FAQ Category: Hip

There have been a few cases of persistent bleeding after surgery caused by herbal self-medication. Usually the patient forgets to tell the doctor that he or she is taking a supplement such as St. John’s wort, ginseng, or ginkgo biloba.

Gingko biloba has an anticoagulant property much like aspirin. This means it prevents the blood from forming clots. That’s important for patients at risk for heart attack or stroke, but it’s a risk factor for anyone who’s just had surgery or who has a bleeding disorder.

he most recent report of gingko biloba causing oozing from a wound after surgery comes from Wales. A 77-year old woman had a hip replacement without problems. Afterwards, the wound site drained blood and a clear fluid for three weeks. When it was finally discovered she was taking gingko biloba and she stopped taking it, the problem cleared up within 10 days.

Pain from one area of the body can be referred to another part of the body.Back pain can be caused by the hip. The opposite is true, too: hip pain can be caused by a problem in the spine.

Sometimes the pain is close by but at other times it can travel far away from the source. A standard rule of thumb for any part of the body is to check for problems at least one level above and below the site of pain.

There are special tests that can be done to find out where pain is really coming from. For example rotating the hip inward can help screen for problems coming from the hip. Likewise, bending the hip and knee and putting pressure through the hip can help identify back versus hip pain. Your doctor has probably used these tests to come to this diagnosis.

The final proof will be in treating the hip. Expect to see your back pain go away by improving hip motion and function.

You’re right. Studies do show that the outcomes for hip and total knee replacements are better when done by surgeons and hospitals with high-volume. There are fewer problems, fewer readmissions, and fewer (if any) deaths. The same is true for patients hospitalized for hip fractures and total shoulder replacements (TSR).

Low-, medium-, and high-volume may be defined differently from study to study. For example, there are more total hips and total knees done each year across the U.S. compared to total shoulders. The number of cases in a high-volume center will likely be much higher for hips and knees compared to shoulders.

In a recent study of shoulder replacements, fewer than four operations per year is low-volume. More than four per year but less than one each month defines middle-volume. High-volume hospitals did at least one TSR each month.

Since TSRs are rare compared to total hips or total knees, some surgeons may only do one a year. Outcomes are better when surgeons do at least one TSR per quarter. Results are even better when a surgeon does TSRs once per month.

There’s still quite a bit of debate over the advantages and disadvantages of a shorter incision for total hip replacement (THR) surgery. Some studies show patients walk sooner and get out of the hospital faster. Other studies show no difference between the standard incision and the new mini-incision.

A recent study was done comparing 104 patients with a mini-incision to 105 patients with a standard incision. The surgeon was used to doing many THRs each year. There were only small differences in the two types of surgeries.

Surgery time and blood loss was the same for both groups. Pain levels and medication used for pain was the same between groups. Pain levels and walking ability were measured six weeks later. There was no difference between the two groups.

More studies are needed to compare short-term and long-term results with both types of incisions. For now it’s clear that you may not go home any sooner but you won’t be delayed either. The hospital stay seems to be linked more closely to anemia present before the operation and made worse from blood loss during the operation.

A second surgery or revision surgery may be needed. X-rays should be taken (if they haven’t been already) to find out what the problem is. There could be a bone fracture or malalignment of the implant.

Sometimes the angle of the hip into the socket isn’t enough to keep it from slipping out. In other cases the muscles that help stabilize the hip are weak, never healed, or even ruptured.

Rarely further repairs or revisions can’t help or may make the patient worse. It’s always a good idea to ask for a second opinion when a second surgery is needed. You may even want to look for an orthopedic surgeon who specializes in hip surgery and specifically hip revisions.

Total hip replacement (THR) using the minimally invasive (MI) approach is fairly new. It isn’t done by every orthopedic surgeon. The first step is to find out who does this type of THR in your area.

he second thing to look for is a surgeon who has taken a course. Ask if he or she has received direct training before doing this operation alone. Third, ask how many THRs the surgeon has done using the MI method. It’s best to find someone who does a high volume of these operations.

Studies show there are fewer deaths at hospitals and centers where a large number of surgeries are done. New research suggests this is mostly because the surgeon has done many similar cases.

Hemoglobin helps transport oxygen into the cells and carbon dioxide out. It is also a measure of how many red blood cells are in the blood. Normal hemoglobin ranges from 12 to 15 g/dL in women and 14 to 16.5 g/dL in men. Patients are followed more closely when levels drop below 10. The patient is very tired and may need a blood transfusion when levels drop below 8 d/dL.

Hemoglobin levels before an operation can help predict who might need a blood transfusion after surgery. Patients with low hemoglobin levels are at greater risk than patients with normal hemoglobin levels. Of course, a blood transfusion depends on how much (if any) blood was lost during the procedure.

Blood loss and transfusion usually means a longer stay in the hospital. On the other hand patients with good hemoglobin levels before coming into the hospital are more likely to go home sooner after surgery.

You may be referring to a doctor called an arthroplasty fellow. The doctor is usually in a 12-month period near the end of training to do surgery. The Fellow already has good surgical skills. Now he or she is going to focus on patients having a joint replacement. This gives the surgeon a chance to observe, assist with, and later perform a large number of joint replacements.

A senior surgeon mentors and supervises the Fellow. Any steps in an operation done by the Fellow must be done with the senior surgeon present. The operation may take a few minutes longer than normal. Studies show there’s no greater blood loss or increased risk of complications after the operation when a Fellow assists.

The Fellow is also expected to be involved in a research project. At the end of the year an article is written to present the results of the study. You will likely be in good hands with no greater risk of danger than if the senior surgeon was alone.

Any operation has certain risks and possible problems that can occur. The new minimally invasive method of total hip replacement (THR) is meant to reduce those problems. By making a smaller incision there may be less blood loss and less damage to the muscles.

In theory the patient gets better faster. In practice this isn’t always the outcome. Many studies have come out now showing no major advantage of the minimally invasive THR. A recent report of three cases in North Carolina showed how extreme problems can occur.

This and other studies repeat the same messages:

Standard total hip replacement is done with an incision long enough to open the hip joint (about four to five inches). Several major muscles to the hip are also cut away. These are reattached later with the standard method.

The newer minimally invasive operation uses an incision that’s only 1 1/2 to 2 1/2 inches long. The joint capsule and nearby muscles are left alone. There may not be big cost savings with the mini-incision. You may have less blood loss. Usually patients donate blood to themselves before the operation for use during the operation.

If your hospital stay is shorter with the mini-incision then your rehab may take longer. When all things are equal, patients in both groups (long or short incision) spend about the same amount of time in rehab.

Each surgeon has his or her own patient criteria for the new minimally invasive surgery for joint replacement. This is common practice when a new approach is being used. It’s better to hand pick patients who are “safe” and most likely to have a good result.

Right now patients are chosen on the basis of weight first. Overweight or obese patients don’t qualify for the new method. A previous surgery on that joint may also disqualify you.

Major arthritic changes or damages from any disease to the joint might require the standard surgery with a larger incision. Some surgeons start out using a smaller incision and then only extend it if needed. The decision isn’t made until the middle of the operation.

You’ll have to find out what kind of patient your surgeon is willing to use the new shorter incision on. You may not know if you’re a candidate until the doctor has examined you and taken X-rays.

Studies comparing patients with the standard length incision and the new shorter incision are now coming available. The results are, indeed, mixed. But there may be some very real ways to explain the differences.

Patient selection is a big factor. Obesity, previous hip surgeries, and smoking are all risk factors that might keep a patient from having a good result. Sometimes the size of the incisions makes a difference. For example, The results won’t be much different if the minimal length isn’t much different from the standard length.

A recent study from a surgeon who has done over 1300 minimally invasive hip surgeries may shed some light on this topic. In this study, one surgeon, one anesthesiologist, and one physical therapist saw all patients. With the same staff for all patients, data from both groups of patients (short and long incision) was uniform.

The minimally invasive group had less bleeding during the operation. They were also less likely to limp during the first six weeks of recovery. There was no difference between groups by the end of one and two years.

Experienced surgeons say the minimally invasive method is safe. A general consensus still isn’t out one way or another.

Implants made of metal have a thin coating around them to prevent flecks of metal from going into the body and blood stream. This coating can breakdown, releasing potentially toxic chemicals into the body.

Several studies have been done that show an increased number of patients with metal hip implants developing cancer. Leukemia and lymphoma are the two types of cancer seen in patients with cobalt-alloy total joint replacements. The same has been reported for metal-on-metal hip replacement.

There’s no proof yet that the metals are the problem. More study is needed before we know for sure.

Your levels are perfectly normal if the figures you reported are accurate. Nickel and chromium don’t usually accumulate in the body despite the fact that they are present in soil, water, and many foods.

For this reason, “normal” levels are very low. That’s why these nutrients are usually referred to as “trace” minerals. Normal values are set at 0.3 ng/mL for nickel (upper limit is 1.1 ng/L) and 0.15 ng/mL for chromium (levels vary in people from different parts of the world).

Scientists are researching the effect of metal implants on blood levels of these trace minerals. There may be some long-term effects but not enough information is availble yet to say for sure.

Age by itself isn’t a risk factor for hip dislocation. But age added to mental confusion is linked to hip dislocation. Post-operative confusion is not uncommon in older adults after surgery. It may or may not go away but it usually takes a few weeks to a few months.

It may be necessary to have some extra help at home during this recovery time. Check with the doctor first to make sure there isn’t a medical cause for the confusion. Sometimes drugs or drug interactions can cause confusion. Changing the drug or the drug dosage may be all that’s needed.

Americans are living longer and in better health. This means they are more likely to need a major joint replacement as they reach their 80s. Joint replacements are available for the shoulder, hip, or knee.

These operations do put older adults at increased risk of problems.

Studies of 80-year old (and older) adults compared to younger adults show there is an increase in the number of serious problems that occur. But the overall rate is low, and it’s more likely to happen in elderly patients with other health problems.

Results should be good if your grandmother is in good health and the doctor has approved the surgery.

It’s best to ask your doctor for his or her guidelines. The type of implant (cement or cementless) makes a difference. Your age and weight, the condition of your bones, and your general health may factor in, too.

A recent survey showed that doctors don’t all use the same timeframe for activity restriction. An average of recommended time for each activity you mentioned would be as follows:

Muscle weakness is the usual cause of a limp while walking. Three to six months after a total hip replacement, the muscles around the hip are still only at 50 percent of normal. Limping is not unusual up until six months after the replacement.

Limping may even go on up to one year later. This is because joint strength and function are still only at 80 percent of normal. It’s important to keep doing your rehab exercises. By five months you should be able to move past the basic program and continue
to improve your strength.

Try to get back to your favorite physical activities. Any nonimpact sports you enjoy will help keep you on track for full recovery. If you aren’t seeing some gradual improvement over time, ask your doctor if there are any special or unusual reasons why you are still limping. Perhaps you’re a good candidate for an updated rehab program.

It depends how long ago you had the operation. During the first weeks-to-months, patients are restricted to lying on the back. Many doctors request they use a special abduction pillow between the legs with another pillow under to knees to keep the hips slightly bent.

When the doctor gives you the go ahead you can sleep on the “good” side. This means the hip replacement is up facing the ceiling. You’ll still need a firm pillow that goes between the legs from the hips down to the ankles.

Lying on your stomach is not advised. If your doctor approves this position, you may need a pillow under the hips to keep them in a slightly flexed or bent position. It’s usually many months (if ever) that stomach sleeping is comfortable or safe.

Sleeping on the operated side is also delayed by many months if it is resumed at all. Most patients find this position too uncomfortable to rest well at night.

Knee injuries after a traumatic hip dislocation can be hard to diagnose. Injury or damage to the bone called bone bruising doesn’t always show up on X-ray.

If there’s no visible evidence of injury, painful symptoms may go away over time with healing. However, some damage may not be seen without an MRI.

A recent study of knee injuries in patients with traumatic hip dislocations showed a 93 percent rate of abnormality. Some were even in knees that weren’t painful!

Magnetic resonance imaging (MRI) was used to find evidence of these additional soft tissue injuries. Knee injuries were divided equally between swelling, bone bruising, and meniscal tears.