FAQ Category: Hip

Even healthy older adults are at risk for dehydration (fluid loss). There is a decrease in thirst as we age and thus, a tendency to stop drinking liquids as much. Many Americans confuse thirst with hunger and eat instead of drinking.

Older adults who have hip joint surgery are also at increased risk of dehydration. There is blood loss with this operation. The problem gets worse if the patient has nausea and vomiting from medications. The presence of any other medical condition such as diabetes, high blood pressure, or thyroid problems adds to the mix.

Even mild to moderate dehydration can slow a patient down. Dizziness, weakness, and fatigue are common. Just getting through the daily activities or dressing, eating, and personal care can zap a patient’s strength. There may be no energy left for exercise needed after this operation.

Results from a recent study show that an eight-week program of exercises before surgery for a total hip replacement is best. Patients who exercise before the operation are less stiff and have less pain. They also have better motion and function.

Exercises will be continued after the operation. Usually, these begin again about three weeks after the procedure. The same exercise program can be used again. Patients begin with a few exercises and slowly progress. Continue the program until 12 weeks after the operation. It’s often helpful to have a physical therapist guide you in choosing the right exercises.

Hip dislocations can cause damage to the soft tissue around the joint. The cartilage and ligaments can get stretched out or even torn. The protective lip of cartilage around the socket called the labrum is also at risk for damage. If any of these injuries have occurred, the patient is at risk for another dislocation.

Recurrent hip dislocations can be prevented with proper treatment. After the hip joint is replaced, the patient is put in a splint or brace to immobilize the joint. This should be worn for three months during the healing phase.

Any further episodes of hip dislocation may be treated surgically. The type of operation depends on the hip anatomy, type of dislocation, and extent of damage to the surrounding soft tissues

To prevent blood clots, an intravenous drug called heparin is used. This prevents the blood from clotting and could result in blood loss. There could even be enough blood loss to need a blood transfusion.

Many doctors advise patients to donate their own blood at least three weeks before the surgery. Family members can also be tested and donate on your behalf. Blood testing for hepatitis has reduced problems with blood transfusion as a source for hepatitis. Likewise, donor screening has reduced the risk of HIV by infusion. This risk is very low (one in one million transfusions).

There’s also a new drug out called Epogen that can increase red blood cells. This has reduced the need for blood transfusion for many patients having joint replacement surgery.

Diastrophic dysplasia is a change in the size and shape of the hip joint. It’s caused by the abnormal development of bone and cartilage. The bone is bent or curved and results in deformity.

All patients with diastrophic dysplasia develop early arthritis of the hips. This can occur even before middle age. Pain and loss of motion prevent walking and carrying out daily activities.

Treatment for diastrophic dysplasia is improving with new medical discoveries. Perhaps by the time your child is an adult, the effects of this condition will be mild. Early treatment with joint replacements can help.

Doctors make this decision based on many factors. These include the reasons for the joint replacement, the type of joint implant used, and the amount of damage to the joint. For example, a severely arthritic joint may be treated differently from a broken hip.

Each doctor has a schedule of what activities can be done after an operation and when to start each one. This is called a protocol. Putting weight on the new hip joint on the first day after the operation is not unusual. In fact, studies show that early motion helps prevent blood clots and other problems.

Arthroplasty is the term used by doctors to describe surgery on a joint to replace it. If both sides of the joint are replaced, it’s called a total joint arthroplasty. When only part of the joint is removed and replaced, it’s called a hemiarthroplasty.

Hips, knees, and shoulders are the main joints that allow for a hemiarthroplasty. Most joint replacements are total. The decision is made based on the condition of the bone, joint, and cartilage.

The doctor uses X-rays and CT scans before the operation to help with this decision. A final decision is made when the joint is opened or viewed from the inside with an arthroscope.

When a total joint replacement must be done over, it’s called a revision arthroplasty. Revisions are more difficult because of any scar tissue that has formed and changes in the area since the first operation. For example, the bone may be shorter on the operative side. There may be bone loss and increased risk of fracture.

The shape of the joint changes with a joint replacement. Muscles around the joint are cut and stitched back into place. Any of these factors can change the anatomy and affect the next operation.

Total hip replacement (THR) involves removing the ball or head of the femur (thigh bone) and the socket it fits into. A partial joint replacement or hemiarthroplasty only replaces one side of the joint. Either the head of the femur or the socket the head fits into is replaced.

Most often, this decision is made based on the condition of the joint. If the cartilage inside the socket is in good condition, then a hemiarthroplasty is done. Arthritis, fracture, or loss of blood supply to the joint can cause damage to the surface of the joint. In these cases, a total joint replacement is usually needed.

The infection rate after a joint replacement is very low (less than 2 per cent). Modern operating rooms have a special laminar airflow system that has reduced the infection rate.

The source of infection after an operation isn’t easy to trace. It’s possible, though unlikely, that the tools used in the operation weren’t sterile. Sometimes, staff in the operating room don’t use completely sterile methods. This can result in an infection.

There can be a wide range of patient factors that can lead to such an infection. For example, anyone with diabetes or a weak immune system is just more susceptible to infection. A history of alcohol or drug abuse puts a patient at increased risk of infection.

Bacteria from another infection can invade the joint. This could be from a bladder or kidney infection. Often, the cause remains unknown.

Doctors take every precaution to prevent fractures during joint replacement surgery. Sometimes, it’s unavoidable when the patient is severely osteoporotic (brittle bones).

In order to prepare the thighbone (femur) for the joint implant, the doctor must cut out and remove some bone. This opens up the bone canal and makes room for the stem of the implant. Fracture can occur during this part of the operation. A certain amount of force must be used to cut away the bone.

The doctor uses special tools to accomplish this task. The right size and shape is important. A recent study showed that a tool called the smooth tamp is more likely to cause hip fracture than the standard tooth broach. This information will help doctors reduce the risk of fractures in the future.

There are many things affecting the life of a joint implant. The first is bone density. The bone must be strong enough to handle the surgery and support an implant. Probably the most important step is to get a good fit of the implant stem into the bone canal. This is crucial for long-term implant results.

The doctor also chooses the implant carefully. There are many different hip joint replacements available. Matching the right size, shape, and style to each patient is important.

The patient must also follow the doctor’s and the physical therapist’s advice carefully. Doing too much or moving the wrong way too soon can have disastrous results.

Doctors who work on bones are called orthopedic surgeons. It is surprising what they must do in some operations. Because bone is such a strong substance, some procedures do call for hammers, drills, and even saws.

During a joint replacement, the doctor must remove some bone in order to make room for the implant. They apply a steady rhythm when striking blows to the bone. The muscles and surrounding soft tissue absorb some of the impact.

Studies on bone from cadavers (humans preserved after death for study) provide information on how much force or stress the bone can handle. Sometimes, the bone does break, especially in the aging adult with osteoporosis.

Studies show that exercise should begin before the operation. The more fit you are, the faster your recovery. Hip strength before surgery is a way to predict how long you’ll be in the hospital. The greater the hip strength, the shorter the hospital stay (and vice versa).

Since you know this will take place this summer, start as early as possible. Each exercise session should include a warm up of about five minutes. To do this, walk in the water with the water level at belly button level. Spend the next five minutes stretching your warmed up muscles.

Water cycling, running in the water, and using weights in the water work well to strengthen muscles. Include both the arms and legs. This will prepare you for getting in and out of bed after the operation.

Consult with your doctor before starting any exercise program. It’s often a good idea to work under the supervision of a physical therapist. In this way, you’ll find the right exercise program for you and prevent any problems after the operation.

The implants are made in a wide range of shapes and sizes. The stem of the implant is placed inside the center of the thighbone. This is called the femoral canal. The size of the femoral canal varies in patients as well.

The doctor will choose the right implant for you. This is decided at the time of surgery when the doctor can see the size of your bones and the size and shape of your femoral canal.

Your doctor and physical therapist will guide you in the postoperative rehab. Generally, patients are told to put as much weight on the leg while walking as they can tolerate. Most likely, you’ll start out with a walker. This will be replaced by one or two canes.

By the end of six weeks, you should be walking without assistance. You can start to put full weight on the leg at that time. A program of exercises will be prescribed from day one. It’s best to do these everyday during the first two months. The therapist will advance the exercises as you progress.

Water aerobic activity is a helpful tool for rehab. This can be started when your physician approves it. The activities in the water help strengthen the muscles while limiting the weight on the leg.

Thigh pain after a total hip replacement (THR) is not uncommon. In fact, up to 40 percent of patients may complain of this problem. It’s more common with implants without cement. These are called cementless total hip arthroplasty or replacement.

Doctors aren’t sure why this happens, which makes treatment difficult. If there isn’t any infection, then the patient is usually given pain medication. Physical therapy can be helpful. If severe pain lasts more than two years, the doctor may suggest a second surgery to repair or replace the THR.

Surgery may not be needed if a patient has a stable fracture. This means that the fracture hasn’t moved or been dislodged. It may knit together if left to heal on its own.

Some patients are unfit for anesthesia. This can happen for a variety of reasons. Severe heart disease, lung disease, diabetes, or obesity may limit a patient’s ability to have surgery.

In some cases, surgery is delayed because the hospital doesn’t have an open operating room.

Intertrochanteric is a location on the bone. At the top of the thigh bone (femur) are two bumps on each side of the bone. These are called trochanters. The larger bump is the greater trochanter and the smaller bump is the lesser trochanter.

An intertrochanteric fracture is a break that occurs between these two bumps. The trochanters are located on the bone before it reaches the hip socket. Falls are the number one cause of this type of fracture.

Dementia is a risk factor for poor outcome after hip fracture. Often patients without dementia who are using a cane or walker don’t regain the ability to walk after hip fracture.

A study in Japan showed that walking does make a difference after hip fracture. Those patients who are able to regain the ability to walk two months after surgery have a better outcome.

Dementia doesn’t affect the ability to walk. In other words, adults with dementia don’t forget how to walk. Instead, they show poor response to rehab or physical therapy after a fracture. This makes recovery slower with more complications. The death rate is higher for patients after hip fracture who don’t walk again.