TOTAL HIP
REPLACEMENT
 TOTAL JOINT REPLACEMENT is one of the most consistently successful
therapeutic measures in all of medicine and surgery today. Overall patient
satisfaction with the relief of pain and enhanced mobility is, in general,
extremely high.
However, as in all major surgical procedures, there are significant
risks that patients will want to discuss carefully and thoughtfully with
their surgeons. Patients should ask their surgeons to explain any risks
or benefits, which will help them make an informed decision.
The following text explains the key points about total hip replacement
surgery and hospital stay. If you need additional materials about hip
replacement, videotapes and other brochures are available. Just ask.
Once again, please keep in mind that procedures and protocols vary,
sometimes widely, from surgeon to surgeon, hospital to hospital and
even patient to patient. Nevertheless, the goals of the process -- to
reduce pain and enhance mobility -- are substantially the same.
We will be more than happy to answer your specific questions and
explain how these procedures will be tailored to fit your personal
condition and needs.
Total hip replacement is a procedure that is done for the severe
arthritic joint, and only after other forms of treatment no longer have
any benefit. It is not done for minor arthritic joint pain.
The
hip is what is commonly referred to as a "ball-and-socket" joint, and it
connects the trunk of the body to the legs through the pelvis. The hip, a
major weight-bearing joint, is surrounded and held together by muscles,
ligaments and other soft tissues. Cartilage is the material that
"cushions" the ball and socket and allows the joint to move in a smooth
and free manner.
As the
arthritic process develops, the cartilage wears out, and the nerve endings
that lie beneath the surface become irritated and produce the symptoms of
pain. As the joint becomes more and more destroyed, the soft tissues offer
less and less support. At that point, it is time to consider surgical
replacement.
The Surgical
Procedure
The surgical procedure involves
removing the diseased portions of the joint and replacing them with new
parts. A new socket is placed within the worn-out socket of the pelvis and
a new ball and stem are inserted into the femur (thigh bone). The new
components are fitted together, and since the painful diseased cartilage
(cushioning) has been removed there is generally a very quick relief of
pain, an outstanding feature of this procedure.
The surgical procedure for total hip replacement usually takes about
two to three hours, and the new joint is often immediately solid. However, strengthening the weakened muscles and soft tissue surrounding and
supporting the joint requires a longer-term program of exercise and
physical therapy. Although many patients see and feel immediate benefits,
they must continue to rehabilitate themselves for several months to get
the total benefit.
Anesthesia
Anesthesiology has come a long way in the last twenty-five years. There
are newer, more stable drugs, and there is more accurate and more complete
monitoring.
There are, however, some risks involved which are largely related to
the severity and amount of underlying disease(s). With an increase in the
amount of severity of the diseases, there is, naturally, an increase in
the risk. Nevertheless, the safety record of anesthesia today is very
high.
It is essential that patients tell their surgeon and anesthesiologist
all of the medical conditions they have, as well as all the medicines that
they are taking.
Hospital Stay:
Before Surgery
Most patients are admitted to the hospital the day of surgery. In many
facilities, much of the pre-admission paperwork has already been done, and
all the patient generally needs to do is sign the release forms. Prior
to surgery, patients may receive a shave prep and an antiseptic scrub to
the surgical area around the hip. The patient's surgeon will be in at
some point and, possibly, the anesthesiologist and/or physical
therapist.
After Surgery
During the first few days after surgery, there is naturally some pain;
this should be expected. But it can be adequately controlled by
medication.
In spite of any mild discomfort, it is important that patients make the
effort to do the deep breathing and physical therapy exercises as
instructed. Patients who breathe well and work at tightening their
muscles improve their lung capacities, circulation and tend to get well faster.
There are also certain restrictions that may be placed on patients
early in the postoperative period in order to avoid unusual strains on the
joint that could result in dislocation or disruption of the
sutures. The nurses and therapists are familiar with the procedures
and give instructions that can be easily handled.
Exercise and Physical
Therapy
One of the most frequently asked questions is, "When can I start
walking again?" While patients are often encouraged to stand and sit (with assistance)
within twenty-four hours after surgery, walking is approached gradually
and in a guided manner so as to avoid injury and complications. It is very
important to rebuild and strengthen the muscles through isometric
exercises.
Social Services
Many patients, especially those who live alone, are concerned about
whether or not they will be able to manage for themselves in the first few
weeks after they leave the hospital. And if they should need assistance,
they are concerned about who will pay for it.
Insurance coverage for home care is generally limited, but there are
agencies available which can provide some help. Someone can visit the home
and show patients how to lay things out so they won't have to worry about
falling. There are a variety of Home Health Care agencies that can arrange
to help with needs like bathing and meal preparation. The hospital
Social Services Department can direct patients to these agencies.
Patient Involvement and
Commitment
With Total Hip Replacement, the surgeon replaces the diseased hip joint
and, along with the physical therapist and nursing staff, guides
the patient through the recovery process. The patient must participate
fully in the rebuilding and strengthening of the weakened muscles. To get
the total benefit of hip replacement, the patient must make a serious
commitment to doing the prescribed exercises and developing and
maintaining an active life-style. |
