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Total Hip Replacement FAQ
Total Hip Arthroplasty
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What materials are used for the arthroplasty? |
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In general, all joint replacements use a combination of materials. These generally include cobalt chrome which is a very high-strength hard alloy that is usually used in places where the components are moving one relative to the other. The other metal commonly used is titanium. This is either in a commercially pure form or as an alloy with aluminum and vanadium. The third material utilized in joint replacement arthroplasty is usually ultra high molecular weight polyethylene plastic. This plastic is generally the weak link in the arthroplasty and the material most commonly involved in the process of wear and in the generation of wear debris. Recent improvements, both in the type of plastic used as well as in the processing of the plastic, should result in a reduction in the wear of component inserted currently with those that were inserted five to 10 years ago. Each of the materials in their bulk form has been extensively tested. There has been no documented case of specific allergy to these materials. In particulate form, however, as they move against each other and generate debris from this wearing process, occasionally patients will react to the small particles of metals and plastic. This can result in a bone resorbing reaction known as osteolysis.
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Where is the incision for total hip
arthroplasty? |
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The incision is located over the outer aspect of the hip. There is a bone that you can feel on the very outermost aspect of your hip. The incision is usually centered over this bone and is approximately four to six inches in length, running from along the length of the leg and right at the top of the bone on the outer part of the hip, running a bit posteriorly towards the buttock.
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How long does it take to heal after
total hip replacement surgery? |
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The incision will heal in about a two weeks and the staples will be removed in your surgeon's office. The soft tissues deep, in and around the hip will take approximately 6 to 8 weeks to heal. This is why it is very important to be careful how you position the hip in the early postoperative period to allow these soft tissues to heal. The total return to normal gait usually takes between two and three months.
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Do I need to take antibiotics after
dental and other procedures for the remainder of my life? |
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Your total joint replacement is an immunocompromised area in your body. Your immune system and white blood cells have a very difficult time clearing bacteria from joint replacements. Therefore, it is best to avoid and reduce the risk of any possible infection. To do this, it is commonly recommended that for dental procedures, particularly those involving a dental abscess, and for other procedures that are at risk for putting bacteria into the blood stream, that a patient be given antibiotics around the time of these procedures. The greatest risk for infection to occur after these procedures is within the first two years. After that time, there is a risk of infection with these procedures but it is significantly reduced. In some countries, no prophylaxis is used whatsoever after joint replacement surgery. However, in the United States, it is very common to use antibiotic prophylaxis for a brief period around the time of a procedure. Commonly used antibiotics for this are amoxicillin, tetracycline and clindamycin.
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Do I need to be careful of a dislocation
the remainder of my life? |
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The greatest risk for dislocation or instability after total hip replacement is within the first 6 weeks. It is always easier to dislocate a replaced hip than an unreplaced hip. Normally, after 6 weeks of restrictions and positioning, your surgeon will allow you to return to more normal activities. However, it is still a good idea to be careful when getting up off the floor or out of a low, soft chair.
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I have difficulty putting on a sock and tying my shoe (before surgery). Will I be able to do this after surgery? |
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Frequently, patients with significant arthritis in their hip will have significant limitation in their range of motion. This will commonly result in difficulty tying shoes, putting socks on the foot, and clipping their toenails on the involved leg. After the surgery, the range of motion is improved. Commonly, patients will not get a normal range of motion, but will have a significant improvement in range of motion after the surgery. Many patients will regain the ability to tie shoes, apply socks and to clip their toenails after surgery.
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Will my hip replacement set off the metal detectors at the airport and governmental buildings? |
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Most likely, yes. Although these materials are not made of stainless steel or iron, current technology will detect these very often. We do offer cards to notify officials that you are a patient who has an implanted metallic device. However, because these cards and other materials we can provide can be easily counterfeited, most officials will disregard these and use the metal detecting wand over the site of the arthroplasty and to pat the area to ensure that there is no other metallic device in that area other than the hip replacement. As our practice is based in the metropolitan Washington, DC area, we have many patients who have traveled throughout the world. While patients may be delayed and the implants detected, we have never had a patient who was detained due to their arthroplasty..
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Can I obtain a handicap parking permit for the period of limited mobility after the surgery? |
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Yes. If you obtain a form from the
Department of Motor Vehicles where your car is registered and either fax,
mail or drop off the form at your surgeon's office, this form can be filled out. There will be a $15 fee. You may include a check payable to MGMC-OS or stop by the office to pay with a charge card or cash. Most commonly, these are temporary forms that will be filled out for approximately six months after the time of surgery. If you feel, due to arthritis in other joints or impaired mobility from other causes, you may wish to request a permanent handicap parking license tag. You should notify your surgeon of this, and he/she can help you in completing the appropriate paperwork and providing any additional documentation that may be necessary.
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Will there be a difference in the length of my legs after the hip replacement? |
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The surgeon's goal at the time of the surgery is to restore the normal anatomy and length of the leg. However, in some circumstances, either due to anatomic variation or weakness in the muscles and soft tissues in the hip area, it may be necessary to lengthen the leg after the surgery. Your surgeon should be able to review this with you prior to the surgery, or to notify you postoperatively if some lengthening was required. Most commonly, the limbs can be restored to within 1/4" to the length of the leg pre-operatively. Occasionally, patients will present with a difference in length of their two legs prior to surgery. If the leg requiring hip replacement surgery is shorter than the contralateral leg, there is the ability to increase the length of that leg. Usually an increase of 1 inch or less may be readily obtained. If the limb is lengthened more than that around the time of the surgery, there is a risk of developing weakness in the sciatic nerve which runs behind the hip. This will result in a foot drop, or a weakness in the muscles that lift your foot up on the front of the calf. If the leg to be operated on is already longer than the other side, there is little that can be done to shorten the leg at the time of hip replacement surgery. To do so will very commonly lead to a looseness or laxity in the soft tissues which will result in dislocation of the total hip replacement. If you have questions regarding the length of your legs prior to surgery, please inquire regarding this specifically with your surgeon.
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How will I know if I am having a problem with my hip replacement after surgery? |
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The most common symptom a patient will notice after hip replacement surgery that may indicate a problem would be pain. However, there are many things such as wear and osteolysis which may be without symptoms. To identify these, it is important to maintain follow up and to have x-rays taken of your hip replacement at least every other year. If a patient delays follow up until a hip replacement is painful, occasionally this can result in significant loss of bone and a greatly increased complexity to any re-operation that may be necessary.
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Is there any adjustment that can be made to the hip replacement after surgery has been performed? |
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Unfortunately, no. It is very important to make sure that the components are inserted as rigidly as possible and positioned optimally at the time of the initial surgery. If this is not done, unfortunately, additional surgery is required to make any other adjustments.
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Will I need to use a cane long term after surgery? |
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No. Many patients are able to walk with a completely normal gait after hip replacement surgery. Very few patients require a cane for long term use after hip replacement surgery. Normally, the reasons for needing a cane in that setting are due to problems with balance, arthritis or other disabling conditions in other joints on their lower extremities.
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Should I have a total hip arthroplasty done with either a metal-on-metal or ceramic articulating surface? |
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The weak link in total hip arthroplasty has been the wear-and-tear debris produced by the polyethylene plastic used in the acetabular component. In trying to address the problems of polyethylene wear and the produce of polyethylene wear debris, several new forms of articulation have been introduced. These include a metal-on-metal articulation and a ceramic-on-ceramic articulation. By eliminating the polyethylene at the articulating surface where the parts move against each other, it is hoped that the amount of wear debris will also be significantly reduced. While these are articulations are currently quite new, in fact, they are a reintroduction of techniques and technologies that have been used in the past. Metal-on-metal was used early on in several forms of arthroplasty. While the overall wear rate was reduced, there is still the production of metallic wear debris.
Generally, it is felt that there is less biologic
reaction to this debris. Metal on metal is also a very strong and durable interface. Patients can participate in more vigorous activities with this type of articulation. Running for exercise is still not recommended. However, patients can play tennis and basketball with a metal on metal articulation. However, there is a concern by some
physicians that tumors may develop at the site of replacements with metal on metal articulations. Currently we have some 30 year experience with the early metal on metal replacements and 10-15 year experience with more modern metal on metal replacements with no evidence of tumor formation or malignancy. With regard to ceramic on ceramic replacements,
these are quite expensive. In addition, there have been manufacturing
problems with ceramics in the past that have resulted in fracture.
Unfortunately, when a ceramic arthroplasty cracks or fractures, it results
in significant damage to the retained metallic components, requiring a
more significant revision surgery. In assessing these new technologies, it
is important to remember that the long-term survivorship of primary
arthroplasty currently is excellent. With several long-term studies, some
with a minimum of 25-year follow up, we have been able to demonstrate that
over 80% of the arthroplasties put in patients who are average age 65 at
the time of surgery will either be in until the patient dies and
functioning well, or be functioning well at the end of 25 years.
Therefore, for the majority of patients undergoing hip replacement
surgery, standard techniques should be able to provide them with an
excellent long-term outcome. The critical issue with new forms of
articulation is for the younger, more active patient. While there may be a
role for metal-on-metal or ceramic-on-ceramic in this setting, current
preferences have moved towards the use of newer cross linked polyethylenes
that have a significantly reduced rate of wear compared to traditional
polyethylene. This allows significant reduction of wear which should,
hopefully, significantly extend the functional life of your total hip
arthroplasty without needing to resort to newer technologies that may
introduce problems we do not currently have with existing techniques. If
you have additional questions regarding the use of newer articulating
surfaces, contact your orthopaedic surgeon.
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What happens when my total hip arthroplasty becomes loose or painful? |
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When a total hip arthroplasty becomes loose or painful or is in need of additional surgery, there is a great deal of variability in what may be required to address the situation. Occasionally, it can be as simple as changing a modular femoral head and a plastic liner, or it may be as complex as completely redoing the entire arthroplasty. The overall outcome and its success rate for these revision surgeries is also highly variable. If your arthroplasty is becoming painful, you should have it evaluated as soon as possible by your orthopaedic surgeon. If additional surgery is recommended at that time, you should be able to get a clear impression of what will be involved at the time of any revision surgery.
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Will my body reject the artificial parts? |
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The materials used for total hip replacement arthroplasty include titanium, cobalt chrome, and polyethylene. To date, there is little evidence suggesting any allergic reaction to these materials, particularly in their bulk form.
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I have been told I have arthritis in my hip. When would the optimal time be to have my hip replacement surgery performed? |
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Due to the nature of hip replacement surgery, whether it is done early after the diagnosis of arthritis or after many years, the surgery, recovery and rehabilitation do not change over time. Therefore, the timing for hip replacement arthroplasty is individualized primarily based upon the degree of pain the patient is experiencing. This pain will also have a significant impact on the activities each individual patient is able to participate in. As the hip becomes more painful, and the activities more limited, a patient would be a good candidate for total hip arthroplasty. However, as long as the pain can be adequately managed through reduction in activities, use of a cane or anti-inflammatory medications, there is no rush or urgency to proceed with hip replacement surgery.
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