FAQ Category: Hip

Many dancers and other athletes are affected by an annoying hip condition that results in a snapping sound and feeling that occurs whenever they bend or flex their hip. Coxa sultans is the medical term for this condition. But it is better known by a more descriptive term: snapping hip.

The treatment depends on the cause. If it’s something loose inside the joint (e.g., piece of bone or cartilage) that’s getting caught, it might have to be removed surgically. If it’s a tendon rubbing over a bone, then stretching might be the answer.

Sometimes the only effective treatment is rest and stopping the motion that aggravates the condition. That’s a tough prescription for a young dancer on a special tour. The first step is to get a proper diagnosis. If possible, have her see an orthopedic surgeon who specializes in dancers or other athletes.

If all other serious possibilities are ruled out, then conservative (nonoperative) care is the way to go. Antiinflammatories may be prescribed by the physician. The therapist shows the affected individual how to stretch properly. Rest is advised along with elimination (or at least moderation) of activities and motions that aggravate the problem.

It may be necessary for the therapist to work with the patient to re-program how and when the hip muscles are activated. This is called neuromuscular re-education. If physical therapy is unable to alter the symptoms, then the physician may try injecting the hip. And if that doesn’t work, then surgery is the final treatment to try.

But before we go any further down that path, get an evaluation and diagnosis. Then a proper plan of care can be put into effect.

It sounds like you may have a problem called snapping hip. It can be a very annoying and painful condition. As many as one in 10 adults is affected. This figure is higher in certain athletes.

Help for the problem usually comes in the form of conservative care including antiinflammatories, rest, and physical therapy. Because there can be more than one thing going on in and around the hip contributing to a snapping hip, diagnosis can take time.

Improvement with treatment but without elimination of the symptoms tells the therapist there may be something else contributing to the problem. With patience and persistence, it is possible to successfully treat snapping hip in the majority of affected individuals. If physical therapy is unable to alter the symptoms, then the physician may try injecting the hip.

If you have not explored conservative care fully, surgery can be delayed until the full extent of the problem has been examined and treated. But if you have already been down this road without success, then surgery may indeed be your final option.

The type of surgery done depends on what’s causing the problem. The surgeon may lengthen the iliotibial (IT) band in a procedure called a Z-plasty. The shape of the incision made to lengthen the band is a Z, hence the name. The IT band is a band of connective tissue from the hip down to the knee along the outside of the thigh. This procedure can leave the athlete or dancer with significant hip abduction weakness (moving the leg away from the body).

If the snapping is coming from the iliopsoas tendon, the surgeon may lengthen it or release it (cut through it) altogether. Surgery doesn’t always take care of the problem. Some patients are still left with the snapping problem — along with weakness and/or other complications from the surgery. The most common complications associated with iliopsoas release include continued hip pain, numbness along the front of the thigh, nerve palsy, infection, and hip flexor muscle weakness.

In some cases, there is more than one problem going on (e.g., labral tear AND iliopsoas tendon rubbing over the bursa). Symptoms can persist until all sources have been removed.

In the first few days to weeks after hip arthroscopic surgery, there is a need to protect the healing tissue while still maintaining hip motion. Patients are usually encouraged to get rid of the crutches within the first week, put as much weight on the foot as possible, and walk with a normal gait pattern (without limping).

During the early postoperative days, the therapist will assess the muscles and look for reflex muscle inhibition. There is a well-known pattern of decreased muscle contraction of the gluteus medius (buttock) muscle in response to the surgery (and pain). The body’s intent is to protect the leg but this phenomenon must be stopped before it interferes with movement. Using crutches to off-load the joint can help reduce reflex muscle inhibition.

The length of time crutches are needed varies with the type of surgery that is done. Some procedures are more extensive and require a longer period of protective ambulation. Most of the time, borrowing crutches is a good idea because they won’t be used for long.

But check with your surgeon and find out what he or she can tell you about the post-operative protocol and expected length of time on crutches. That information will be helpful in making the decision to purchase or borrow.

Hip arthroscopy is becoming a more common orthopedic procedure now with more and more hip injuries among the athletic crowd. Better imaging technology has also made it possible to find what’s wrong or what’s causing painful symptoms. Loose bodies in the joint is just one of the many reasons why arthroscopic procedures are used so successfully.

But you are right — there is a postoperative program. And it’s important that patients complete this program in order to restore full joint motion, strength, flexibility, and function.

The specifics of the program depend somewhat on the type of surgery that was done. For example, removing free-floating debris in the joint is a much simpler procedure than repairing deep holes in the cartilage.

Likewise, repairing a torn labrum (fibrous rim of cartilage around the hip socket) may only require a simple home program. But there are some procedures that take longer to recover from and involve a slower pace of recovery.

And competitive athletes will follow a four-step process of rehab progression. These four phases include 1) mobility and initial exercise, 2) intermediate exercise and stabilization, 3) advanced exercise and neuromotor control, and 4) return to activity.

A physical therapist will show you what to do, how to do it, and how to advance or progress the program. You will probably start out on crutches for the first week to 10 days and gentle active motion of the hip. When you have full motion, the exercises assigned next are designed to restore strength and normal contract/relax sequences of all the muscles around the hip.

Core (pelvis and trunk) stabilization exercises are recommended next along with balance training. And finally, if you are active in a sport or specific activity, you’ll be shown how to prepare to return to that sport. The goal is to participate fully without fear of reinjury.

Athletic pubalgia is a common cause of groin pain in athletes. Soccer and hockey players seem to be at greatest risk but any athlete can be affected. Males are affected most often. It’s a rare injury in women.

This condition involves injury to the abdominal muscles, especially the rectus abdominis where it attaches to the pubic bone. In many cases, the adductor longus muscle is also injured. When contracting, the adductor muscles move the leg toward the body. This muscle also attaches to the pelvis so any injury of the adductors can cause groin pain and pelvic instability.

The connective tissue over the affected abdominal muscles called the fascia can weaken and tear. This leads to an inguinal hernia as part of the problem. With an inguinal hernia, a portion of the bowel slips through the tear and can get pinched or compressed. Hernias of this type can be serious problems.

Surgery is usually required for hernias or other causes of athletic pubalgia. Conservative (nonoperative) care can be tried first, but symptoms often persist when abdominal wall weakness or tears are present.

The diagnostic imaging studies that are planned for you will help determine the exact cause, location, and severity of your problem. Treatment is the next step but the exact plan of care won’t be clear until all the test results are in.

Groin pain is serious business for athletes trying to stay in the game or on the field. Adductor muscle strain seems to top the list as far as causes for groin pain go. The adductor muscles are located along the inner thigh. There are six different muscles and any one or combination can be affected.

The first thing to do is make sure the tissues have healed fully before jumping back into activities and exercises that can aggravate the problem. The temptation to play through the pain can lead to worse problems later. In your case, it may be running while in pain is part of the picture.

Studies show that muscle weakness and loss of flexibility can contribute to adductor muscle injuries (and reinjuries). When it comes to muscle weakness as a cause of groin injuries, decreased hip abduction (moving the leg away from the body) is a problem. And adductor muscle strength being weaker than the hip abductors is also linked with adductor muscle strains.

The adductor muscles move the leg toward the body. The abductor muscles do the opposite (move the leg away from the body). So, in other words, when the abductor muscles are stronger than the adductor muscles, the risk of an adductor strain goes up dramatically.

An incorrect rehab program can be a risk factor. Adductor strengthening is important. This can be done with a variety of exercises such as squeezing different size balls between the legs, using a sliding board, and working against the resistance of various strengths of elastic bands. Sports-specific training refers to mimicking the type of activities required by the game that put stress on the adductor muscles.

You will be ready to progress to the final phase of sports-specific training when two conditions are met. First, the passive motion of the injured leg is equal to the uninjured leg. And second, the injured adductor muscles have 75 per cent of the strength of the abductor muscles on the same side.

When all three phases of recovery and rehabilitation have been completed, then it is safe to return to practice and finally, competition. Maintaining prevention program as outlined is important in avoiding any recurrence of this problem.

Working with a physical therapist or an athletic trainer is a good idea. They can help identify the specific problem(s) that might be holding you back and get you past this hump of recurrent strains before it’s too late and a chronic problem develops.

Orthopedic surgeons see all kinds of injuries in the athletic population. One of the less common but very challenging areas of injury to evaluate is the hip. Hip pain can be coming from the hip itself, of course. But it could also originate in the spine or knee.

The medical diagnosis is based on an understanding of what happened, how it happened, clinical presentation (signs and symptoms), and the results of specific tests. It’s really a differential diagnosis meaning the physician sorts through all the possible problems that could be present. Using the information collected so far, the doctor rules out those that don’t fit the description. Then further tests are done until the final diagnosis is made.

Some of the most common choices in the differential diagnosis include: hip pointer, greater trochanter bursitis, iliotibial band syndrome, snapping hip syndrome, tendon tears, and meralgia paresthetica. Let’s take a closer look at each of these conditions.

Athletes who collide with others or who take the force of a helmeted head into the lateral hip can end up with a hip pointer. This injury or contusion is visible as blood under the skin leaves a large bruise. It is treated with a leave it alone approach. Ice, rest, and compression help the body complete its natural course of healing.

Bursitis is best treated by finding out what is causing the friction in the first place and dealing with that problem. It could be tight, inflexible muscles, tendons, or fascia. Stretching, strengthening, and manual therapy under the supervision of a physical therapist may be advised. Or it could be a postural or alignment problem such as a leg length difference, unsupported flat feet, or even broken down running shoes.

Sometimes a tendon (e.g., the iliotibial band along the outside of the leg) snaps over the bone underneath. This condition is called iliotibial (IT) band syndrome or snapping hip syndrome. The IT band can be so tight that movement causes a pop that can be seen and heard. The athlete is taught how to avoid those movements and how to stretch the involved soft tissues. In chronic cases that don’t respond to physical therapy, surgery to release or lengthen the tight tissue may be needed.

That brings us to lateral hip pain caused by tendon tears. The tendons involved most often are from the buttock muscles (gluteus medius and gluteus minimus). Because of the way these muscles attach to the greater trochanter (part of the femur or thigh bone), tendinitis of the gluteal muscles can look just like bursitis or iliotibial band syndrome.

And finally, meralgia paresthetica must be considered whenever there is numbness along the front and side of the thigh. Meralgia paresthetica is caused by entrapment of the lateral femoral cutaneous nerve. This nerve can get pinched or compressed by tight clothing, after surgery to remove bone from the pelvic crest, a large belly associated with obesity, or in association with diabetes.

There are some more serious types of problems that can affect the hip. Bone fractures, infections, and tumors head the list and are part of the differential diagnosis. Fortunately, these are rare and not easily overlooked when present.

Once the physician diagnoses the problem, then an injury-specific treatment plan can be determined and carried out. With the exception of the more serious problems, most of these hip conditions are considered self-limiting meaning they will eventually go away in time.

Treatment is first with conservative (nonoperative) approaches. The most common plan of care is for oral anti-inflammatory drugs, rest, and physical therapy. The therapist will work on correcting postural issues or malalignment, stretching and/or strengthening, and modification of aggravating activities or movements.

Of course, fractures, infections, and tumors are dealt with in a different way. Treatment is also injury-specific but may include surgery, immobilization, antibiotics, and so on.

You are on the right track to see an orthopedic surgeon and get a diagnosis. The rest will fall into place from there.

Players are often unwilling to report injuries to the team athletic trainer or coach for two reasons. One, it might keep them out of the game. And two, they don’t want to be seen as a weakling or baby.

Every player experiences his fair share of injuries that leave bruises. Most of the time, the injuries are minor and will heal on their own. We call these problems self-limiting. But there are those rare times when what seems like a simple problem turns out to be more serious than originally suspected.

From your description, it sounds like your boyfriend may have what’s called a hip pointer. Athletes who collide with others or who take the force of a helmeted head into the lateral hip can end up with a hip pointer.

This injury or contusion is visible as blood under the skin leaves a large bruise. It is treated with a leave it alone approach. Ice, rest, and compression help the body complete its natural course of healing.

Pain that doesn’t go away with an injury like this could be a sign of a bone fracture. X-rays may be needed to know for sure. The biggest risk is for recurrent bleeding. Athletes are advised to rest and avoid vigorous activity for at least 48 hours after an injury like this.

Pain along the back of the hip or buttock can be a very complex and puzzling condition to figure out. Sometimes a muscle gets overworked and goes into spasm. There could be an alignment problem of the spinal joints in the lumbar spine causing your symptoms. There could even be a disc pressing on a nerve creating your symptoms.

The best way to find out is to see a musculoskeletal specialist. This could be a sports medicine physician, orthopedic surgeon, or physical therapist. Give some thought to your symptoms because the physician or therapist will ask you many questions about where it hurts, how it feels, what makes it better or worse, how long it lasts, and so on. The answers to these questions are key to understanding what’s going on.

Pain along the back of the hip is rarely coming from inside the joint. We know this from anatomy studies and understanding the nerve pathways that supply the joint and surrounding soft tissues.

It is most likely coming from elsewhere — like the sacroiliac joint, low back, or knee. It could be from a muscle strain, hernia, bursitis, degenerative disc disease, fracture, or even from a hip dislocation. Rarely, buttock pain can be caused by more serious problems like infection or tumor.

There are many clinical tests that can be done to sort out what anatomical structure is getting pinched, overworked, or is out of balance or alignment. Change in joint motion, areas of muscle weakness, muscle tightness, and even the way you stand and walk will provide the necessary clues to identify the underlying problem.

Sometimes, X-rays or other imaging studies such as MRIs, CT scans, or ultrasound studies are needed. But most of the time, the problem clears up with conservative care and doesn’t require expensive or invasive tests.

If your symptoms don’t improve or go away with a few days rest, warm baths, and stretching, then make an appointment for an evaluation. Early diagnosis and treatment preventing worsening of the problem often saves both the pocketbook and the buttock from further suffering.

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement.

The operation begins by making an incision in the side of the thigh. This allows the surgeon to see both the femoral head and the acetabulum (or socket). The femoral head is then dislocated out of the socket. Special powered instruments are used to shape the bone of the femoral head so that the new metal surface will fit snugly on top of the bone.

The cap is placed over the smoothed head like a tooth capped by the dentist. The cap is held in place with a small peg that fits down into the bone. The patient must have enough healthy bone to support the cap.

The hip socket may remain unchanged but more often it is replaced with a thin metal cup. A special tool called a reamer is used to remove the cartilage from the acetabulum and shape the socket to fit the acetabular component. Once the shape is correct, the acetabular component is pressed into place in the socket. Friction holds the metal liner in place until bone grows into the holes in the surface and attaches the metal to the bone.

With a total hip replacement, both the femoral head and the acetabulum are removed and replaced. Understandably, there are pros and cons with each type of procedure. The joint resurfacing technique is usually reserved for younger, more active adults who will eventually need a total joint replacement.

Hip joint resurfacing helps delay the total joint replacement. The total replacement implants don’t last forever. And with adults living longer and longer, avoiding second and even third hip replacements is important.

Your surgeon will help you choose the right treatment plan for you. Your age, condition of your bones, and size will all be taken into consideration. Generally, anyone 75 years old or older will have a total hip replacement. Adults 50 and younger are more likely to have a joint resurfacing procedure. It’s that age group in between that is harder to predict.

Activity level is another factor. There’s a big difference between the requirements of someone who is fairly inactive and another person who aims to get back to work full-time in a job that requires heavy manual labor. Again, the surgeon who is doing the procedure is the best one to give you all the pros and cons to weigh and consider in the decision.

The American Academy of Orthopaedic Surgeons (AAOS or Academy) asked a panel of nine surgeons from around the United States to review the status of metal-on-metal hip resurfacing and publish a summary. Here are a few points that made that might be relevant to your question and situation.

Resurfacing can indeed be used both for patients with osteoarthritic changes of the hip as well as for those who have dysplasia of the hip from birth. Dysplasia means the hip socket is too shallow to hold the femoral head in place. Partial or complete hip dislocation is often the result.

After reviewing all of the available studies, they found that hip resurfacing may be more successful for hip osteoarthritis than for hip dysplasia. But further study is needed before making any recommendations in this area because there are other factors to consider besides diagnosis.

For example, the age and sex of the patient, type of implant used, and whether the implants are cemented or not can possibly affect the measured outcomes. Risk factors for resurfacing failure include small component size (used more often in women than men) and age (risk increases with age; older than 75 has the highest risk of failure). Younger age (less than 55) is more of a risk factor for total hip replacements.

Other factors have been studied such as smoking, body mass index (BMI), activity level, and menopausal status. None of these seemed to be significant in terms of success or failure of the resurfacing procedure. But the studies done so far are fairly limited in scope. The panel could not make any firm statements regarding the effect of these particular patient characteristics on outcomes or revision rates for hip joint resurfacing.

Most of us are familiar with older adults who fall and break a hip — or break a hip and fall. It’s an unfortunate event that adds insult to injury. But young adults are also at risk for hip dislocation from trauma. This time it’s more likely as a result of a high-speed car crash. The incidence of hip dislocations is on the rise, not just from motor vehicle accidents, but also from falls, sports injuries, and getting hit by a moving vehicle if you are a walker.

It’s easy to fall into the trap of thinking that young people can heal easily and quickly and go their merry way. But, in fact, the risk of hip joint arthritis on that side goes way up after a traumatic hip dislocation at a young age. Even more so when there are other injuries along with the dislocation.

Bone fractures, torn ligaments, and damaged joint cartilage are often present when the force of the injury is enough to dislocate the hip. Final results can depend on how quickly treatment (especially surgery) is provided.

The accuracy of diagnosis is also important. If there is debris in the joint from bleeding or if there are bits of torn cartilage floating around inside the joint that go undetected, the patient’s results can be compromised.

There are many other factors affecting the outcomes such as type of dislocation, presence of additional damage in and around the joint, need for more invasive surgery, and so on. And the wisdom of age has its advantages. Older adults may know better how to rest, apply common sense, and progress forward bit by bit. Younger adults may overdo, fail to follow their surgeon’s advice, and reinjure themselves during the prescribed period of rehabilitation.

Today’s hip replacement patients are getting implants at an earlier age and wearing them out faster than ever before. Some of that wear and tear is because today’s seniors are active Baby Boomers (born between 1946 and 1964).

Choosing the best implant for your activity, lifestyle, and physical size isn’t as easy as it might seem. There are four basic implant designs. Let’s start with the metal-on-polyethylene implant.

This is probably the most commonly used hip implant. The socket has a plastic liner. The round head of the femur that fits into the socket is metal with a metal stem that sets down inside the femoral shaft to hold it in place. It’s the least costly of all the types available. It goes in easily and doesn’t have to be set into the bone exactly-so to have a good result. But there are some problems. Most notably, it wears out faster than other types and isn’t as stable. Older adults who are fairly inactive are the best candidates for the metal-on-polyethylene implant type.

Next comes the ceramic-on-polyethylene. The plastic liner is the same as the one used in the metal-on-polyethylene implant. The difference here is in the material used for the stem and femoral head: ceramic instead of metal. Ceramic is hard and scratch resistant. That’s important in keeping wear debris out of the joint. There is a risk that the ceramic will crack or fracture and it doesn’t hold up as good as the ceramic-on-ceramic implants.

Those ceramic-on-ceramic surfaces have the lowest friction, roughness, and biologic reactivity. The surface is resistant to wear and tear so this type is used most often for younger, more active patients. And, of course, it can be used with anyone who has metal sensitivities. With both surfaces made of ceramic, there’s an even greater risk of implant fracture. Pieces of the ceramic can get imbedded in the joint capsule making it difficult to remove the broken implant. The two other disadvantages of ceramic-on-ceramic are the cost (most expensive) and the fact that these implants can squeak loudly enough to be heard.

The last choice with an equal number of pros and cons is the metal-on-metal implant. This type of implant does create tiny flecks of metal that enter the blood, urine, and organs and to which patients may react. This type of implant is not advised for women who can get pregnant or anyone with kidney disease. The implant is the most stable and gives more athletic adults greater freedom to run, jump, and participate in sports activities.

There isn’t a perfect implant that can be used for everyone. Each type has its own advantages and disadvantages. The surgeon tries to make the best choice for each individual based on age, size, activity level, and sensitivity to materials (ceramic, plastic, metal).

Patients like you often want to participate in that selection process. Hopefully, this information will help you understand your surgeon’s recommendations and come to a mutually agreeable selection.

Chances are the type of hip replacement you received is very different from what your grandmother might have been given. That’s because we are now on the third-generation of hip replacement implants.

Third-generation means the implants have changed in major ways three times since they were first introduced more than 40 years ago. Changes in implant materials, surface, and component parts (e.g., liners, sockets, femoral head and stem) have all been improved many times over in those four decades.

In the 1950s, Teflon and stainless steel parts were used. This was replaced in the 1960s and 70s with ultrahigh molecular weight polyethylene sockets on a metal head. Ceramic implants were developed during that time as well and have continued until today.

Thinner shells combined with an ability to polish itself have made it possible to reduce wear and prolong the life of the implant. The self-polishing feature makes it possible for scratches that develop to smooth away with movement. Manufacturers have been able to create an implant with a larger femoral head to increase joint stability while preserving mobility (motion). The risk of hip dislocation is lower with a larger femoral head size.

In the future, we can expect to see new surface coatings developed that will reduce debris while extending the life of the implant. Long-term studies 20 to 30 years after implantation will give us more feedback on what works best for which patients.

A simple hip dislocation refers to dislocation without a fracture. Complex fracture-dislocations involve popping the round head of the femur (thigh bone) out of the acetabulum (socket) with a fracture of the acetabulum at the same time. Acetabular fractures affect the joint surface where the head of the femur moves against the joint surface to provide joint motion.

If you can look at it this way, a simple dislocation has some long-term benefits, too. Only one out of every four patients with a simple dislocation results in hip arthritis later. It’s the dislocations accompanied by an acetabular fracture that present later with problems including arthritis. About 88 per cent of those complex fracture-dislocations damage the joint resulting in death of the bone (osteonecrosis) and osteoarthritis.

Simple dislocations are often easier to reduce (set back in place) without major surgery. The patient is still sedated to achieve deep relaxation of the surrounding muscles. But with a few quick and easy techniques, closed reduction is possible.

The more complex dislocations with fractures or other injuries often require arthroscopic or even open-incision surgery. There is a greater risk of complications with loss of blood flow, osteonecrosis (death of bone), infection, and poor outcomes with complex dislocations.

Have you reported this to your surgeon and had it evaluated yet? That’s the first step to eliminating the problem. Sometimes the squeaking goes away by itself over time (that’s more likely when the implant is made of metal).

Squeaks that develop after getting a new hip implant are not uncommon. But everyone shares your reaction to this problem — clearly, it is not acceptable! The cause of the squeak can be multifactorial (meaning multiple causes combined together to create the problem).

The surgeon must re-evaluate the size and type of implant used and alignment obtained during surgery for both components (cup and stem). X-rays can be used to look for an obvious cause of the problem. There could be issues of alignment. Is the cup tilted or angled off a bit? Was the correct-sized femoral head and neck length used for that individual? Or perhaps infection or loosening of the implant is a contributing factor.

Unfortunately, sometimes squeaks generated by a ceramic-on-ceramic implant can’t be identified and never go away. The surgeon ends up removing the ceramic lining inside the metal socket and replacing it with polyethylene (plastic) liner instead. That solution is almost 100 per cent foolproof.

An investigation at the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania might just have an answer to that question. They compared results for patients receiving two different designs of a ceramic-on-ceramic implant.

Group one got an implant that had a special coating on the stem made of a titanium-aluminum-vanadium alloy. The stem was shaped with a C-taper neck and had a wide, thick midsection. The stem portion of a hip replacement fits down inside the long shaft of the femur (thigh bone). Group two was given an implant with a stem made of a different combination of metals: titanium-molybdenum-zirconium-iron alloy. The design was a V-shape instead of a C-shape and the midsection wasn’t as thick as in group one.

Statistical analysis showed that patients with the thinner V-shaped neck and titanium-molybdenum-zirconium-iron stem were seven times more likely to develop a squeak. This stem is more flexible with a lower frequency of resonance. Vibrations created by the ceramic-on-ceramic movement are amplified (made louder) when there’s a lower frequency. And evidently, the oscillations can be amplified enough to generate a sound that can be heard.

The authors concluded by saying patients don’t have to give up the good quality of motion provided by ceramic-on-ceramic hip replacements. Surgeons just have to avoid using implants with the V-40 neck and choose the stiffer, C-taper stem instead. They should also make sure the materials are not made of the titanium-molybdenum-zirconium-iron alloy.

What you are probably seeing is a mechanical compression pump designed to increase the flow of blood from the legs back to the heart. The increase blood flow stimulated the release of different chemicals in the body that are clot busters and also relax the blood vessel walls.

These two effects prevent blood clots from forming and keep blood clots that do form from attaching to the blood vessel. They also break down clots that start to form. The danger of blood clots is that they can break loose and travel to the heart (causing a heart attack) or to the brain (causing a stroke).

The pump works by using and on/off cycle that applies intermittent but repeated pressure to the legs. The limb sleeves fit over the legs and are connected to the pump with a special hose attachment. The on cycle applies compression for a much shorter period of time compared to the off cycle (e.g., eight seconds on, 40 seconds off).

The disadvantage of these units is they do keep the patient from getting up and walking. They are pretty bulky and uncomfortable for some folks. The on cycle can cause an impact sensation that bothers patients. Since blood clot prevention must be carried out for at least 10 days after surgery, these compression units aren’t always very practical.

Newer, portable units that can be worn while walking are being developed now. The patient can get up and move around, even walk with the help of a small, battery-operated unit. The unit can apply intermittent compression for up to six hours before recharging is required. They function under the same principles described above for the hospital-based units you are seeing on your father-in-law.

It’s a well-known fact that without some type of prevention (a concept called thromboembolic prophylaxis), at least half of all patients having a total hip replacement do, in fact, develop blood clots. Those blood clots form in the legs and are called deep venous thrombosis (DVTs).

The risk of heart attack or stroke is increased with blood clot formation because those blood clots can break away from the blood vessel wall and travel to those the heart or brain. Once there, the clot can block blood flow causing these serious, life-threatening problems. Other studies have shown that 90 per cent of clots that go to the lungs (and then quickly travel to the heart or brain) come from the deep venous thromboses (DVTs) in the legs.

That’s why today’s standard of practice is to provide low-molecular-weight heparin (Coumadin or Warfarin) for all patients who are having total hip or total knee replacements. There are some disadvantages to being on a blood thinner and some patients just can’t use this type of prophylaxis. For those individuals, mechanical compression is provided through a pump system. The pump keeps the blood moving rhythmically and repetitively — no chance for a blood clot to get attached to the blood vessel wall, grow, and break off to travel to the lungs, heart, or brain.

Talk with your surgeon about your concerns and options. Keep in mind he is making this recommendation on the basis of solid evidence. Without preventive measures, your risk of blood clot formation after hip replacement surgery is double what it is before surgery.

When hip replacements, or arthroplasties, first became common, they were done mostly on patients in their late 60s or older. At that point, as the patients aged, their replacements’ life span seemed more than adequate. However, as people are developing problems with their joints earlier, such as you have, or are living longer, surgeons are beginning to rethink how they approach replacements and what to do if – and when – patients outlive their replacements.

What the surgeons and researchers learned was that revision surgeries were needed when replacements failed, but if they had taken out the entire joint and replaced it, it could be that there wasn’t enough bone left to do such a revision. By doing partial replacements, the surgeons leave behind more bone that they can work with if they need to operate again later.

The type of replacement that you mention, resurfacing, takes away even less bone than a traditional partial replacement. With this surgery, only the damaged surface of the joint and/or ball of the bone is resurfaced and replaced, leaving everything else intact.