Hip replacement is usually considered once other therapies, such as pain medications, have failed. Most people undergo hip replacement as a result of osteoarthritis of the hip joint. But you might also consider hip replacement if you experience severe pain, loss of motion or deformity of your hip joint. Hip replacement is also used in people with hip injuries, rheumatoid arthritis and other medical conditions, such as a bone tumor or bone loss due to insufficient blood supply (avascular necrosis).
Osteoarthritis(OA) is more common in women than men but the prevalence increases dramatically with age. 45% of women over the age of 65 have symptoms while radiological evidence is found in 70% of those over 65.Osteoarthritis of the knee is a major cause of mobility impairment, particularly
among females. OA was estimated to be the 10th leading cause of non-fatal burden in the world in 1990.
The underlying disease process of OA does not remit, although it may fail to progress. Relief of symptoms may be achieved by arthroplasty or joint replacement surgery. Total joint replacement is a highly cost effective operation for severe osteoarthritis and provides good pain relief and
improvement in mobility and quality of life in the majority of patients. In the United States, osteoarthritis is the most common indication for total hip arthoplasty, accounting for the majority of elective procedures in Americans aged 65 and above.
You will return from surgery with a large dressing on the hip area. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area. Many surgeons also place a knee immobilizer or special pillow between the legs in the operating room to prevent the hip from dislocating.
You will experience moderate to severe pain after surgery. However, you may receive patient-controlled analgesia (PCA), intravenous (IV) analgesics , or epidural (via the spinal cord) analgesics to control your pain for the first 3 days after surgery.You will be given a regular program of exercises to do each day as long as you are in the hospital. Your therapist will begin by helping you move from your bed to a chair. By the second day, you'll begin walking longer distances using your crutches or walker. Your therapist will teach you exercises to begin strengthening the thigh and hip muscles.
Obese people, especially women, are more likely to suffer complications following hip replacement surgery, Swiss researchers say.
A Geneva University Hospital study included patients who had a total of 2,495 hip replacements (589 in obese patients) done at the hospital between March 1996 and July 2005.
The study, published in the journal of Arthritis Care & Research, found that obesity was associated with: a substantially higher risk for infection in women; more dislocations (a greater number in women than in men); and more revisions (redoing the hip replacement) due to septic loosening caused by infection.
The researchers also evaluated outcomes for 635 hip replacements in non-obese patients and in 183 hip replacements in obese patients five years after the surgery. Obese women, but not obese men, reported moderately lower functional outcomes and slightly less satisfaction, mostly due to a higher rate of complications, the study said.
Gender-related differences in body fat distribution and metabolic response may explain why women tended to have poorer results than men, the researchers suggested. They also said that lower peripheral muscle strength may be the cause of the higher number of dislocations noted in obese women, and that a higher rate of osteoarthritis and other factors may explain the lower functional outcomes in obese women.
"Because our study revealed increased complications among obese women, we suggest that surgeons counsel this group of patients so that they are made aware of this fact," the study authors wrote. "In addition, participating in a weight-loss program prior to surgery might be beneficial for such patient
Risks associated with this procedure:
*A spinal anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used for this type of anesthesia.
*There is a risk of infection or bleeding from the operation.
*A blood clot may form in the veins, escape into the bloodstream, and block an artery in the lungs. You may be given a blood thinner to try to avoid this.
*Your legs may not be the same length after the operation.
*Other bones may break during the surgery. This may require a longer hospital stay.
*The nerves in the hip area may be injured from swelling or pressure. This can cause some numbness.
*At the time of surgery the new ball joint is forced into the femur (thighbone) where the bone marrow is. As a result, pieces of fat in the bone marrow may become loose, enter the bloodstream, and get into the lungs.
*The new hip joint will not move as well as a normal joint. It can be dislocated more easily. You must be careful not to sit too low or cross your legs.
*The replacement parts may become loose or break. This occurs a small percentage of the time and usually many years after the operation.
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