Arthritis, pelvic fractures, and trauma to the upper femur can sometimes complicate the once normal function of the hip joint. Discomfort, inflammation, and pain in the hip can do more than just make it hard to put on your shoes or pick something up off the floor. It can severely compromise your mobility and hamper your overall quality of life.
For some people, pain medications and physical therapy might provide some temporary relief. Though in the case of a severely damaged hip joint or advanced arthritis in the hip joint, the most effective treatment plan might be a hip replacement.
To understand if you are a good candidate for a hip replacement, it helps to know some of the symptoms, questions, and potential concerns.
The Anatomy Of The Hip
The hip is actually the largest joint in the human body. It is a complex structure that incorporates the ball of the femur, as well as a socket in the acetabulum of the pelvis, all bound together in dynamic motion by a series of muscles and connective tissues.
Both the femoral head and the acetabulum socket of the hip are padded by smooth articular cartilage. Not only does this help the joint to move smoothly when you walk or bend at the waist, but it also cushions the underlying sensitive bone tissues. There is also a thin synovial membrane that envelops the hip joint and contains a special fluid that further helps reduce friction in the relationship between the femoral head and the pelvic socket.
What Are The Common Causes of Hip Pain?
While hip pain can be linked to physical trauma from a sports injury or an automobile accident, most hip pain is related to some type of arthritis.
Osteoarthritis
This is a gradual breakdown of healthy cartilage that cushions and protects the bone in the joint. It is often related to the natural processes of aging. Osteoarthritis tends to worsen over time to the point that medications and physical therapy prove ineffective for symptom relief.
Rheumatoid Arthritis
This is a type of arthritis that is linked to autoimmune disorders that lead to chronic inflammation issues in the joint as well as other parts of the body. Rheumatoid arthritis can also affect joint linings, causing painful swelling. Chronic long-term rheumatoid arthritis can gradually start to cause bone erosion as well as joint deformity.
Post-Traumatic Arthritis
Is often associated with a severe physical injury to the pelvis or upper portion of the femur. In some of these cases, the cartilage may be damaged even after the trauma to the bone tissues has healed.
Osteonecrosis
This is often associated with a severe dislocation of the hip joint and often involves decreased blood supply to the bone tissues in the upper femur. Also known as avascular necrosis, the surface of the bone can start to collapse causing severe arthritis hip pain.
What Is A Total Hip Replacement?
Also known as hip arthroplasty, a total hip replacement essentially removes the compromised cartilage and bone tissue in the hip and upper femur, then replaces them with artificial prosthetic components.
In most of these cases, the compromised tissues of the femoral head are removed and replaced with a metal stem made from titanium or another metal that will gradually fuse to the surrounding healthy bone tissue. A ball is then placed in this stem to replicate the original femoral head.
Next, the compromised cartilage of the acetabulum hip socket is removed and replaced with a metal socket. It’s then secured in place by screws or cemented to the surrounding bone tissues. At that point, the physician will then insert a special plastic, ceramic, or metal spacer between the new ball and socket to reduce friction between the surfaces and help maximize the fluid motion of the joint.
Am I A Good Candidate For A Hip Replacement?
A complete hip replacement is not something to take lightly. Your physician can help you understand your treatment options and will likely refer you to an orthopedic surgeon or another specialist for more advanced diagnostics. Most candidates for hip replacement surgery have an extensive history of hip pain, or who have recently suffered a traumatic injury to the pelvis or upper leg.
Hip replacement candidates often experience some of the following symptoms:
- Hip pain limiting basic motions like walking or bending
- Hip pain that persists when resting and sleeping
- Stiffness in a hip that limits mobility
- Decreased effectiveness from pain medication drugs, physical therapy
Typically, orthopedic specialists base their recommendation for a complete hip replacement based on the degree of dysfunction in the joint and overall disability. The average age for most hip replacement candidates ranges from 50 to 80 years old. Though age itself is not a primary factor. Especially in cases where the dysfunction of the joint is linked to a recent injury to the pelvis or the upper leg.
How Are Hip Problems Diagnosed?
Determining the severity and underlying cause of hip pain usually calls for a multi-faceted approach. It starts with gathering and assessing your medical history, particularly how long you have been experiencing hip pain, as well as other conditions that might be affecting the hip. This phase of the diagnostic process also assesses how the hip pain has been affecting mobility and quality of life.
Then a physical examination will be performed to assess mobility, strength, and the alignment of the hip. This is usually followed up with an X-ray to evaluate the deformity in the hip as well as the affected cartilage and bone tissues.
An MRI might be required if these initial tests show a significant cause for concern. This magnetic resonance imaging gives physicians a better understanding of the tissues in the hip joint. Especially the soft tissues that may have been compromised by trauma, joint degeneration, or inflammation.
Recovering From Hip Replacement Surgery
Planning and preparatory tests are part of a successful recovery strategy. This might include blood and urine samples, as well as X-rays and evaluations of other medical conditions that might affect your recovery from hip replacement surgery. Be sure to let your orthopedic surgeon know about any medications you are taking or skin conditions you’ve been dealing with.
Develop An Effective Support System
Having family and friends help you during the recovery process is an essential factor in reducing your risk of complications. Some patients might be able to walk with a cane, crutches, or walker shortly after surgery. Though you should expect that you will need help from others for many daily tasks like cooking bathing, shopping, and general housekeeping.
You might also need to make some modifications to your home. This could include things like:
- Installing security rails in the bathroom, hallways, and stairs
- Using a bench or a special seat in the shower
- Using a special chair
- Installing a raised toilet seat
- Dressing aids like reaching sticks and shoehorns
- Removing loose carpets and throw rugs to prevent an accidental fall
Post-Operative Care
Most hip replacement patients will spend a day or two in the hospital after surgery for observation. If you don’t have a significant support system at home or other complications, you might need to spend additional days at a nursing home for rehabilitation.
Pain Management During Hip Replacement Recovery
Your orthopedic surgery will likely prescribe you some type of pain management medication. This might include opioids, NSAID anti-inflammatory medications, or acetaminophen. They will tailor the pain management strategy to your needs.
Wound Care After Hip Replacement
The incision area of your hip and upper leg might be sutured or stapled to hold your skin together while it heals. It typically takes around 2 weeks for the dermal tissues to properly heal. During this time you will need to keep the wound from getting wet and may need to take additional measures to seal it and keep it dry when bathing.
Rehabilitation & Exercise After A Hip Replacement
Rehabilitation is a critical component of the recovery process after a hip replacement. The more diligent you are about following your physical therapist’s recommendations the less likely you are to experience complications.
Your physical therapist will customize your rehab program to your overall health and progress. This usually calls for a graduated walking program and other basic exercises to help rebuild your strength and overall mobility.