any kind should go over their complete list of drugs and nutraceuticals with the doctor. This is important because some over-the-counter products
can cause bleeding or decrease the effect of the prescribed drug.

For example you may have heard that grapefruit juice shouldn’t be taken with cholesterol lowering drugs, calcium channel blockers for high blood pressure, and some migraine medications. The juice keeps the body from using and getting rid of these drugs from the
body.

Vitamin K should not be taken by anyone who is also taking Coumadin (warfarin) to prevent blood clots. Warfarin works by stopping vitamin K factors needed to make blood clots. Too much vitamin K can keep the warfarin from doing its job.

These are just a few examples of drug-herb interactions. Your doctor will be able to see if you’re taking anything that could be a problem.

Ginkgo biloba is a natural herbal product advertised as a memory enhancer. It’s used to improve mental alertness and give patients clear thinking. Many older adults use it to prevent dementia. Some patients use it for ringing in the ears and for dizziness.

Ginkgo biloba has an i>anticoagulant property. This means it acts like a blood thinner. It keeps platelets in the blood from clumping together to form a blood clot. That’s good if you are at risk for blood clots. But it’s not good after an operation when bleeding doesn’t stop.

It’s always best to follow the advice of your doctor and nurse. It’s just for a short time until your body returns to normal. Be sure and ask when you can resume taking it again.

Blood clots or thrombi occur more often after hip and knee surgery than any other orthopedic procedure. They affect between two and 10 percent of adults age 65 and older. In fact, advancing age is a risk factor for blood clots to form.

There are two main reasons blood clots form after total hip or total knee replacement. The first is the body’s response to what it considers an “invasion” around the major blood vessels to the leg. The system sends out messages to the blood to “get ready” for bleeding. The best way to combat bleeding is to form blood clots to plug any holes in the blood vessels.

Secondly, during the operation, the major vein to the leg (femoral vein) gets kinked. This stops blood flow to the area below the kink. The result can be injury to the vein. Injury once again sets up a series of steps the body takes to form a blood clot.

You’ll want to ask your doctor this question for the answer specific to your situation. Known factors that put patients at increased risk for blood clots include: