Hip Replacement Surgery
What is Hip Dysplasia?
The hip is the largest ball-and-socket joint in the body, and is held together by ligaments, tendons and a joint capsule. The ball is called the femoral head, which is at the top of the femur bone, and the socket is called the acetabulum, which is part of the pelvis. The femoral head fits into the acetabulum creating the hip joint, so the ball can rotate freely in the socket. Cartilage covers the femoral head and the acetabulum, called the joint capsule, so the joint glides easily during motion.
Hip dysplasia means the hip joint is the wrong shape, or the hip socket is not in the correct position to cover and support the femoral head. This causes abnormal wear and increased force on the cartilage, making the joint surface wear out faster. Certain changes can be made to preserve the life of the hip joint, since the cartilage surface cannot re-grow itself. These changes can be lifestyle changes, such as losing weight, using a cane, or taking arthritis medication, which can help temporarily. Another change can be surgical treatment.
What are the Signs and Symptoms of Hip Dysplasia?
The first sign of hip dysplasia in a young adult typically is hip pain and/or a limp. In some cases, a clicking or popping may be the initial sign. It is important to be aware that these symptoms can also be caused by other hip disorders. To determine the cause of hip pain, x-rays are the standard first step in diagnosing a disorder. Hip pain from dysplasia is usually associated with activities, with pain deep in the front of the groin. But, pain in the side or back of the hip is also frequent. When symptoms first occur, they may be only mild and occasional, but over time they can increase in intensity and frequency.
Once the symptoms of hip dysplasia become more severe, a mild limp can occur because of the pain. A painless limp can be caused by limited flexibility of the hip joint, weak muscles, or bone deformity. A limp does not always indicate hip dysplasia, because it can be related to many other hip disorders.
What is Hip Replacement Surgery?
Hip replacement surgery is a procedure where a damaged hip joint is removed and replaced with an artificial joint, which is made from metal and plastic components. There are many different conditions that can damage the hip joint. The most common reason is osteoarthritis. This occurs when the cartilage in the hip joint breaks down, causing the bones to rub together. Growths of bone, called spurs, can also form around the joint causing pain and stiffness. Injuries, fractures, rheumatoid arthritis, bone tumors, and osteonecrosis can be other possible causes of hip damage. Doctors often recommend hip replacement surgery if stiffness and pain interfere with the ability to do everyday activities, especially if other treatments have failed to provide adequate pain relief.
Causes of Pain After Hip Replacement
Hip replacement surgery is also called a total hip arthroplasty. Included in the hip is a ball and socket joint, which is made of bone. In hip replacement surgery, the ball and socket joint is replaced with ball and joint components made of synthetic material. The ball joint is made of ceramic or metal, and the lining of the socket component is also made of ceramic or metal. Hip replacements are performed to relieve pain and to improve mobility and function of the hip.
Femoral Neck Fracture
According to the Bulletin of the NYU Hospital for Joint Diseases, a femoral neck fracture can develop after hip replacement surgery, which can result in pain. A femoral neck fracture is a fracture in the bone, just below the newly implanted ball joint. Women are more likely to develop a femoral neck fracture, possibly due to lower bone densities than males. Also, obesity has been shown to correlate to an increased risk of developing a femoral neck fracture.
The implanted components can loosen and become a source of pain. There is little concern that wear is a factor in the loosening of the components. The "Bulletin of the NYU Hospital for Joint Diseases" notes that unevenness of cement is more likely a factor. For whatever reason the components become loose, a loose implant can be a source of pain.
Hypersensitivity to the metal used in a hip replacement can result in pain. The pain can result from a number of different conditions that arise due to the hypersensitivity. These conditions include joint effusion, which is a build-up of fluid, and enlarged bursa, which are fluid-filled sacs that are normally present.
Hip impingement can result in pain after hip replacement surgery. Hip impingement occurs when the normally smooth motion of the ball joint in the socket is interrupted, or the smoothness of the motion is impaired. There are a number of factors that can increase the risk of hip impingement. These include various deformities of the femoral neck.
Most Common Side Effects After Hip Replacement Surgery
Hip replacement surgery is most frequently used to alleviate painful symptoms experienced by patients with osteoarthritis, a condition in which the hip bone progressively degrades, Cedars-Sinai reports. During this procedure, a surgeon removes damaged bone within the hip and replaces it with prosthetic components made of metal, plastic or ceramic. Before having this procedure performed, patients should be aware of the most common side effects that arise after hip replacement surgery.
Patients commonly experience sensations of pain within the hip joint after hip replacement surgery, the American Academy of Orthopaedic Surgeons, or AAOS, explains. Hip discomfort can interfere with a patient's ability to stand or walk normally during the first few days following surgery. A doctor typically prescribes pain medication that affected patients can use to control or manage hip pain symptoms. Generally, hip pain progressively subsides as a patient begins to heal from hip replacement surgery. Prolonged, increased or severe pain can be a sign of infection and affected patients should seek prompt care from a medical professional.
Hip Joint Loosening or Dislocation
Loosening of the hip joint and hip dislocation are common side effects experienced by patients after hip replacement surgery, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The hip bone prosthetic inserted into the hip joint during surgery is typically smaller than a patient's natural hip bone. This size difference makes it easier for the prosthetic hip ball to slip out of the hip socket. The newly placed hip joint may also inflame or irritate surrounding tissues, which can degrade the remaining healthy hip bone tissue. Bone degradation can cause the hip joint to loosen, increasing a patient's risk of experiencing a hip dislocation. Hip dislocation or joint loosening can be painful and may require additional surgery to replace the prosthetic hip joint into its proper location.
How do I Recover from a Hip Replacement?
Full recovery from hip replacement surgery involves work, and each precaution and exercise given is there for a reason. Following instructions and enduring some limitations during recovery will ensure the best possible outcome. Short term recovery is the time it takes the body and hip to initially heal from surgery. During this time there will be pain, but medications can make it more manageable.
There are several important precautions that will help prevent a new hip joint from dislocating, or popping out of place, while it heals. A doctor or physical therapist will give specific instructions according to the type of hip surgery that was performed. A few of the most common precautions that should be taken for any hip surgery are:
- Do not sit in low chairs, low stools, or soft couches.
- Do not bring the knee up higher than the hip.
- Do not lean forward while sitting or as you’re sitting down.
- Do not reach down to pull up blankets while lying in bed.
- Do not turn the feet excessively outward or inward.
- Do not cross the legs at the knees for at least 8 weeks.
- Do not stand pigeon-toed.
- Do not kneel on the knee of the surgical leg.
A doctor will advise when it is safe to return to work and other physical activities. Usually this takes place by 3 to 6 months from the time of surgery.
There will be some precautions to follow even after achieving full recovery and getting back to normal activities. Be cautious about infections from this point on. Alert dentists or doctors about having a joint replacement because antibiotics will likely be needed before invasive procedures are performed. This will help prevent an infection from getting in the body and settling in the artificial joint. Strenuous athletic pursuits should be avoided, such as basketball, downhill skiing, jogging, and other activities that put intense pressure on the hip. These add wear and tear on the components, and can loosen the replacement joint or cause it to wear out early. Light activities that can be engaged in include walking, doubles tennis, and golf.
Some hip replacements can be detected in airport metal detectors, depending on the material that was used. A card can be carried in the wallet that describes the implant, making it helpful when passing through airport security.
Exercise After Hip Replacement
Hip osteoarthritis is a debilitating condition caused by wearing down of the cartilage, or padding, in your hip joint. Walking causes severe pain as the bones in this ball-and-socket joint rub together. Joint replacement surgery is performed to decrease pain and improve mobility. After surgery, exercises are performed to improve movement and strength, usually under the direction of a physical therapist. In most cases, precautions must be followed after surgery to avoid movements that increase the risk of hip dislocation.
Exercises after hip replacement progress in phases. The first phase begins as soon as the first day after surgery. Exercises are performed while lying in bed or in a seated position. Ankle pumps -- moving your ankle forward and backward -- are started immediately to decrease the risk of clots caused by blood pooling in your legs. Other exercises include bending and straightening your knee and isometric strengthening of your thigh and buttock muscles, which means tightening your muscles without actually moving your leg. Some standing exercises may be initiated if your doctor allows weight bearing on your leg.
Phase 2 exercises are performed for 1 to 6 weeks after surgery. These exercises focus on strengthening your hip muscles -- particularly the ones that move your leg out to the side and backward. Stationary biking or upper body cycling may be added for endurance. Sit-to-stand exercises are performed to improve mobility. Standing exercises are progressed to include walking backward and on uneven surfaces to improve balance. Step ups, mini-squats and sidestepping are also usually incorporated.
Phase 3 continues with exercises performed in phase 2, using strap-on ankle cuff weights or elastic bands for added resistance. This phase typically occurs 7 to 12 weeks after surgery and continues to focus on improving balance, walking speed and endurance. Exercises may include treadmill or pool walking. Your surgeon may also allow you to resume some recreational activities, such as swimming.
Twelve to 16 weeks after surgery is the usual time for phase 4 of your rehabilitation after hip replacement surgery. Your doctor may allow you to resume recreational sports during this period. Functional exercises such as pushing, pulling and squatting are incorporated, particularly if you are returning to work. Endurance exercises continue, with gradual increases in time and speed. Formal rehabilitation is often complete within 6 months after hip replacement surgery. However, functional limitations -- not being able to perform some tasks and activities -- may continue for more than a year. Your therapist may give you a home exercise program to continue indefinitely to maintain strength and range of motion after you finish rehabilitation.
What is a Hip Brace?
A hip brace, also known as a hip orthosis, is regularly used by those who require a better alignment for their hip to relieve pain, or by those who have undergone hip revision surgery or an injury. When used after surgery, a hip brace is a device that helps prevent the hips from moving into an incorrect alignment and has a similar appearance to a step-in harness.
A hip brace can come in many styles to best fit personal needs and fulfill its primary purpose. It can be used by infants, young children and adults to give proper hip alignment. A hip brace is usually available in a variety of colors and its materials differ based on its purpose. Some braces are specifically designed to hinder movement, while others are made to encourage movement, therefore, different materials are used to accomplish these goals. A removable and machine washable lining is a popular feature, though some braces may be spot cleaned or hand washed only. It is especially important for growing children to wear a properly fitted hip brace. And it is always recommended to consult with a healthcare professional before wearing any type of hip brace.
A hip abduction brace is a special brace that keeps the hips and knees apart. It provides support of the hip joint to allow proper healing in the abduction position after surgery or hip dislocation. The abduction brace limits the amount of hip movement, causing sitting upright or other regular activities to not feel normal. A doctor will explain how long the brace needs to be worn, if it needs to be worn all the time, or if it can be taken off while in bed.
General information to keep in mind:
- Always follow hip precautions when wearing the brace.
- Use a pillow on the seat of a chair to make sitting more comfortable.
- Do not sit on chairs, sofas or toilets that are low to the floor.
- Use arms to assist when rising from a chair.
- Inspect the skin under the brace every day. If any irritation or redness remains after removing the brace, call your doctor. It may need to be adjusted.
- It can be cleaned with a damp cloth.
- Wash the pad with mild detergent and let it air dry overnight.
HIP ABDUCTION BRACE