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After Hip Surgery

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Recovering from Hip Surgery

What happens after hip surgery? Here are answers to commonly asked questions.

What can I expect during the hospital stay?

You can expect to see several people who will help with your recovery. A physical therapist will assist with hip exercises and walking. An occupational therapist will assist you with learning everyday activities, such as dressing and bathing, while your hip is healing. Your surgeon, his associates, medical doctors, and nursing staff will see you daily. A nursing assistant will help with bathing and activities that you are unable to do yourself.

The first night or two may be hard considering that you will have an unfamiliar bed, diet, and medications. Ask for a sleeping pill or anti-anxiety medication if that will help. Anticipate several weeks before your normal sleeping, eating, and resting patterns are restored.

How long will I stay in the hospital?

The average hospital stay after hip replacement is one or two days. The day after your surgery, you will be helped into a chair and you may be able to walk limited distances. Your activity will increase with each day that follows.

Recovery time varies from one patient to another. Much depends on other existing medical conditions. For example, arthritic disease in other major joints, heart disease, diabetes, obesity, depression, and other related conditions will affect recovery.

Most people return to their own place of residence after a hip replacement. Some elderly or debilitated patients may need to go to a nursing home to recuperate.

Preventing blood clots

What measures are taken to reduce the risk of blood clots?

For routine hip surgery, it’s common to use a blood-thinning medicine for about 4 weeks after surgery. In addition to a blood thinner, doctors also use early mobility, spinal anesthesia, leg exercises, foot pumps, and efficient surgery as adjunctive measures to minimize the risk of blood clots.

Why is a blood thinner needed after surgery?

This is to reduce the risk of a blood clot. Hip surgery is associated with a risk of blood clots developing in the calf, thigh, or pelvic veins. These clots often do not have any obvious symptoms or signs. Clots can cause chronic swelling of the legs, pain, and circulation and skin problems. In rare instances, a clot can break off and travel to the lungs, which can sometimes be fatal. This is why blood clots and blood-thinning medications are taken so seriously.

The risk of clots greatly decreases when the blood is thinned after surgery. Therefore, we use a blood thinner in every patient following hip surgery.

If you have ever had a blood clot before, or have ever had an adverse reaction to a blood thinner, please let your physician know so that he or she can plan an accordingly.

Common sensations

What sensations can I expect right after surgery?

Typically, patients have little to no pain, but nausea is more common. This nausea can come from the anesthetic drugs or from pain medicines and we can help control it by changing pain medicines and prescribing anti-nausea agents if necessary. If you have pain, nausea, or any other disagreeable sensation, let the nursing staff know. They are very knowledgeable in controlling such symptoms. Usually, an adjustment of medications is all that it takes to address any disagreeable sensations.

Why do I have a popping sensation in the new hip?

This can happen from a tendon, called the psoas tendon, rubbing against the new hip. With exercise and time, this sensation will disappear, assuming that it ever manifests in the first place. Usually this popping sensation occurs while the hip is healing, and while turning the leg side to side.

Why is the outside of my thigh numb?

This is normal after most anterior approaches to hip replacement or hip resurfacing. The incision cuts small nerve fibers that run from inside to outside of the hip, so the skin to the outside of the cut always feels numb after hip surgery. Usually, this sensation will resolve over time and is not a major problem for patients. Most patients will not notice that the outside of the scar feels numb.

Is it normal for the muscles to spasm and tighten after surgery?

Yes. Sometimes unexpected spasms of the leg muscles occur after surgery, usually as the person is healing from the operation. These spasms will go away. If they are particularly troublesome, your doctor can prescribe a muscle relaxant medicine, which can help.

Why are my appetite, mood, food-taste, and sleep different after surgery?

Altered appetite, bowel habits, depression, and mood swings are common after hip replacement. This is very important to know, understand, and anticipate. In some cases, medications might be necessary to control such symptoms.

All surgery elicits powerful psycho-social and physiological responses, which vary from one person to another. These responses are normal,; your medical team will help you get through them. It takes time for the body, mind, and soul to recover from any invasive operation.

Caring for your incision

Should I keep the incision covered?

Yes. Covering daily with a gauze dressing is best. You can shower with the dressing on, protecting it as much as possible, and then changing with a new dressing after the daily shower. Avoid touching the incision; the skin around the scar should be kept clean with soap and water. No antibiotic ointments are necessary.

Alternatively, you can remove the dressing, wash around the incision with soap and water, pat dry, and cover with a new dressing. Showering is safe at any time after surgery, but immersing the incision in a bathtub should wait until the stitches/staples are removed.

Can I put any lotion on the scar?

While stitches or staples are still in, avoid applying anything to the incision; simply keep it clean and dry. Once stitches or staples are out, you can use Vitamin E cream to massage and loosen the scar. Massaging the thigh area with an anti-inflammatory or cortisone cream can reduce skin inflammation and tenderness; many such ointments are available over the counter.

What if I am allergic to the adhesive used in the dressing?

If your skin cannot handle the adhesive or tape, or if there is drainage from the incision, a useful tip is to use feminine hygiene pads as a dressing. These are self-adhesive, comfortable, very gentle on the skin, and very absorbent.

Who will remove stitches and when?

Usually the home health nurse will remove stitches or staples, no earlier than 21 days after surgery. In some cases, the stitches may be left in longer, depending on the rate of healing. Home health nurses should take a digital photo of the incision if there is a concern and send it to your physician via e-mail.

When can I shower, take a bath, or swim?

Shower anytime after the surgery, if you can sit or stand safely with help. The incision can be covered with a plastic wrap. A new, dry dressing should be used to cover the incision after the shower.

Tub baths and immersion into water, such as a swimming pool, should be delayed until the stitches or staples are out and the skin has sealed completely. This takes at least a couple of weeks after surgery.

Swelling

How long will I have swelling and warmth in the surgical site?

Swelling and warmth around the scar are common after a hip replacement or hip resurfacing operation. The ankle may also swell on the operated leg. This represents the normal process of healing and can last for several weeks to months, depending on factors such as circulation, body weight, diabetes, and other variables.

Obesity, diabetes, poor circulation, poor muscles, varicose veins, high activity, heart disease, and swelling before surgery will usually result in a longer period of swelling and heat in the operated leg. Elevating your leg at night and wearing compression stockings during the day will help.

Deep aches and swelling in the hip can persist for a long time because bone, a living tissue, continues to re-model and adapt around the metal implants. This increased metabolic activity can lead to lingering soreness and swelling after heavy activity, all of which will disappear with time.

When can I stop wearing the compression stockings after hip replacement?

Compression stockings may be applied to both legs after surgery to control swelling, and many patients inquire when these can be discontinued. The answer is that if swelling is not a concern, you can stop wearing the stockings at any time.

These stockings are prescribed to control one of the most common nuisances after any hip operation, namely, swelling in the leg and ankle. The stockings have nothing to do with preventing blood clots; for that problem, it’s common to use a blood thinner and other strategies discussed here.

Preventing infection

How do you prevent infections during hip replacement?

Some of the key factors in reducing the risk of infection involve scrubbing of the skin with an antiseptic, antibiotics given before surgery, surgeon experience, a team-approach designed to promote efficiency, and standardized protocols. It is impossible to completely eliminate this risk, but it’s possible to get the risk down to nearly zero. It is very rare to have an infection after routine hip replacement. .

Is there a long-term risk of infection in an artificial hip?

Yes, there is a lifetime risk of infection with any artificial implant in your body, whether a hip joint, heart valve, or other synthetic component. As long as you maintain good health and appropriate body weight, avoid smoking, maintain proper hygiene, keep diabetes under control, and promptly address even minor infections in your body, the risk of infecting an otherwise well-functioning hip implant is essentially zero.

What if an infection does develop?

An early infection shows up as redness and pain around the healing incision. This can generally be treated with oral antibiotics alone, usually taken for 5 to 10 days. Very rarely, the hip joint has to be opened and washed out to clean the tissues and effectively treat an early infection.

A late infection that happens months or years after surgery is more serious, and will require additional surgery. Such infections occur because the immune system can be weakened by age, infirmity, tobacco use, heavy alcohol use, cancer, and other conditions.

In these cases, the infected prosthesis is removed and a temporary antibiotic-loaded hip is implanted. After three or more months, a new hip joint is implanted. Six weeks of antibiotics and these two operations will effectively treat an established deep infection in the hip. Fortunately, such cases are very rare, and late deep infections usually occur in immune-compromised patients with other serious medical problems.

Leaving the hospital

How will I manage at home?

after hip surgery nursing helpIf help from an adult family member or friend is not possible, it may be necessary to stay at an inpatient rehabilitation facility. You will not be able to drive for the first couple of weeks after surgery. If you go home, a home health agency will check on you at home, about three times a week or more, to help with walking, exercise, incision checks, medications, and communication with the doctor.

The home health agency will send a nurse to do blood draws and follow-up care, a physical therapist to continue therapy, and possibly an occupational therapist. The nurse also communicates with your physician to keep them updated on your progress.

How is my hospital discharge handled?

Typically, a social worker will visit with you after surgery and work with the therapists and nurses to formulate a discharge plan. The social worker will assist in coordinating discharge to your home, a skilled nursing facility, in-patient rehabilitation facility, or nursing home.

What determines when I can go home after hip replacement?

You can go home when you can ambulate safely with a walker, go up and down stairs, and get to the bathroom. Typically, you will have had a bowel movement before discharge, and will be able to take a shower. Your doctor is the one making the ultimate decision about the safety and timing of your discharge. You will need someone to drive you home from the hospital.

When must I come back for a visit after hip surgery?

You will return for a visit about one month after surgery; call or e-mail if you have questions before that time. This guide and your home health nurse can be helpful resources. Long-distance patients may use email, sending digital photos of their incisions and digital X-rays; this works very well and saves time and travel expense.

When should seek medical help?

Contact your doctor if you have any of the following:

  • persistent drainage from your incision;
  • excessive redness around the incision;
  • increase in the incision pain;
  • increased leg swelling;
  • pain and swelling in the calf of the leg;
  • temperature above 101 degrees;
  • numbness or tingling down the back of the operative leg;
  • chest tightness;
  • new cough;
  • difficulty breathing;
  • or any related concern.

Your family doctor is a good resource if you develop a cold, flu, nausea, vomiting, diarrhea, or constipation. If you are unsure, please contact your surgeon. If unable to reach a doctor, and you feel there is a problem, please go to the local emergency room.

Getting moving

Can I place full weight on the operated leg after surgery?

Yes. But, use some form of assistive device for at least a month after surgery, to avoid a sudden twist and fall. Hip implants are loaded in torsion (a rotational stress is placed on the implant each time you get up, turn in bed, or go up or down stairs), as well as loaded in compression (your weight pressing down). Putting full weight on your hip right after surgery is never a problem.

About a month after surgery, if you feel confident and balanced, you can walk without a cane, but if there is any question, stay with a cane until you feel safe.

In complex, repeat hip implant surgery, these instructions will be more specific to each unique situation. In almost all cases, however, at 12 weeks after such surgery, patients can resume all activities.

Can I kneel down after hip replacement surgery?

Yes. As soon as you’re comfortable, kneeling is safe, as is crossing our legs and lifting weights by bending the knees or back. It is not possible to damage the implants.

How soon can I drive after surgery?

With a left hip replacement, an automatic transmission, and a healthy right leg, you can drive any time after surgery that you are comfortable. Typically this time is about two weeks from surgery, but sometimes longer.

If the right leg is operated on, you can drive in 3 to 4 weeks after surgery. If you feel sleepy or sedated because of pain medications, then you should avoid driving until you are alert and can concentrate on driving.

How much therapy will I need?

You need approximately four weeks of therapy, usually at home, with a visiting home health nurse. Some patients need therapy after this four-week period, and others are already independent. If you need outpatient therapy, usually 4 to 6 weeks will suffice. Once you learn basic hip exercises, you will be able to do them at home.

How much movement can I expect in the new hip?

The amount of movement you achieve should be close to that of a normal hip. That said, existing scar tissue, contractures of the hip joint, severity of arthritis, pain tolerance, motivation for exercise, body size, and other variables profoundly affect how much mobility a person will get. For most patients, the amount of hip movement gained after replacement allows them to engage in all activities of daily life.

Should I exercise after hip replacement?

Yes. A regular program of light aerobic exercise is beneficial from many standpoints, and will optimize the outcome of your hip replacement. After your six- week post-operative appointment, recommended exercises include walking, swimming, golf, hiking, treadmill walking, stair climbers, light aerobics, weight training, and elliptical exercise equipment.

How active can a person be after a total hip replacement?

You can be as active as you want, and lift as much weight as you desire. Heavy impact exercises, such as basketball, football, soccer, and tennis are probably best avoided, since they contribute to increased prosthesis wear. Low-impact aerobics, bicycling, treadmills, swimming, and similar exercises are fine. Climbing, hiking, and other outdoor activities can be performed as tolerated.

Strength and endurance will build up over time. Modern total hip implants are very durable and designed to take repetitive impact loading for many decades, even in active and heavy patients.

When can I ride a lawn mower, tractor, horse, bicycle, or ATV?

Defer these things for one month after hip implant surgery. You may feel like you can handle such activities sooner, but there is no point in rushing things.

When can I go back to work after surgery?

It depends on the type of work. If you are in hard labor, it is best to wait for three months before swinging into full action. Prior to that time, you can return to some light duty work if this is possible.

For jobs that require some standing, sitting, and walking, it is possible to return earlier. It really depends a lot on the individual and the job. Typically, most people will give themselves at least 3 to 4 weeks after joint replacement before returning to work in some capacity, but some people have returned to work after just two weeks.

When can I drink alcohol after surgery?

Moderate, social alcohol use can be resumed anytime that you wish. Avoid alcohol while you are on any blood thinner or pain medication.

When can one resume sex after a hip replacement or resurfacing?

You can resume sex as soon as comfortable, and in any position that does not cause discomfort. With earlier hip replacement methods, certain restrictions and precautions applied, but these do not apply to modern hip replacements.

How soon can I travel?

As soon as you are comfortable with sitting down, you can travel by airplane or car; there is no specific time period. If you travel, be sure to exercise your calf muscles and ankles frequently. Also, get out of the car or walk the aisle of the airplane frequently to avoid the possibility of blood clots. Continue taking blood thinners while you travel during the first month after surgery.

How long does it take to feel normal after a hip replacement?

A great deal of the recovery takes place in the first two months, but complete return to normal takes longer. Bone around the metal parts keeps changing and remodeling for 1 to 2 years after surgery, which is why you can feel deep aches and can tell when the weather changes. After that time, the hip will feel normal.

Do you use a machine to move the hip after surgery?

No benefit has been shown from the use of continuous passive motion (CPM) machines in hip replacement. Some surgeons use such machines after knee replacement, but they are not needed following hip replacement.

How much can I lift after hip replacement?

You can lift as much weight as you can comfortably tolerate. Once tissues have healed, lifting, climbing ladders or stairs, getting up on roofs, and related activities are safe. Avoid these things for about three months after surgery, until we are sure that your bone has healed into the implants.

Mobility Tips

Tips on walking

The therapist will demonstrate proper and safe walking after a hip replacement, with the use of crutches or walker. The purpose of the walker or crutches is to avoid a fall or sudden twist. Weight-bearing is safe immediately after surgery. But until the implants have grown into the bone, a process that takes 4 to 6 weeks, a fall or other sudden twisting force on the leg can risk implant loosening or injury to the leg. Reflexes take time to return, and narcotic pain medications can further dull the senses. That is the reason for learning to use an assistive device as long as necessary after surgery.

The assistive device can be a walker, crutches, or a cane in either hand; as long as you feel confident and safe in balancing yourself and minimizing the risk of a fall. When using a walker, lean forward, and lead with either leg. When using crutches, avoid putting weight into the armpits; the proper technique is to load the arms as much as needed for a comfortable stride. When using a cane, the most bio-mechanical advantage comes from holding the cane on the side opposite the replaced hip.

Assistive devices can be discarded anywhere from 1 to 4 weeks after surgery, depending on a number of factors, such as narcotic use, return of strength, confidence in walking, return of reflexes, and patient preference. Patients recover differently from each other, and there is no harm in using an assistive device to help in walking for a longer or shorter duration. Because the hip replacement components are designed to heal directly to bone without use of bone cement, the skeletal stability of the implants is assured by 4 to 6 weeks, at the minimum. Around that time, the assistive devices can be discarded, in favor of normal walking in nearly all cases

Tips on stairs

The ability to go up and down stairs requires strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good and down with the bad.” In other words, going up stairs, lead with the good (non-surgery) leg, and coming down stairs, put the bad (surgery) leg down first.

You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity.

Do not try to climb steps higher than the standard height (seven inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Managing pain & discomfort

Should I apply ice or heat to the hip as it is healing?

After surgery, and for the first two weeks, ice is more effective in reducing swelling and pain. After complete healing of the skin has occurred, you can use a moist heat pack if it feels comfortable. Soaking in a hot tub at this point may also be helpful.

Whom should I call for pain pills?

Please call the doctor’s office for pain medicines. State regulations allow some medicines to be phoned in; others require a written prescription. Please plan ahead, since narcotic prescriptions on weekends or Friday afternoons can be difficult to call in, mail in, or otherwise get filled.

How long can I have pain medications refilled?

Most patients will taper off the use of narcotic pain medications very quickly. Be aware that some narcotics cannot be phoned into pharmacies. If you will need refills over a weekend or holiday, be sure to contact medical staff during regular office hours.

Some patients require pain medications for a longer time, while others do not need them at all. Your physician will individualize treatment for every person.

How long should I take pain pills?

Most patients use pain medication for anywhere from 1 to 3 months. After three months, you should taper off and begin anti-inflammatory medicines and other non-addictive medicines for pain.

When taken over a long period of time, narcotic drugs create a tolerance that makes them less effective. That is why it is preferable to taper off narcotic drugs quickly after surgery, unless there are compelling reasons to continue use.

What if I need narcotics three months after surgery or if I have been taking them before surgery?

In such cases, the doctor who was filling the prescriptions prior to surgery may resume dispensing the medication. Very rarely, referral to a pain specialist is necessary for patients who are dependent on long-term narcotics.

If you were taking narcotics regularly before surgery, pain control is usually more difficult and complicated since the body is desensitized to the pain control medicines we use after surgery. In such cases, let your doctor know what you are taking before surgery so that they can adjust pain medicines accordingly.

Life with an artificial hip

How long will the artificial hip last?

In most cases, the hip replacement should outlast your lifespan. The 15-to-20-year data on the longevity of hip replacement components is excellent, with more than 90 percent of the implants still functioning well in many studies. But, this is neither a guarantee nor assurance, for the simple reason that life is unpredictable.

Many factors affect the future of a hip replacement or resurfacing, such as accidents, fractures, late infections, and deterioration in your overall health. How well you take care of yourself down the road is something the surgeon cannot control.

The longevity of a hip replacement thus depends on many factors, including the following:

  • Surgeon skill in implanting the components
  • Known history or track record of the implants
  • How well you take care of yourself and your health
  • Understanding and respecting the limitations of a prosthetic lifestyle
  • Your activity level and body weight
  • Avoiding high-impact or extreme sports

How do I know if I have a metal allergy to the hip part?

Orthopaedic implants are made of alloys of cobalt-chrome and titanium that have been implanted in millions of patients over the past several decades. Most instances of a persistently painful hip after replacement have to do with a problem related to the surgery, or possibly an infection. A true metal allergy is extremely rare, and seldom encountered in clinical medicine.

What will weather changes feel like in the hip?

Some patients report increased pain and stiffness, or can feel changes in the weather after hip surgery. These sensations are not common though, and usually will disappear over 1 to 2 years after surgery. For the first couple years, the bone adapts and grows around the metal prosthesis, and this bone activity probably leads to sensitivity to weather and pressure changes.

How about future dental work and other surgery?

Because you have an artificial hip joint in place, you must take care to protect it from infection. The same applies to any artificial implant in your body. Before having dental work (teeth cleaning, fillings, extraction or root canals) or certain medical procedures (colonoscopy, biopsy, endoscopies, etc.), you must take an antibiotic.

The antibiotic will help prevent bacteria from getting into the blood stream and thus into your hip. The odds of this happening are very rare, but the antibiotic can reduce this already small risk.

For routine dental prophylaxis following hip replacement surgery, antibiotics are recommended for your lifetime after the surgery.

In what other situations will I need antibiotics after the hip replacement?

Antibiotics given for other medical procedures may vary. Contact your medical professional for advice if there is any doubt. Antibiotics are needed if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.

If you have a cut anywhere that develops an infection, conditions like a tooth abscess or ingrown toenail developing, seek medical attention urgently. Ignoring a festering sore means that there is a risk the bacteria could migrate to the hip, resulting in a serious deep infection, even though it happens rarely.

Will the new hip set off a metal detector at the airport?

Most likely, it will. Tell airport personnel that you have an artificial joint prior to entering the metal detector. Metal detection sensitivity at airports is highly variable, and it is impossible to say if a certain detector will set off the equipment. You will be given an implant identification card that you can carry to prove that you have metal hip replacement parts.

Can I have a MRI scan after hip replacement?

Yes. MRI scans of other parts of your body are safe after hip replacement. Although some old MRI scanning equipment may not be compatible with your prosthesis, the majority of MRI scanning equipment today is safe and compatible with hip replacement parts. You may also have a CT scan of any part of your body after a hip replacement.

How will I know if my hip implants are recalled?

In the extremely unlikely event of a recalled implant, you will be contacted by the company who made the device. All implants have lot numbers registered with the implant maker. This information is kept in your medical record. If you want a copy of your X-ray or exact implant type and model for your records, please let your doctor know.

Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.

Is there a long-term risk of failure of hip implants?

Implants are engineered to withstand your body weight and activity level, but the moving parts of a hip replacement do wear over a period of several decades. A properly aligned hip replacement done by a competent, experienced surgeon will usually last the lifetime of most patients.

Subtle component mal-positioning and suboptimal orientation can however compromise the lifespan of the implant. This is why the skill and expertise with which the hip is implanted in your body is a critical determinant of durability.

Filed Under: About Hip Replacement, Featured, HIP, hip surgery Tagged With: blood clots, home, infection, metal allergy, movement, post-op, swelling

After Knee Surgery

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Recovering from Knee Surgery

When you’re considering knee surgery, you probably have many questions about post-surgery care. This informative article should address many of your concerns. Don’t hesitate to ask the members of your medical team for their advice and procedures.

What can I expect during the hospital stay?

You can expect several professionals to see you and help you with recovery. A physical therapist will help with knee exercises and walking with an assistive device, such as a walker. An occupational therapist will help you with everyday activities, such as dressing and bathing, while your knee is recovering. Your surgeon will see you often, as will a primary care doctor. Nursing staff will attend to your daily needs, ensuring that the doctor’s instructions are carried out and that you are comfortable. A nursing assistant will help with bathing and activities that you are unable to do yourself.

As you can imagine, the first night or two may be difficult; the hospital environment is new, the bed is not your own, and you will have multiple medications in your system. If you have trouble sleeping in the hospital, please ask the nurse for a sleeping pill. Expect to take a nap during the day, and anticipate several weeks before your normal sleeping patterns are restored, even after you go home.

How long will I be in the hospital?

Most patients are in the hospital for two to three days after a routine knee replacement; some need a longer duration of stay. A social worker will communicate with your insurance about the expected length of stay, and the duration approved by the insurance carrier. The social worker will help with discharge planning.

Preventing Blood Clots

What measures are taken to reduce the risk of blood clots?

Many physicians routinely use a blood-thinning medicine such as warfarin. This drug, or an alternative blood thinner, will be taken for about two weeks after surgery to lower the risk of a blood clot. The hospital pharmacist will monitor the blood-thinner dose, and will advise you if there is any change in the dosage.

After leaving the hospital, you will have a blood test twice a week, or more if necessary, to monitor the efficacy of the blood-thinner.

In addition, the exercises, foot pumps, lack of a tourniquet, efficient surgery, and early walking after surgery all serve to minimize the risk of blood clots. Most physicians use this type of multi-modal program to reduce the risk of blood clots forming.

What more should I know about blood clots?

Any surgery increases the risk of blood clot formation. Some patients are genetically predisposed to clot formation and are at a higher risk. If you have ever had clots in the past, please be sure to let your doctor know.

Clots can cause serious problems such as heart or vascular disease, or a stroke. A lung injury can occur if the clot migrates to your lungs from the leg. A large enough clot migrating to the heart or lungs can be fatal.

Anti-coagulation (blood-thinning) therapy is recommended after all knee replacement operations to reduce the likelihood of developing a clot. Even if a clot develops in the leg, if you are on a blood-thinner, the risk of the clot enlarging and migrating to the lungs is reduced. Exercises, spinal anesthetics, early mobilization, intermittent foot pumps, and blood-thinning medications are all aimed at reducing the risk of blood-clot formation after surgery.

What should I know about the blood-thinning medicine that I will be given?

At present, the most common blood thinner used after knee replacement is the drug warfarin. It is an inexpensive medication that requires adjustment on the dosage for each patient.

You will take warfarin at the same time each day. The dose will be based on a blood test that measures how fast your blood clots. The results are recorded as PT (prothrombin time) and INR (international normalized ratio); the pharmacist will look at these test results and figure out how much warfarin you should take. The goal of taking warfarin is to keep your INR between 1.8 and 2.5. If you miss a dose of warfarin, take it as soon as you remember, but do not double the next dose.

Many things, such as diet, other medications, physical activity and illness can affect warfarin dosing. Vitamins, over-the-counter remedies, herbs, nutrition supplements and other alternative treatments also affect warfarin, and should not be taken while you are on warfarin.

Are there risks to taking a blood-thinner?

Yes, and the obvious risk is bleeding. By thinning blood, we increase the risk of bleeding (something that can be managed), and decrease the risk of clot formation (which can be lethal). Thus, there is a trade-off in risks. The risk of bleeding is common to all blood thinners.

Drugs sometimes used instead of warfarin include heparin and aspirin. Some people may not be able to take warfarin; in that case it’s common to use a drug called enoxaparin. After about 10 days of warfarin, or enoxaparin, doctors typically switch patients to twice-daily aspirin; this combination is safe.

Side effects of warfarin and enoxaparin include dizziness, headache, weakness, cuts from shaving/injury that do not stop bleeding, nosebleeds, bleeding of the gums when brushing your teeth, vomiting blood, bruising or skin rashes, dark brown urine, red or black color to stools, unexpected vaginal bleeding, or unusual pain or swelling. If any such symptoms appear, we may have to switch to a different blood-thinner.

Warfarin interacts with many drugs, both prescription and over-the-counter. Special caution should be given to anti-inflammatory medications such as aspirin, ibuprofen-containing drugs; naproxen, ketoprofen, cimetidine, ranitidine; and food supplements that contain vitamin K.

Supplements, such as ginkgo biloba and danshen also interact with warfarin. Some herbal teas have tonka beans, melilot (sweet clover), or sweet woodruff in them, which contain vitamin K. In addition, foods containing fat substitutes such as olestra are supplemented with vitamin K.

Because so many dietary items affect warfarin, it is essential to monitor the action of this drug two or three times every week with blood draws that are done by the home health agency while you recover at home.


Preventing Infection

How do you prevent infections during knee replacement?

Scrubbing of the skin with an antiseptic, antibiotics given before surgery, surgeon experience, a team-approach designed to promote efficiency, and standardized protocols are some of the key steps in reducing the risk of infection. It is impossible to completely eliminate this risk, but it’s possible to get the risk down to nearly zero. It is very rare to have an infection after routine knee replacement.

Is there a long-term risk of infection in an artificial knee?

Yes, there is a lifetime risk of infection with any artificial implant in your body, whether a knee joint, heart valve, or other synthetic component. As long as you maintain good health and appropriate body weight, avoid smoking, maintain proper hygiene, keep diabetes under control, and promptly address even minor infections in your body, the risk of infecting an otherwise well-functioning knee implant is very low.

What if an infection does develop?

An early infection shows up as redness and pain around the healing incision. This can usually be treated with oral antibiotics alone, usually taken for five to 10 days. Very rarely, as a precaution, the knee joint has to be opened up and washed out to clean the tissues and effectively treat an early infection. This usually happens if the knee starts draining fluid after surgery, which is a rare occurrence.

A late infection that happens months or years after surgery is more serious, and will require additional surgery.

In these rare cases, the infected prosthesis is removed and a temporary antibiotic-loaded knee is implanted, to allow the patient to walk and function, while the infection resolves. After three or more months, a new knee joint is implanted. Six weeks of antibiotics and these two operations will effectively treat an established deep infection in the knee.

Fortunately, deep infections after knee replacement surgery are very rare, usually occurring in immune-compromised patients who have other serious medical problems.

Swelling

How long will I have swelling and warmth in the surgical site?

Swelling and warmth around the scar are common after a knee replacement operation. The ankle may also swell on the operated leg. This represents the normal process of healing and can last for several weeks to months, depending on factors such as circulation, body weight, diabetes, and other variables.

Obesity, diabetes, poor circulation, poor muscles, varicose veins, high activity, heart disease, and swelling before surgery will usually result in a longer period of swelling and heat in the operated leg. Elevating your leg at night and wearing compression stockings during the day will help.

Deep aches and swelling in the knee can persist for a long time because bone, a living tissue, continues to re-model and adapt around the metal implants. This increased metabolic activity can lead to lingering soreness and swelling after heavy activity, all of which will disappear with time.

Leaving the Hospital

What is the average length of hospital stay?

The length of hospital stay after knee replacement varies from just one day to five or more days. There is no standard formula; each person and each recovery is different. Typically, a routine knee replacement requires two to three days in the hospital; there is little to be gained by trying to accelerate this process. People need time to heal.

How is the discharge from the hospital handled?

During your hospital stay, a case manager will work with your doctor to plan your discharge, whether to your home, a skilled nursing facility, in-patient rehabilitation facility, or nursing home. A social worker may also visit, and work with the case manager to formulate a discharge plan.

What determines when I can go home after knee replacement?

You can go home when you are able to get into and out of bed; walk up to 75 feet with a cane, walker, or other assistive device; go up and down stairs; and get to the bathroom. Typically, you will have had a bowel movement before discharge, and will be able to take a shower. Your doctor is the one making the ultimate decision about the safety and timing of your discharge. You will need someone to drive you home from the hospital.

How will I manage at home?

After knee replacement surgery, you will need help at home from an adult family member or friend. If this is not possible, it may be necessary to stay at an inpatient rehabilitation facility. You will not be able to drive for the first couple of weeks.

A home health agency will check on you at home, about three times a week or more, to help with walking, exercise, incision checks, medications, and communication with the doctor. The home health agency will provide a nurse to do blood draws and follow-up care, a physical therapist to continue therapy, and possibly an occupational therapist. The nurse also communicates with your doctor to give regular progress updates.

While at home, if a concern arises, please contact your medical team.  If there is a worry about the incision, taking a digital photo and sending it by email works very well.

When do I have to come back to see the doctor after knee surgery?

You will return for a visit about one month after your operation. If you have problems or questions before then, do not hesitate to call or e-mail your physician. Your home health nurse is also an excellent resource. Patients coming from far away can communicate by e-mail, send digital photos of their incisions and digital X-rays the same way; this works very well and saves a lot of driving and time.

Under what circumstances should I contact a doctor?

It is advisable to contact your surgeon’s office office if you have any of the following:

  • Temperature above 101 degrees
  • Drainage from your incision
  • Excessive redness around the incision
  • Increase in the incision pain
  • Increased leg swelling
  • Pain and swelling in the calf of the leg
  • Numbness or tingling down the back of the operative leg
  • Any other concern, even if it seems minor
  • Your family doctor may be your closest resource for advice if you develop a cold, flu, nausea, vomiting, diarrhea, or constipation. If you are unsure which doctor to call, call your surgeon.

If you cannot reach a doctor and feel that there is a problem, please go to the nearest emergency room. It is best to be vigilant and not take chances.


Common Sensations

Why do I hear a popping noise in the new knee?

Clicking, popping, and other noises in the knee alarm many patients. These are the harmless result of synthetic joint surfaces contacting each other and are common to all prosthetic knee components. The sounds may change over time, may disappear entirely, or may persist. The noises of an artificial knee joint will take some getting used to.

Why are my appetite, mood, food-taste, and sleep different after knee replacement?

Altered appetite, bowel habits, depression, and mood swings are common after any major elective surgery, including knee replacement. This is very important to know, understand, and anticipate. In some cases, medications might be necessary to control such symptoms.

All surgery elicits powerful psychosocial and physiological responses from the patient and vary from one person to another. These responses are normal, and we will help you get through them. It takes time for the body, mind, and soul to recover from any invasive operation.

Why is the outside of my knee numb?

This is normal after all knee surgery. The incision cuts small nerve fibers that run from inside to outside of the knee, so the skin to the outside of the cut always feels numb after knee surgery. Usually, this sensation will resolve over time and is not a major problem for patients. Most patients will not notice that the outside of the scar feels numb.

Is it normal for the muscles to spasm and tighten after surgery?

Yes. Sometimes unexpected spasms of the leg muscles occur after surgery, usually as the person is healing from the operation. These spasms will go away. If they are particularly troublesome, we can prescribe a muscle relaxant medicine, which can help.

Will my leg be longer after knee replacement?

Not noticeably, since it is not possible to lengthen or shorten a leg after knee replacement surgery. The reason is that blood vessels and nerves behind the knee present a practical limitation. Some patients say that the leg feels slightly longer. This comes from straightening out a crooked leg, which ends up feeling longer as a result. The sensation disappears as the patient gets used to having a normally aligned leg again.


Caring for your Incision

How long is the scar for knee replacement?

In most cases, a four- to five-inch incision is enough for knee replacement surgery. Your surgeon will use the shortest possible incision length. Incision length ultimately depends on each patient’s disease severity, anatomy, and amount of body fat.

Many orthopaedic implant companies have developed special instruments to assist in making shorter incisions, and provide training on their effective use. The general rule is to make the incision as short as possible, without compromising the accuracy, precision, or safety that is required for a successful long-term outcome. Since each patient is different, incision length can vary from person to person, even though the same type of knee replacement implants may be used.

Who will remove the staples from the incision?

For the first month, a home health nurse will visit you to check the incision, do blood work to monitor the blood thinner, and help you exercise and walk. That person should remove stitches no earlier than 21 days (three weeks) after surgery.

If there is any question about healing, it is safer to wait another week before removing stitches. Home health nurses can take a digital photo of the incision if there is a concern and send it to your doctor via email.

The preferred method to remove staples is to remove every other one, and apply adhesive-reinforced tape strips to ensure the skin stays together. If there is any concern about the skin edges coming apart, the rest of the staples can be left in for another week; delayed healing can occur in patients with a history of poor wound healing, cancer, diabetes, obesity, and other factors.

Please share this information with the home health person if there are any questions about staple removal. It is safe to shower anytime after staples are removed. Immersion of the incision in bath water, or in a pool should wait till the skin is fully healed.

Can I put any lotion on the scar?

While the staples are still in, it is best not to apply anything to the incision, and to keep the wound clean and dry. Once the staples are out, you can use vitamin E cream to massage and loosen up the scar. Most patients find this beneficial, and some feel that it makes the scar less visible. Massaging the knee area with an anti-inflammatory or cortisone cream can also help reduce skin inflammation and tenderness after knee surgery.

When can I shower after knee replacement?

You can shower as soon as you want after surgery. The incision will be covered with a plastic dressing, and the nursing staff will assist you. If the wound dressing gets wet, you can change it after the shower and use a towel to dry the skin around the incision. Showering reduces the bacterial load on your skin. Once the staples are out and the skin is dry, you can soak the knee in a bath also, but do not soak the incision area in a bath before the staples are removed.


Getting Moving

How long will I be off my feet after knee replacement?

nurse helping patient walk with crutches

You can put full weight on the replaced knee right after surgery. The therapist will get you up and walking the day after surgery. You will need the assistance of a walker or crutches, but putting weight on the knee and twisting is safe. Most patients are reasonably independent after four weeks, although individual recovery times will vary.

Will I need a walker, crutches, cane, or other assistive device?

Yes. You will likely require a walker for some time after knee surgery. If you have a walker, bring it with you to the hospital. If you do not have one, we can arrange for a walker while you are in the hospital.

Prior to surgery, you should pick up all throw rugs and secure extension/electrical cords at home, and make sure your furniture is arranged to allow you to use a walker safely, without the risk of falling. You can transition to a cane or crutches at any time you are comfortable.

I have pain and stiffness in the first few steps, then the knee feels OK. Is this normal several weeks, or even months after knee replacement?

Yes. Muscles, tendons, and ligaments take time to stretch and accommodate after surgery. The pain that is worse after sitting and goes away with walking is called start-up pain, and can persist for a long time. These symptoms will decrease as tissues heal. An anti-inflammatory medicine can help.

Will I have to learn how to walk again?

Considering that a prosthetic knee has no nerves and that the arc of movement after knee surgery will vary from before, many people feel like they must learn how to walk again. This is to be expected after knee replacement surgery. Take your time, and do not rush the process. There is no point comparing your recovery to anyone else, since recovery is very individual and depends on many patient-specific variables. At some point in your recovery, the new knee will begin feeling like a part of your body. Until then, it is true that you are, in a sense, learning to walk again.

How much therapy will I need?

You need a minimum of four weeks of therapy, usually at your home, with a visiting home health nurse. This person will see you about three times a week. Some patients need therapy after this four-week period, and others are already independent. If you need outpatient therapy, usually four to six weeks will suffice. Once you learn basic knee exercises, you will be able to do them at home.

Maintaining a regular program of exercise and mild aerobic activity long-term is an excellent idea, and you will maximize the benefit of your new knee.

Can I kneel after having a knee replaced?

Yes, although it may take several months before you can do it comfortably. The reason is that the kneecap experiences heavy loads during knee bending; loads that exceed your body weight. Soreness may keep you from kneeling after knee replacement surgery. You can safely kneel as soon as you are comfortable; you cannot damage the knee replacement by kneeling.

What happens if I do not get motion back in the knee quickly?

With minimally invasive surgery, lack of a tourniquet, and minimal muscle disruption, knee motion returns very quickly after replacement surgery. In very few cases, if the knee is not gaining mobility, it may be necessary to manipulate the knee joint under an anesthetic to “fast-forward” you in therapy, and break up early scar-formation in the knee joint. This is rarely necessary, and performed only on individuals who form heavy scar tissue.

Why does scar tissue form in the knee joint?

Scar formation is normal after all operations. After knee replacement, scar formation inside the joint is usually overcome by knee movement. Because of genetic factors and other variables, some patients will form scar very quickly inside the knee joint. Such patients may need additional or more aggressive therapy, and such patients will find that their recovery of knee mobility takes longer than others. This is normal, and again emphasizes that no two patients recover alike since patient anatomy and physiology vary from person to person.

How much bending will I get in the knee joint after replacement?

Implants bend safely to 150 degrees, which is about the physiologic limit of human knee anatomy. Existing scar tissue, contractures of the knee joint, severity of arthritis, pain tolerance, motivation for exercise, body size, and other variables profoundly affect how much mobility a person will get. For most patients, zero degrees of knee extension (bringing the knee out straight) and about 125 degrees of flexion (bending) are easily achieved; this is more than enough for almost all activities of daily living.

Do you use a machine to move the knee after surgery?

No benefit has been shown from the use of continuous passive motion (CPM) machines. Most surgeons use them now out of habit, or because some patients prefer them. If you would like a machine to move your knee after surgery, discuss it with your medical professional. Usually, outcomes from knee replacement are just as good without these machines. CPM machines are never a substitute for using your own muscles and motivation to regain mobility.

Should I exercise after knee replacement?

Yes. A regular program of light aerobic exercise is best, with weight training added to the exercise regimen. Exercise is beneficial from many standpoints, and will optimize the outcomes of your knee replacement. Recommended exercises include walking, swimming, light aerobics, golf, treadmill, stair-climbing, weight-training, and elliptical exercise equipment.

How soon will I be able to return to everyday activities?

Soon after surgery, you will begin to walk short distances in your hospital room and perform everyday activities. This early activity aids your recovery and helps your knee regain strength and movement. A nurse or therapist will assist you as necessary.

Returning to regular activity in terms of walking, exercising, and work vary greatly between patients; most patients return to their regular activities in six to 12 weeks.

How active can a person be after a total knee replacement?

You can be as active as you want and carry as much weight as you can tolerate. Heavy impact exercises, such as basketball, football, soccer, and tennis are probably best avoided, since they contribute to increased prosthesis wear. Low-impact aerobics, bicycling, treadmills, swimming, and similar exercises are fine. Climbing, hiking, and other outdoor activities can be performed as tolerated.

Strength and endurance will build up over time. Modern total knee implants are very durable and designed to take repetitive impact loading for many decades, even in active and heavy patients.

When can I drive after knee replacement surgery?

For the left leg and an automatic transmission in your car, drive whenever you can comfortably sit in a car and have control of the operated leg. For the right leg (and left in the case of driving a car with a clutch), it takes about two to four weeks before you regain the confidence and control in the leg to drive. Of course, you should not drive if you are taking narcotics that make you sleepy or reduce alertness. Avoid driving any time comfort or pain is an issue.

How much can I lift?

You can lift as much as you are comfortable doing. Start out with small weights, and build up your tolerance. As long as the knee does not hurt, lifting weights is fine.

Can I ride horses after knee replacement surgery?

Yes, once your recovery is such that you are independent, strong, and comfortable, you can ride horses, ATVs, and bicycles, with reasonable precautions that apply to each.

When can I go back to work after knee surgery?

The faster you get back to work, the better it is for you, psychologically and physically. We can accommodate your requests for time off work and your return to limited duties. Each individual and job situation is different. Your medical team will work with you to expedite your transition back to your job. Some people with desk jobs have returned to limited work in two weeks after knee replacement; others have preferred to take several months off.

Can I climb ladders?

Yes, climbing ladders is fine as long as the knee is fully healed and your strength has returned.

When can I resume sex?

You can resume sex at any time after knee surgery that you feel comfortable. Unless specifically instructed otherwise in very selected and unusual cases, there are no precautions to follow after knee replacement surgery.

When can I travel after surgery?

Whenever you feel comfortable, go ahead and travel by car or airplane. It is best to avoid the same seated position for over an hour, so try to get up and move around when possible. Otherwise, make sure to do ankle and calf exercises every hour to keep the blood pumping and avoid the possibility of blood clots forming. Prolonged sitting will also cause leg swelling, so it is best to change position during travel if possible.

When can I drink alcohol after surgery?

Moderate, social alcohol use can be resumed anytime that your appetite dictates. Avoid alcohol if your blood is too thin on the warfarin, and your warfarin dose is being held. Heavy alcohol use after any surgery is dangerous.

How long does it take for me to feel normal after a knee replacement?

While 80 to 90 percent of recovery is usually over by the first two months, the last 10 percent can linger. Even though patients can resume normal activities, the bone around the new implants will keep remodeling in response to the altered biomechanics. As a result, it can be up to two years or so before an artificial joint really feels like your own. It can take that long for the skeleton to accommodate the new knee, and feel normal.

Why is recovery after knee replacement said to be harder than after hip replacement?

One, the hip has more muscles covering it, and fewer nerves.

Two, the hip joint is relatively simple, consisting of one kind of movement (ball and socket).

Three, hip surgery can be done even less invasively than knee replacement using modern techniques.

Four, after a hip replacement, very little exercise is necessary for recovery, since there is little risk of the hip getting stiff. In contrast, the knee is a complex joint, relying on outside ligaments for support. These ligaments get stretched with every step. There is very little muscle cover around the knee, so that any bump is felt in the joint.

Finally, the knee tends to scar and stiffen quickly, and the joint must be moved actively to prevent this, and regain motion. For these reasons, recovery after hip replacement is typically a lot easier than recovery after knee replacement.


Helpful Tips

Tips on Walking

Proper walking is the best way to help your knee recover. At first, you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg; in most cases full weight is safe right away.

Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Advance your walker or crutches a short distance; then reach forward with your operated leg with your knee straightened so the heel of your foot touches the floor first.

As you move forward, your knee and ankle will bend, and your entire foot will rest evenly on the floor. As you complete the step, your toe will lift off the floor and your knee and hip will bend so that you can reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor.

Walk as rhythmically and smoothly as you can. Don’t hurry. Adjust the length of your step and speed as necessary to walk with an even pattern.

As your muscle strength and endurance improve, you may spend more time walking. You will gradually put more weight on your leg. You may use a cane in the hand opposite your surgery and eventually walk without an aid. Early on, it is best to moderate the exercise and avoid overdoing it.

When you can walk and stand for more than 10 minutes and your knee is strong enough so that you are not carrying any weight on your walker or crutches (often about two to three weeks after your surgery), you can begin using a single crutch or cane. Hold the cane or crutch in the hand opposite the side of your surgery. You should not limp or lean away from your operated knee.

Tips on Stairs

The ability to go up and down stairs requires strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good” and “down with the bad.” In other words, going up stairs, lead with the good (non-surgery) leg, and coming down stairs, put the bad (surgery) leg down first.

You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity.

Do not try to climb steps higher than the standard height (seven inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.


Managing Pain and Discomfort

How much pain can I expect?

With modern surgery, pain can be controlled very well. Even though modern pain medicines are very effective, some aching and soreness in the knee may persist for many months. This is part of a normal recovery, as long as you notice steady improvement.

Each patient will recover differently; even two knees replaced in the same patient on the same date will recover differently. For example, effective pain control may be a problem for patients who take narcotics regularly before surgery. In these patients, pain relief can be hard to attain since the body desensitizes itself to narcotics.

Will there be persistent pain after surgery?

No, although pain perception varies greatly among patients and the time to full recovery is highly variable. The important thing to watch for is a steady decline in the level of discomfort; the knee should feel better month-to-month. If there is persistent pain, or increasing pain, then further inquiry is necessary. Remember, there will always be patients who go home in a day or two, and never seem to have any pain after knee replacement. There are others who recover far more slowly. The important thing to remember is that both types of recovery are entirely normal.

Should I apply ice or heat to the knee as it is healing?

After surgery, and for the first two weeks, ice is more effective in reducing swelling and pain. After complete healing of the skin and removal of staples, you can use a moist heat pack if it feels comfortable. Once healed, soaking the knee in a hot tub helps, too.

Whom should I call for pain pills?

Please contact your doctor’s office for pain medicines. State regulations allow some medicines to be phoned in; others require a written prescription. Please plan ahead, since narcotic prescriptions on weekends or Friday afternoons can be difficult to call in, mail in, or otherwise get filled.

How long should I take pain pills?

Most patients use the narcotics that are sent home with them for anywhere from one to three months. Over time, they taper off and begin anti-inflammatory medicines and other non-addictive medicines for pain by three months.

Narcotic drugs taken over a long time creates a tolerance that makes them less and less effective. That is why it is preferable to taper off narcotic drugs after three months, unless there are compelling reasons to continue use. This is a general observation; some patients will require narcotic medications for a longer period of time.

What if I need narcotics three months after surgery or if I have been taking them before surgery?

In such cases, the doctor who was filling the prescriptions prior to surgery may resume dispensing the medication. Very rarely, referral to a pain specialist is necessary for patients who are dependent on long-term narcotics. These medications are carefully monitored and tracked in the pharmacy databases, and specialized pain doctors are better trained and equipped to monitor their long-term use.

If you were taking narcotics regularly before surgery, pain control is usually more difficult and complicated since the body is desensitized to the pain control medicines we use after surgery. In such cases, let your doctor know what you are taking before surgery so that we can adjust pain medicines accordingly.

There are no hard rules. Your medical team is there to help you; they understand that every person is different and that pain is very individual.

Filed Under: About Knee Replacement, Featured, KNEE, Knee Surgery Tagged With: blood clot, infection, pain, recovery, scar, swelling, warfarin

About Hip Replacement

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Hip Replacement FAQ

Hip replacements should not be undertaken lightly; below are some of the most common questions patients have.

What is a total hip arthroplasty?

Surgeons use the word “arthroplasty” to mean replacement. The word “total” means that both the ball and socket part of the hip are replaced. “Total hip arthroplasty” means the same thing as total hip replacement.

Is there a partial hip replacement?

Yes. In some cases of hip fracture in elderly patients who have no arthritis in the joint, surgeons may elect to replace only the ball. This means a metal ball moves inside the patient’s own socket.

In low-demand patients, this is a reasonable option, although a total hip replacement is usually more durable and offers more predictable pain relief (see illustration).

When should hip replacement be considered?

The ideal time for surgery is when other measures, such as medicines, exercise, weight loss, and alternative therapies no longer work. If hip pain causes a limp, affects your lifestyle, interferes with work or recreation, and negatively impacts your body image, then surgery is a reasonable option.

Will a new hip joint be a perfect substitute for my own hip?

Metal and plastic cannot fully replicate the complexity, intricate engineering, and healing ability of the human body. Hip replacement components are products of modern science and engineering that come close but cannot duplicate the natural hip joint.

However, a prosthetic hip provides dramatic pain relief and improves movement, function, and lifestyle. Many patients experience complete resolution of their pre-surgery pain and discomfort.

How does the artificial hip joint get lubricated?

The replaced hip develops a lining around it, and the cells secrete synovial fluid (a biological lubricant) into the synthetic joint. This fluid provides lubrication so that the artificial bearing is never dry.

Synovial fluid is recycled by the cells. No external lubrication of the new hip joint is ever needed. Injections into an artificial hip joint are not beneficial and will increase the risk of infection.

About how long does a hip replacement take?

It varies – a common time is about half an hour. However, patient preparation for surgery, safe positioning, safety checks, and anesthesia add considerably to this time. Individual patient and anatomic variations may also alter surgical times. Each person is unique and surgery is never an assembly-line procedure.

Is it possible to replace both hip joints at the same time?

Yes. This has become routine when patients need both hips replaced and are in good health otherwise. Rehabilitation time is perhaps slightly longer than for one hip replacement, but not noticeably so.

Many surgeons use the “anterior” surgical approach to hip replacement, which means that the patient is on his or her back, and muscles are spread, rather than cut. This usually makes surgery on both sides much simpler, safer, and faster.

Ask your surgeon about their surgical approach; new procedures are always being developed and refined to improve recovery and minimize surgery needs.

What is the optimal age for hip replacement?

Hip replacement is usually done in patients in their 50s through their 80s, although the operation is also done in patients who are older or younger than this age range. With modern implants and bearings, young age is not a contraindication to successful surgery. In the past, hip replacement was reserved for the elderly, because the implants and synthetic bearings were not as durable as they are today.

Should I wait, or get my hip replaced now?

The availability of new technology, streamlined surgical methods, and improved implants should not rush your decision to have a hip replacement. Non-surgical methods of relieving pain should be tried first; sometimes they can help postpone surgery for many years. A reasonable period of waiting and careful decision-making is always wise.

Will waiting to get a hip replacement make things worse?

No. Waiting is safe. Even if the hip joint gets becomes more deformed, the surgery is just as easy. The only downside to waiting is that muscles might get weaker and more stiff, thereby making recovery a bit longer. This can be offset by maintaining a reasonable body weight and following a program of light exercise to keep your muscles in shape.

One exception applies to revision hip implant surgery. If your joint was replaced many years ago, and the wear particles are starting to dissolve bone, your physician may advise you to have surgery sooner rather than later.

Another exception applies to joints that have been replaced, and are suspected of having a deep infection of the prosthetic device. In those cases, corrective surgery is recommended early, so that the infection does not penetrate the bone.

How many joints can one have replaced?

hip replacement implant installed in the pelvis boneIt is possible to have multiple joints replaced safely. For patients with other serious health conditions, it may be best to get these done one at a time, starting with the worst one first.

Some patients do have more than a single hip or knee replacement; it is not unusual for people to have artificial joints in both hips, knees, shoulders, and more. The ability to replace painful joints is a remarkable advancement in medicine.

What if my previous hip replacement surgery did not work out?

Hip surgery can be complicated by deep infection, implant mal-positioning, nerve injury, leg length discrepancy, and other unhappy outcomes. A second opinion is worth exploring even if a surgeon tells you nothing can be done.

Many factors can compromise the results of hip replacement, even though the X-rays look fine. A step-by-step approach to identifying the reason for an unsatisfactory outcome, and addressing it, can help patients who have had a poor outcome.

Hips can be replaced more than once. Modern technology allows replacement of deficient bone, even if the entire femur bone is lost.

Where else can I learn about hip surgery?

To learn more about the anterior hip replacement technique specifically, visit newhipnews.com. Another useful source is bonesmart.org, which even has a patient dialogue forum. Manufacturers of hip implants have patient education websites as well.

Can arthritis occur in a hip after it is replaced?

Replacement surgery eliminates all diseased cartilage in the hip joint. It is not possible to have arthritis since the native cartilage is gone and will never grow back.

However, arthritis is a complex disease that affects tissues around the joint, such as nerves, muscles, ligaments, and the synovial lining of the hip. This is why some pain, stiffness, and internal swelling can persist for many months even after X-rays show complete healing following a hip replacement.

Muscles and tendons, weakened and stiff from years of disuse, can take 1 to 2 years to stretch and adapt after hip surgery.

Will hip replacement get rid of all my pain?

Yes, if all the pain is really coming from the hip joint. But an artificial hip cannot relieve pain coming from an arthritic spine, weak muscles, arthritic knees, hernias, poor circulation, fibromyalgia, rheumatoid arthritis, and other such conditions.

How long is recovery after hip replacement?

Most recovery is in the first 4 to 6 weeks. By then, bone grows into the metal components and most patients become mobile enough to walk without a cane.

During the first 4 to 6 weeks, be cautious and use a walker or cane while walking, and avoid sudden twists and falls. Eight weeks after surgery, most patients can resume light lifting and other daily activities.

Very heavy lifting, returning to strenuous jobs, and extended exercise should wait until three months. These timeframes are approximate; healing varies from patient to patient.

The bone around the metal implants continues to adapt and remodel for 1 to 2 years after surgery. During that time, expect some mild aches and pains, and discomfort with pressure and weather changes. Ultimately, all such sensations will resolve.

Is recovery from hip replacement faster for younger patients?

No, not necessarily. The recovery appears to be more or less the same for young and older patients with hip arthritis. The recovery from hip replacement also seems to be very similar between men and women, as well as between thinner and heavier patients.

Is recovery faster after hip replacement than knee replacement?

Yes, people recover faster after hip replacement, with less pain and less need for physical therapy, when compared to knee replacement. There could be several reasons for this.

The knee joint is more complex, and involves many different types of movement; the knee may have more nerves transmitting pain sensations; hips have a heavier protective layer of muscle and tissue compared to knees, and there may be other explanations why recovery from hip replacement is usually easier than a knee replacement.

Patient perception between a knee replacement and a hip replacement is also different. It can take a couple of years, or longer, for an artificial knee to feel natural and like the real thing. In contrast, a hip replacement feels natural, and more like the real thing after considerably less time.

What are the inherent risks of hip surgery?

Inherent risks are those complications that can occur, no matter where you have surgery done, or who performs it. You should know these in order to make an informed decision about surgery.

No hospital, physician, or surgical method can eliminate the inherent risks associated with hip surgery; beware of any hospital or surgeon who claims otherwise.

Complications after hip surgery are rare, typically occurring with a frequency of 1 percent to 2 percent of the cases. Each complication listed below is discussed in more detail, elsewhere on this website. If you prefer to discuss this in person, please ask your physician.

Possible adverse outcomes after hip surgery include, but are not limited to, blood clots, pneumonia, nerve injury, blood vessel injury, blood transfusion risks, anesthetic complications, heart attack/cardiac complications, stroke, failure of implants, dislocation of the components, superficial or deep infections, bone fracture, leg length inequality, and even death.

How much does a new hip joint cost?

Insurance contracts, hospital pricing, medical billing, and other variables related to cost are complex. In fact, specially trained personnel are required to do medical billing. If you want to know the costs involved, please contact your physician’s office; their billing team will give you an accurate answer.

Will Medicare or my insurance cover hip surgery and therapy?

Yes. However, insurance plans and related benefits vary; to be certain, it is best that you check with your insurance company. Talk to your medical team as well, since surgery and hospital stays must be pre-authorized with insurance companies.

Filed Under: Featured, HIP, hip surgery Tagged With: arthroplasty, artificial hip, hip joint

Life with an Artificial Knee

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Once you have an artificial knee, what will be different? Here are answers to common questions.

How do I know if I have a metal allergy to the knee part?

Orthopaedic implants are made of alloys of cobalt-chrome and titanium that have been implanted in millions of patients over the past three decades. Allergies to solid metal alloys are sometimes speculated, but are rarely seen in practice. Most instances of a painful knee after replacement have to do with a problem related to the surgery, or possibly an infection. A true metal allergy is extremely rare, and seldom encountered in clinical medicine.

What will weather changes feel like in the knee?

Some patients report increased pain and stiffness, or can feel changes in the weather after knee surgery, especially with an artificial joint. These sensations are not common though, and usually will disappear over one to two years after surgery. For the first couple of years, the bone adapts and grows around the metal prosthesis, and this bone activity probably leads to increased sensitivity to weather and pressure changes that some patients can feel in their joints.

What do I need to know about future dental work and other surgery?

Because you have an artificial knee joint in place, you must take care to protect it from infection. The same applies to any artificial implant in your body. Before having dental work (teeth cleaning, fillings, extraction or root canals) or certain medical procedures (colonoscopy, biopsy, endoscopies, etc.), you must take an antibiotic.

The antibiotic will help prevent bacteria from getting into the blood stream and thus into your knee. The odds of this happening are very rare, but the antibiotic can reduce this already small risk.

For routine dental prophylaxis following knee replacement surgery, antibiotics are required for your lifetime after the surgery.

What antibiotics are used to protect the prosthetic knee joint if I have dental work?

Cephalexin and amoxicillin are antibiotics commonly prescribed before and after dental work. You may take azithromycin or clindamycin if you are allergic to amoxicillin. You also may take any antibiotic recommended by the American Heart Association.

What other situations will I need antibiotics for, after the knee replacement?

Antibiotics given for other medical procedures may vary. Contact your doctor for advice if there is any doubt. Keep in mind that it will be necessary for you to be treated with a full course of antibiotics if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.

If you cut your foot, or have broken skin on the leg, or infection in a toenail after a knee replacement, seek medical attention immediately. Ignoring a festering sore means that there is a risk the bacteria could migrate to the knee implant, resulting in a serious deep infection, even though it happens rarely.

Will the knee set off a metal detector at the airport?

Most likely, it will. Tell airport personnel that you have an artificial joint prior to entering the metal detector. Metal detection sensitivity at airports is highly variable, and it is impossible to say if a certain detector will set off the equipment. Your doctor or nurse will supply you with an implant identification card that you can carry to prove that you have metal knee replacement parts.

Can I have a MRI scan after knee replacement?

Yes. MRI scans of other parts of your body are safe after knee replacement. Although some old MRI scanning equipment may not be compatible with your prosthesis, the majority of MRI scanning equipment today is safe and compatible with knee replacement parts. You may also have a CT scan of any part of your body after a knee replacement.

How will I know if my knee implants happen to be recalled?

In the extremely unlikely event of a recalled implant, you will be contacted by the company who made the device. All implants have lot numbers registered with the implant maker. This information is kept in your medical record. If you want a copy of your X-ray or exact implant type and model for your records, please ask your physician.

Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.

Is there a long-term risk of failure of knee implants?

No, the implants are engineered to withstand your body weight and activity level, but the moving parts of a knee replacement do wear over a period of several decades. A properly aligned knee replacement done by a competent, experienced surgeon will usually last the lifetime of most patients.

Subtle component malpositioning and suboptimal orientation can however compromise the lifespan of the implant. This is why the skill and expertise with which the knee is implanted in your body is a critical determinant of how long the knee will last and how well it will perform.

How many times can you replace a total knee?

With modern technology, cases that were considered hopeless a few years ago can undergo successful knee replacement surgery. Such complex knee replacements are done every week in our specialty practice, and are referred from all over. So, there is no hard and fast rule as to how many times a knee can be replaced. Knees that have had multiple operations may be missing structural bone support, muscle cover, and quadriceps support.

While doctors hope that you never need such complicated knee operations, it is possible to get patients mobile again in situations that would have resulted in an amputation in the past. This reflects advances in surgery techniques and related technology.

What if I receive conflicting advice and opinions from other people taking care of me in the hospital or during home health visits?

Your own surgeon is your best resource.

 

Filed Under: Featured, KNEE, Knee Surgery Tagged With: antibiotics, dental work, failure, metal allergy, recall, weather

Parts and Materials for Knee Replacements

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Are there different kinds of knee implants?

components of the kneeYes. There are several different types of knee replacements. All of them are variations of the basic design introduced more than 30 years ago, which is called the “total condylar posterior stabilized knee.” The choice of implants depends on factors such as the status of ligaments and the amount of deformity in the knee. Usually, surgeons use a “high-flex” design that is safe for deep knee bending. The implants come in “gender-specific” versions engineered to match the knee anatomy of men and women. As new designs in total knee replacements are developed, we expect surgeons to adopt them only after carefully considering the advantages, safety, and scientific merits of such designs.

What brand of knee implants do you use?

For most knee replacements, a custom implant tailored to each patient is the best option. The company that makes these is Conformis (www.conformis.com). This technology is the best design as of this writing (2014.) We have also used the Zimmer brand of knee implants (www.zimmer.com, and www.pacewithlife.com)

(Note: No implant company pays Dr. Bal to promote or implant its products and no commercial entity has contributed, in any way, to the preparation of this guide.)

Can you show me the parts used in a total knee replacement?

Your surgeon should be able to show you actual parts and will probably have other materials such as animations or video that you can see.

What if I want a different brand of knee prosthesis?

New implants are sometimes hyped up by local surgeons and hospitals eager to get your business. Some of these newer designs are true improvements, while others are simply old designs with new packaging, gimmicks, and slick marketing. As a new design is introduced and marketed by the orthopaedic implant industry, we will present it with an unbiased discussion on this website.

If truly innovative implants are introduced, the odds are that I or some of my colleagues have been using them well before they are released to community orthopaedic surgeons. If you have an interest or preference for a particular type or brand of knee implant, please talk to your surgeon.

Can ceramic parts be used in knee replacements?

Yes. The advantage is the lower wear rate of ceramics when compared to metals. In the United States, ceramic knees are used on a limited basis since the Food and Drug Administration (FDA) has not approved them for general use. Several years ago, we conducted one of the few clinical trials in the country on ceramic knees.

Ceramic parts are useful in the rare cases of a true metal allergy in selected patients. Ceramic components will likely become more common in the future. At the time, ceramic materials in total knees are more common overseas. Balancing the very low wear rates of ceramics is the fact that we do not have enough scientific data from U.S. studies to support their routine use in total knee replacements as of yet.

Do you use the same model of knee implant for all knee replacements?

No. Each patient situation is unique, and the type of implant chosen depends on many patient variables, including age, gender, weight, bone dimensions, ligament condition, bone quality, anticipated activity level, and occupational history.

In older patients with weak and osteoporotic bone, for example, the best choice may be a cemented model supplemented by design features that will support external knee ligaments. On the other hand, for a healthy young person with physically demanding job, the ideal model may be an uncemented total knee design that allows as much bone preservation as possible.

In patients who have had knee replacement in the past and are in need of repeat surgery, it is often necessary to use more complex models, to reconstruct deficient and missing bone.

Are newer knee implants much different from old ones?

Yes. There are newer “high-flex” knee designs that allow greater safety during deep knee bending. There are also newer “gender-specific” total knees made to fit the anatomical differences in the knees of men and women. All knee replacement components that we used incorporate these modern design features.

Other variations in total knee implants include a ceramic “oxinium” surface, the “rotating-platform” knee, and other brands marketed by implant companies. Discuss this with your surgeon and medical team; they will help you make an informed choice.

Can I get a “golfer’s knee” implant?

As above, if you prefer one kind of implant over the other, ask your surgeon. Keep in mind that no knee implant is better suited for golf or any other sport. Participation in activities such as golf is equally possible, and equally easy with any of the competing knee designs out there, whether or not they claim to be a “golfer’s knee.”

What about a custom knee replacement made just for my leg?

One of the most exciting innovations when I was practicing is the concept of custom-manufacture of knee implants that are made specifically to each patient’s size and unique anatomy. CT or MRI imaging is used to determine the precise anatomy of the patient’s ankle, hip, and knee. These data are sent to a company called CONFORMIS (Boston, MA), where the metal and plastic pieces are custom-made for the patient in about 5-6 weeks, much like a tailor-made suit. The instruments used to implant the knee prosthesis are designed for a one-time use, specific to the patient, and are made of a biodegradable material. One neat package contains everything needed for the operation, and is unique for each knee joint, fitting only that one.

We used this in my practice beginning in 2013 and found it truly innovative, a meaningful step forward in knee replacement surgery. Our results showed earlier and easier recovery for the patient, and x-rays that are beautifully precise in terms of rotation, alignment, and sizing. This technology incorporates all of our knowledge and design understanding in knee replacement, worldwide. It increases patient safety, promotes quality and consistency, ensures precision and a perfect fit every time, and therefore has our full support.

(Please interpret this information in light of a conflict, in that Dr. Bal serveds as consultant surgeon for CONFORMIS, and was on a surgeon advisory and design team for this company. He did not receive any royalty or other payment to promote or implant CONFORMIS knee products, however, since the consulting activities concern other CONFORMIS technology platforms.)

Are there other implants that are used to treat knee arthritis?

In unusual cases of knee arthritis and in relatively young patients, a shim-like device called the uni-spacer may be used. This device acts like a spacer to separate the worn-out knee surfaces and keep them from grinding against each other. Very few patients meet the criteria for this type of surgery, and a uni-spacer is a temporary option, best reserved for very young patients with knee arthritis.

In what cases do you use human tissue for knee replacement?

In rare cases, cadaver tissue can be used for reconstruction of the extensor mechanism in selected knees. These are complex cases with previous trauma that has ruptured the quadriceps tendon in addition to causing arthritis of the knee. For the majority of knee replacements, no human tissue is ever needed.

How does the artificial knee joint get lubricated?

After a joint replacement, the artificial bearing gets its lubrication from synovial fluid, just like the natural knee joint. After surgery, the synovial lining re-forms and secretes synovial fluid. In cars, oil must be changed regularly, but in the body, synovial fluid is recycled by the cells. No external lubrication of the knee joint is ever necessary. In fact, any injections placed into your artificial knee joint increase the risk of infection.

Can patients become allergic to the knee replacement parts?

The metals used in artificial knees are alloys of cobalt-chromium and titanium. The bearing portion of the joint is made of a high-grade, wear-resistant plastic. The metal-plastic bearing combination is the most common type used in knee replacement implants worldwide. These metals have been used in humans for many decades and millions of patients with very successful results. Allergic reaction to artificial knee parts is virtually unheard of, and is not a routine clinical concern.

In the extremely rare case of a true metal allergy verified by testing, there are material science options to replace a knee without exposure to titanium, nickel, or cobalt-chrome, which are the usual metals used in standard knee replacements. In other words, metal-allergic patients can still get a knee replacement.

What actually moves inside an artificial knee joint?

In an artificial knee joint, highly polished cobalt-chromium metal moves against a very durable plastic spacer to allow movement. This bearing is lubricated by your body’s own synovial fluid, which is constantly replenished by living cells. The power to move the artificial knee, once implanted in your body, comes from your own muscles. That is why the condition of your muscles affects how quickly you recover after any type of knee surgery, including a total knee replacement.

Filed Under: About Knee Replacement, Featured, KNEE Tagged With: allergy, ceramic, conformis, prosthesis, zimmeer

Treating Hip Arthritis

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We compiled a list of some frequently asked questions about treatment for hip arthritis and hope you find it useful!

Will exercise help an arthritic hip?

Yes. Exercises strengthen the muscles around the hip joint. Weak muscles mean higher forces across an arthritic hip joint, and more pain. That is why regular, light aerobic exercise helps to relieve pain from arthritic hips. Recommended exercises include walking, swimming, elliptical exercisers, and similar activities.

Reasonable levels of exercise will not accelerate the wear and tear of an arthritic hip joint. Stronger and more conditioned muscles reduce the loads placed on the hip, and relieve pain. Exercise may help postpone hip replacement surgery.

One caveat: If exercise hurts, then refrain from that activity and try another form of exercise.

Does a cane help with an arthritic hip?

Yes. A cane in either hand helps, but is most effective if used in the hand opposite the painful hip. A cane reduces the load across the arthritic hip, thereby relieving pain and improving walking ability.

Will injections into the hip joint ease arthritic pain?

Yes, cortisone injections placed into an arthritic hip will ease pain temporarily. For mild cases of arthritis the injections may help for many months. However, injections cannot build up cartilage or otherwise cure arthritis.

Cortisone injections can also help pinpoint the source of hip pain, if there is any doubt where hip pain is coming from. If hip pain is really from hip arthritis, and not referred from a bad back or another source, then cortisone injections should relieve pain, even if temporarily.

Hip joint injections require X-ray imaging to guide the needle into the hip joint. This is why such injections must be done in a special procedure room, equipped with X-ray imaging equipment. If done in the clinic, these injections can be guided by ultrasound technology.

Lubricant injections that are marketed as “visco-supplementation” can help arthritic hip joints temporarily. However, they are more commonly used for treating arthritic knees.

Research to alleviate the pain and inflammation of hip arthritis is ongoing and exciting, such as injections using gold nanoparticles with mild radioactivity.

Is there surgery for hip bursitis?

Yes, if injections in the hip bursa do not work reliably, there is an arthroscopic technique, done as outpatient, that works very well using only a couple of small holes made in the skin. Pain relief is predictable with this small operation. Again, this applies to hip bursitis, which is very different from hip arthritis.

What else, other than surgery, can help an arthritic hip?

If possible, avoid stairs and concrete floors; weight lifting; deep bending at the hip; and repetitive impact exercises such as jogging, golf, and racquetball. Reasonable exercises include walking on a treadmill, swimming, low-impact activities, and upper-body conditioning. There are no effective braces for hip arthritis.

Will arthroscopic surgery help hip arthritis?

In mild or early hip arthritis, yes. Mild hip arthritis can result in hip cartilage tearing; this condition, called a torn labrum, can be addressed with hip arthroscopy. Arthroscopy refers to an outpatient operation, involving small skin openings through which a small camera and surgical instruments are introduced to trim torn pieces and clean up the joint. At the same time, the surgeon can remove bone spurs that physically impinge against each other, causing pain and stiffness.

But, if the arthritis is too advanced, then arthroscopic surgery may not be too helpful.

One benefit of arthroscopic surgery is the ability to look directly inside the joint and understand the extent of arthritic damage. With this information, a surgeon can advise on further treatment.

What is osteotomy of the hip?

camera use in arthroscopic surgeryOsteotomy refers to cutting bone and realigning the leg, to relieve the pain of an arthritic hip. By altering biomechanics favorably, the loads across the ball and socket joint are lessened. Osteotomy was once a commonly used surgical option in young patients, back when hip replacements were not suitable for young and active people.

In cases where the socket or ball is mis-shapen since birth and the arthritis is diagnosed early, osteotomy can help, especially in young patients. The surgeon can cut the femur and the pelvis to create a more aligned hip joint, thereby slowing the progress of arthritis.

Osteotomy is a complex, major procedure, and requires special skills that we offer in our practice. The goal of osteotomy in such cases is to preserve the patient’s own hip joint. Few patients are candidates for such a procedure, because in most instances, hip arthritis has progressed enough that a hip replacement is more desirable.

What is a hip fusion?

This is another hip operation that was more common in the past. It involves eliminating the hip joint, by surgically welding, or fusing, the ball to the socket. By eliminating movement in the hip joint, pain is relieved without using implants.

Hip fusion is also called an arthrodesis. Increased movement in the back and knee usually compensates for the stiff hip after the fusion.

Hip fusion is nearly obsolete now, since hip replacement surgery is so durable and predictable. But back in the days when hip replacements were not quite as advanced, hip fusion was worth considering for young patients.

Does weight loss help relieve arthritic pain?

Yes. Biomechanical studies show that body weight is multiplied 2 to 3 fold across the hip joint. Losing excess body weight relieves arthritic pain by unloading the joint. Weight loss also decreases surgical risks should hip replacement be necessary.

Will chiropractic manipulations help hip arthritis?

For some patients, chiropractic manipulations seem to help arthritic pain. Alternative remedies, such as glucosamine, vitamins, oils, yoga, hypnotism, herbal supplements, heat packs, ice packs, massage, aromatherapy, aqua therapy, prolotherapy, and acupuncture might also help. Use these remedies if you feel that they are helpful, and if you are familiar with their proper use.

If you are scheduled for surgery, stop all alternative medications and vitamin supplements at least 10 days before surgery. This is to avoid excess bleeding and risky interactions with the anesthetic drugs.

What about injections for hip bursitis?

Injections to the outside of the thigh are commonly used to treat hip bursitis. These injections do not enter the hip joint, and do not need X-ray guidance for accurate placement.

Hip bursitis is not related to hip arthritis. Bursitis is a local inflammation in the tissues near the hip joint, caused by muscles and tendons rubbing against each other. The pain from hip bursitis is located on the outside of the thigh, making it hard to walk or lie on that side. Hip arthritis, in contrast, is deterioration and inflammation of the ball-and-socket joint itself.

A visit to the doctor can usually help determine if you have bursitis or arthritis.

Should I use pain medicine for hip arthritis?

Medicines such as aspirin, acetaminophen, ibuprofen, naprosyn, and other anti-inflammatory drugs can be taken for a long time, within proper dose range. These medicines are not addictive. Your primary physician should monitor any possible side effects, especially if you take such medicines regularly.

Alternative remedies, such as glucosamine chondroitin, are available over the counter. These can help arthritic hips and can be used without risk of addiction.

Narcotic drugs can also relieve pain, but can create dependence and related psychological problems. Long-term use of narcotic drugs before surgery will make pain relief after surgery more difficult. If you regularly require narcotic medicines to control hip pain, it may be time to consider hip replacement surgery.

Why not replace the hip instead of trying nonsurgical measures?

Patients who invest the time to understand all options will know what to expect, and usually have the most satisfying outcomes. Nonsurgical treatment can give you time to learn more about hip arthritis and assess all treatment options.

Also, nonsurgical means of pain relief can work for a long time, at least for some patients; hip replacement surgery should be the last step.

Will arthroscopic surgery buy some time with an arthritic hip?

It could, depending on the extent of arthritis. In mild cases, with cartilage tears in the hip joint causing catching and pain, arthroscopy can buy time before a hip replacement. But if X-rays show advanced hip arthritis, arthroscopic surgery will probably not have any lasting benefit.

What is a hip resection, or Girdlestone, procedure?

This refers to a removal, or resection, of the diseased hip ball, and replacing it with nothing. Historically, this operation was done for conditions like tuberculosis of the hip, long before the days of modern hip replacement. The infected bone would be removed, and the hip cavity would be left empty.

Over time, the empty hip cavity would fill with scar tissue and the leg would shorten by a couple of inches, making walking very difficult. But, removal of the infected ball would give the patient a chance at healing the tuberculosis infection, and relieve pain.

Today, a Girdlestone resection in the hip is done very rarely. Circumstances in which the procedure is considered include a serious infection that cannot be eliminated otherwise, severe bone loss from multiple failed operations, muscle paralysis, or advanced cancer.

Filed Under: Featured, HIP, hip surgery Tagged With: arthrodesis, arthroscopic, bursitis, chiropractic, fusion, Girdlestone, osteotomy, resection

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