FAQ Category: Hip

More and more studies are showing the benefits of having both hips or both knees replaced at the same time. The overall costs are less with only one anesthesia and one hospital stay.

Patients have equal pain during recovery so there’s less chance of using one joint more than the other. The surgeon has a better chance of correcting severe deformities that occur when muscles are tight or out of balance.

On the down side, any surgery has certain risks. There’s the risk of infection, blood clots, heart attack, and stroke. Any of these problems can lead to death.

The good news is that death in patients having both hips replaced at the same time is low (1.6 percent). Older adults with more health problems are at greater risk.

Hopsital billing inaccuracies are not uncommon. Sometimes the patients are overcharged but just as often patients are undercharged. Several studies on the cost of inpatient versus outpatient operations have pointed this problem out.

Hospital charges for materials used don’t always match actual materials used. Patients can be double billed by mistake or not billed at all.

It’s always wise to review medical bills. Mistakes happen and should be reported. When too many errors occur, the hospital or doctor will be alerted to the need to review billing practices.

With the new minimally invasive operations patients are able to go home quickly after joint replacements. The incision is smaller and the blood loss is less. The time under anesthesia is much less, too. Patients are up and walking with the therapist much faster.

One way to accomplish this is through pre-operative training. That means you’ll see a physical therapist before the operation. The first visit takes place about two weeks before the surgery. Then three to five days before your hip replacement, you’ll see the therapist again.

The therapist will teach you the exercises you’ll need to know. You’ll learn how to walk
with crutches. In fact you’ll be required to practice both the exercises and the crutch walking before the operation.

You will need someone to help take care of you for a few days after the surgery. A nurse and a therapist will visit you in your home. You’ll be reminded of the dislocation precautions. Your blood levels will be checked. Your doctor will be notified if there are any problems. Most patients do very well with this approach.

If you’re a good candidate, your doctor may consider you for the minimally invasive operation (MIO). Only a small incision is made. If you do well, you can be discharged and go home the same day.

A recent study comparing inpatient versus outpatient total hip replacements showed the outpatient method saved up to $4,000 per patient. That’s a big chunk of change if you’re paying out of pocket. Not all surgeons are set up to replace joints using the MIO method.

Once you find one who is then ask about the kinds of patients who are allowed to have this surgery. Usually you have to be in stable health without heart, lung, or other major problems. If you have diabetes, a heart condition, or seizures, you may have to be in the hospital.

Follow all of the instructions the nurses and therapists give you both before and after the operation. This will help ensure a better result with fewer problems.

There are two basic kinds of pedometers: dial read out or digital read out. The most basic pedometer of either kind shows the number of steps you take. That’s all you need for your intended purpose.

There are many other features available on some pedometers. The first to look for is stride length. This allows you to get a more accurate idea of the distance you’ve walked. Depending on your needs, you may want a large screen display to see the numbers easily.

If you walk in the early morning, at dusk, or at night you can get a pedometer with a light. Other features include memory, time of day, stopwatch, even an alarm, or a radio. Be sure and ask if there is a leash, clip, or belt clip to attach the pedometer. Sometimes one of these comes with the basic unit. Sometimes it’s ordered separately for an additional charge.

Researchers are always trying to find ways to predict which patients will have the best results after surgery. A group of surgeons from The Center for Hip and Knee Surgery in Indiana followed 900 patients with total hip replacements (THRs) for nearly 30 years. They compared single THRs to both THRs being done at the same time. Here’s what they
found out.

The death rate was higher in older adults. Patients having the bilateral THRs had fewer total days in the hospital. This was a cost savings. They had less time out of work (or play). They only had to have anesthesia one time.

Overall outcomes in terms of physical function and life of the implant were the same between the two groups. Implants with the most post-operative problems were identified and reported. Surgeons can avoid using the most problematic implants when doing bilateral THRs.

All patients thinking about having bilateral, simultaneous THRs. should be advised about the risks of having both hips done at the same time. Older adults in poor health and without family support at home may want to reconsider and have one hip done at a time.

Hospital care and post-operative care requires unique and advanced skills. Primary care doctors are stretched trying to see patients in the office while taking care of their hospitalized patients. Surgeons are skilled in surgical technique but look to other
specialists to help with medical problems.

Thus, a new specialty has been born: the hospitalist. This doctor works with all patients who are hospitalized for any reason. Early studies show that hospital death rates drop when patients receive special pre- and post-operative care by an internal medicine specialist. This led to the hiring of a doctor skilled in problems typical of patients in hospitals.

One of the best things about having a hospitalist is the ability to respond quickly to changes in the patient’s medical status. Sometimes patients are unhappy being given to a new doctor during a very stressful time. If prepared in advanced about what to expect, most patients and their families quickly see the benefits.

The idea has been used in other countries for a while. The United States is just starting to try this idea. If you would like to read more about it go to: http://www.hospitalist.net

One way to approach this problem is to change the way you get up. Go from a sitting position to lying down on your back. Roll to your side then get your knees under you. Use your arms to push up onto hands and knees.

If you have enough strength and flexibility you may be able to go from a sitting position right to a hands and knees position without lying down first.

Once you are on your hands and knees, crawl to a chair, couch, or other sturdy piece of furniture. Hold onto the furniture for balance and support. Move to a half-kneeling position using your stronger leg first. Use your hands against the thigh of that leg to
push up or keep hold of the furniture and pull yourself up while transferring your weight onto the foot.

It seems like a simple task but it’s not one people think of when they feel stuck on the floor. The important thing is to use solid, unmoving items to help steady you. Don’t let your grandchildren help you, if you can avoid it. It’s very easy to overpower a small child and lose your balance and fall.

The first thing to look at is: what’s holding you back. Are you in pain? Are you afraid of falling? Can you see well enough to avoid cracks or holes in the road that could trip you up? How’s your balance? Do you get short of breath when you try to go faster?

Many people don’t get back to their prefracture level of activity after a hip fracture. There are many possible reasons for this such as pain, decreased strength, and poor balance.

A recent case study by two physical therapists working with a 68-year old woman showed that the first physical therapy program in the hospital after fracture may not be enough. It helps get the patient back up on his or her feet and walking, perhaps even walking
without a walker or cane. But there may not be enough load against the muscles to get full strength back.

Future studies are needed to look at how much exercise, what kind, and how long it must be done to return muscle to prefracture levels of force. Aerobic capacity must also be addressed as many patients become deconditioned from immobility during the six to weight
weeks of fracture healing.

In the meantime, talk to your doctor about seeing a physical therapist for a more advanced exercise program to help you meet your goals.

It’s very likely that the fracture couldn’t be put back together evenly. If the pieces of broken bone couldn’t be put back in place exactly, then the bone (and your leg) could indeed be shorter than it was before the fracture.

Ask your doctor to take an X-ray or measure you for a leg length discrepancy. Measurements with a plastic tape measurer should be taken lying down. The doctor can measure from your belly button to the inside ankle bone and compare the right to left legs. Sometimes the hip bone is used as the starting point.

You can also try an experiment at home. Stand in front of a mirror and put your hands on your hips. Use your index fingers to find the front pelvic bones. Are they level? Or is one hip higher than the other? Put a thin book or magazine under the foot of the leg with the lower hip. Keep adding layers of books or magazines until the pelvic bones are level.

Measure how thick the books are and try a lift the same height inside your shoe. If this works you can continue using a lift or have your shoe modified by a shoe repair shop to make up the difference. If you have any back, leg, or hip pain from doing this, have your
doctor or a physical therapist help you out.

Mortality (death) rate during the first year after hip fracture repair is 55 percent in older adults when the surgery is done within the first 48 hours. The death rate goes down to 24 percent for surgery done 48 hours to one week later. Surgery done more than a week after injury is linked with only 14 percent death rate.

The reason for this? Doctors think many older patients are in poor condition when they fall. Medical treatment before surgery can make a difference. The person gets fluids and proper nutrition. Their medications are reviewed and adjusted. Those who have diabetes get their blood sugars regulated. Other health concerns can be taken care of.

All these things help improve the patient’s general condition and give them a chance for a better surgical result.

Researchers are trying to find factors that are linked to good or poor recovery. The plan is to avoid or prevent those factors that put patients at risk for a poor recovery.

A recent study of patients 90 years old or older with hip fracture showed better results for those without dementia and without spinal fractures. We don’t know how to prevent dementia yet. Loss of bone density is possible. Osteoporosis prevention begins with diet and exercise early in life.

Exercise and getting the right amount of vitamin D and calcium remain important for men and women of all ages. When you compare your aunt and her sister, do you see any differences in their lifestyles? Consider smoking history, exercise levels, presence of dementia, and history of osteoporosis.

Studies show that 50 percent of all elderly patients with hip fractures are unable to live on their own after treatment. Only a third of these patients regain their prefracture level of function. Patients with previous spinal fractures from osteoporosis have poorer results.

The presence of dementia is also a risk factor for poor results. Rehab is more difficult when the patient has dementia. They are poorly motivated. They may be unable to understand the need to walk or do exercises. Many never finish the rehab program. Those who don’t regain their ability to walk end up in a wheelchair or bedridden.

Despite these poor predictions, patients should be given every chance to recover as much as possible. A consistent approach and daily rehab focus can make a difference.

Hip exercises are commonly prescribed for older adults after hip injury or surgery. Even without hip problems, it’s also a good idea to maintain muscle strength as we get older. Keeping muscles and balance tuned can help prevent falls and fractures.

Physical therapists at the University of Kentucky compared six different hip exercises for the gluteus medius muscle. This is a hip abductor (moves the leg away from the body). It’s located on the outside of the hip.

Three of the exercises were done without putting weight on the leg. Three were done in the standing position while putting full weight on the leg. It turns out that the standing weight-bearing exercises activate the muscle the most.

Some examples include:

Some people refer to this style of walking as “power walking.” With a small one or two pound weight in each hand and swinging the arms, you can get a boost to your workout. You’ll keep your pace up and raise your heart rate. You may even burn a few more calories and shed an extra pound or two.

There’s the added advantage of stress on the bones of the upper extremities, which can help with osteoporosis. Bone growth is stimulated whenever tension is applied by the tendon to the bone.

Some men and women who try this method of walking say it helps them remember to swing their arms and keep a more moderately brisk pace.

It might be helpful for you to schedule a quick follow-up visit with your doctor. Make sure there isn’t a serious reason for the limp (tumor, infection, or fracture).

If you get the “all clear” signal, see your therapist. He or she will recheck your posture, alignment, strength, range of motion, and balance. One or several of those factors might be to blame.

The therapist will also check the entire kinetic chain of motion from ankle to knee to hip. Changes in any of the areas above and below the hip could be part of the problem.

Starting back where you left off may not be such a good idea. You might not be treating the real problem. Sore muscles from the wrong exercises or even the right exercises done improperly can set you back even more.

It won’t take long to find out what’s wrong and what to do about it. A small investment in your time and effort can go a long way to restore your full function.

You’re talking about the new minimally invasive (MI) surgery for hip replacements. Surgeons use an arthroscope to see inside the joint. A large incision isn’t needed when using this special tool.

Researchers are studying the use of this method. On the one hand it makes the surgery possible with less trauma to the soft tissues. If the surgeon doesn’t have to cut through the muscles to get into the joint, the patient has less pain and a faster recovery.

On the other hand if a larger incision makes it possible for the surgeon to give the patient a better fitting implant, then who cares what the scar looks like? Some say a longer recovery time with an extra six weeks in rehab is worth the 20 or 30 years a good implant can give a patient.

More long-term studies are needed to help sort out what’s important and what works best.

You are describing a problem called heterotopic ossification (HO). Sometimes it’s called myositis ossificans. It can occur anywhere in the body but seems to affect the hips most often.

Trauma to the muscle tissue is a major risk factor for HO. Patients who have decreased hip motion before the total hip replacement (THR) are also more likely to develop HO.

It can happen in almost any patient after THR. Reported incidence ranges from 15 to 90 percent.

Recurrent dislocation depends on several things. First, was the doctor, surgeon, or emergency staff able to put the hip back in place without another operation? If yes, that’s in your favor. The hip is more likely to remain stable if it was reduced without surgery.

Second, how long has it been since the dislocation? If you are still within the early postoperative period, your risk is higher than if you are several years past the total hip replacement.

Third, are you having any symptoms to suggest the joint is unstable? Does your leg give out from underneath you? Is there any pain? Any clicking or popping of the joint? If the answer is ‘no’ to all these questions, then your risk of another dislocation is less.

Make sure you talk with your surgeon about these concerns. The knowledge an exam and an X-ray can give goes a long way in reducing your fears.

Good question. At least one study shows that motivated patients can have a rapid recovery after total hip replacement. That IS a matter of attitude. But the same study showed that younger patients were more motivated than older patients.

The same study pointed out that recovery may be faster and easier for patients of all ages if pain is managed after the operation. Some new ideas are being put forth to help reduce tissue trauma through pain management techniques.

For example, several different ways are used to help control pain. First a local numbing agent can be injected into the operative site and around the scar. Pain medications can be used after that to help the patient get up and moving.

The goal is to have no pain, walking without a limp at the end of six weeks. The patient can be walking one to two miles without support by the end of the three months.

Again, younger patients tend to meet these goals more often than older patients. A good attitude goes a long way in rehab at any age.