How is a Hip Replacement Performed?

How do surgeons replace a Hip?

Total hip replacement is a successful and cost-effective surgery. This procedure offers relief of pain and improvement in function in patients with hip arthritis. Currently, a hip replacement can last for up to 20 years. According to a recent clinical study, the prevalence of total hip replacement in the United States is 1%, with 2.5 million people having a hip replaced each year. Total hip replacement is an excellent treatment option for many people.

Anesthesia

You may be able to choose which type of anesthesia given during surgery. The two options typically are:Hip pain

  • Epidural (spinal) anesthesia – Involves placement of a small catheter into the epidural space near the spinal cord that delivers medication to numb the lower body. This is often combined with administration of a sedative.
  • General anesthesia – This involves use of an intravenous medication to put the patient to sleep. The patient will have no pain or memory of the surgery.

The Procedure

Once you are moved to the operating area, you will be given anesthesia. The hip region will be shaved and cleaned with an antiseptic solution. Once you are asleep, the surgeon will make an incision on the top of the hip (anterior), on the side of the hip (lateral), or on the back of the hip (posterior). The surgeon then displaces, detaches, and/or manipulates the muscles and soft tissues to expose the joint.

One the hip joint is visualized, the upper aspect of the femur (thigh bone) is removed, and the natural socket (acetabulum) is hollowed out to fit the femoral head (top of femur bone). The socket is fitted into the hollow region of the pelvis, and a short, angled metal shaft with a smooth ball is fitted into the thigh bone. The ball will fit into the socket to move the thigh in a normal fashion. The cup and stem are usually fixed with a special cement.

Once all changes are made, the muscles and soft tissues are returned to usual position. This may require suturing and reattachment techniques. After the incision is closed using surgical staples or sutures (stitches), the area is covered with a sterile, dry bandage. The patient is usually placed in compression stockings that inflate to prevent blood clots.

Materials Used

Stryker-Hip-Revision-Surgery-Myositis-Ossification-ComplicationsProsthetic components may be cemented or uncemented. With the uncemeted method, the parts are made from a material with a rough surface. This allows bone to grow into the component to hold it in place (press-fit). The prosthetic parts may be held in place using acrylic cement.

Most prosthetic components are made using a high-density polythene (plastic) for the socket, titanium alloys for the femoral shaft (stem), and a ball made of chromium, cobalt, and/or molybdenum. Some surgeons use a metal ball and socket, because they do not wear as quickly as plastic components.

Choosing your Prosthesis

There are more than 60 different kinds of prostheses (implants). The options are usually only limited to around five, however. The surgeon will advise you won which type will best suit your health condition. The National Institute for Health and Care Excellence (NICE) recommends implants known to have at least a 95% chance of lasting 10 years. The orthopedic surgeon will discuss your options with you.

Recovery

After your total hip replacement, you will remain in the hospital for 2-6 days, depending on your health condition and progress. You will be discharged home or to a skilled nursing facility for rehabilitation. It takes around 3-6 weeks to recover from a hip replacement, and incisions and tissues are still healing after a year. It is important to participate in physical therapy and a strenuous exercise program to regain full hip function.

OSPI offers top orthopedic surgeons who are hip and knee replacement specialists in Gilbert and Chandler AZ. Patients are seen from all over the Valley including Mesa, Queen Creek, Maricopa, Scottsdale and Phoenix. Most insurance is accepted, call us for an evaluation today!

Physical Therapy After Total Hip Replacement

One of the most commonly performed orthopedic surgeries is a total hip replacement (THR). The surgical techniques and prosthesis used for a THR have improved over the years, allowing the patient to now achieve optimal recovery and less pain. Physical therapy is an important aspect in a successful, full recovery after hip replacement.

In the Hospital

Right after your total hip replacement, a physical therapist begins working with you to restore joint motion and strength. Initially, therapy begins in physical therapy1the hospital the day after surgery. A therapist shows you how to get in and out of bed, ways to get into the shower and car, and how to walk using a walker or crutches. In addition, the therapist has you perform simple exercises in bed to prevent blood clots, such as gluteal squeezes and tightening the thighs.

After a hip replacement, some patients received additional physical therapy in a rehabilitation facility before going home. This will depend on the age of the patient, what the home environment is like, and functioning when discharged from the hospital. The physical therapist works with the patient using exercise equipment for strengthening and mobility. Balance exercises are used to decrease risk of falling. In addition, the physical therapist uses heat to warm up tight muscles and ice to reduce soreness and swelling.

Avoiding Dislocation

After a total hip replacement, there are some considerations the physical therapist follows to help you decrease risk of dislocating the new hip. With the posterior approach hip replacement, you cannot bend the hip past 90 degrees, must avoid crossing your legs, and cannot rotate the hip inward. Maneuvers to assist with avoiding these activities include use of a raised toilet seat and shower chair, use of a pillow between the knees, and using an orthopedic device to put on shoes and socks.

Home Physical Therapy

Once you go home, the physical therapist will visit you 3-4 times each week to improve hip strength, mobility, and flexibility. Common therapy exercises include:

  • Buttock contractions – Tighten muscles and hold to a count of 5.
  • Abduction exercise – Slide leg out to the side as far as possible and then back.
  • Quadriceps set – Tighten thigh muscles and try to straighten knee. Hold for 5-10 seconds.
  • Straight leg raises – Tighten thigh muscles with knee straight. As muscles tighten, lift leg sever inches from bed and hold for 5-10 seconds.
  • Standing exercises – These include standing knee raises, hip abduction, and hip extensions.
  • Walking and full weight-bearing – These exercises are used to help you perform light everyday activities.

physical_therapy

Recovery at Home

Don’t be surprised if you feel fatigued right after surgery. This will improve over the next few weeks, however. You should arrange to have someone help you out for 1-2 weeks after your total hip replacement. The exercises given to you by your physical therapist are an essential part of recovery.

You should be able to stop using crutches or a walker, and resume normal leisure activities within 6 weeks of the surgery. However, it could take up to 12 weeks for pain to completely resolve. Your new hip is continuing to recover for up to 2 years after the operation, which involves scar tissue healing and restoration of muscles.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top surgeons specializing in joint replacement (hip and knee), along with sports medicine too. Most insurance is accepted with patients being seen from all over the Valley including Mesa, Chandler, Queen Creek and Scottsdale too! Call us today.

Recovery after Anterior Approach Total Hip Replacement

Anterior hip replacement is a less invasive approach to hip joint surgery. With the anterior approach to total hip replacement, the orthopedic  surgeon in Gilbert AZ accesses the joint from the anterior (front) of the hip as opposed to the lateral (side) or posterior (back). The anterior approach allows the Arizona hip surgeon to make repairs and replacements without detaching tendons, muscles, or soft tissue.

Small Incision

The anterior approach to hip replacement was first described in the 1940s. This approach is gaining in popularity, and advocates for anterior approach total hip replacement consider its advantages to be earlier restoration of walking, low dislocation rates, and muscle-sparing ability. The ModularEndoprosthesisprocedure begins with the patient lying on his/her back. The surgical incision is slightly lateral to the front superior iliac spine of the pelvis. The 4- to 5-inch incision runs toward the lateral aspect of the ipsilateral knee. After moving soft tissue and muscle, replacement is made.

Because the anterior total hip replacement surgery uses a small incision, and muscles are moved rather than cut, the result is less trauma and damage to the hip soft tissues. Recovery time is usually faster with the anterior approach than traditional surgery, and patients report less post-operative pain. After only 2-3 weeks, patients begin walking without assistance, which is compared to 5-6 weeks with posterior hip replacement surgery.

Length of Hospital Stay

After the minimally invasive hip replacement, you will stay 1-4 days in the hospital. You may stay longer if you have serious health conditions, severe hip arthritis, and complications during the procedure. The length of stay varies from patient-to-patient, but the anterior approach to hip replacement is usually related to a shorter length of hospital stay than the posterior or lateral approaches.

Physical Therapy

Physical therapy begins the day of surgery. To strengthen the hip joint, you must do small exercises, such as contracting buttock and leg muscles and ankle pumps. The therapist works with you to learn exercises that help regain full hip movement. You will work with the therapist two times each day. Once you return home, the physical therapist will see you 3-4 times each week.

 

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Home Recovery

After you leave the hospital, you should have family or friends stay with you for a few days. You will need help with errands and household activities. In addition, you cannot drive for 2-4 weeks, so you will need transportation home from the hospital, to follow-up appointments, and to the pharmacy. It is also important to stock up on easy to prepare foods, such as frozen, canned, and premade meals.

Incision Care

Your anterior incision will be closed with staples or sutures, which are removed around 10-14 days after surgery. The surgical site will be numb, sore, bruised, and/or swollen for a few days. You may experience itching or pulling of the incision site as well. We recommend using an icepack for 10-20 minutes several times a day to relieve discomfort. In addition, avoid using any lotions or creams on the hip area. To keep the incision clean and dry, avoid showering until your wounds are healed. You can bathe, however.

Physical Activity

Being physically active is an important aspect for recovery. Within 2-4 weeks, you will be able to resume your daily routine and normal activities. During the first week, you will start walking with a walker and advance to using a cane. To avoid falls and injuries, you should only walk in areas where there are handrails, no loose rugs, and no cords. You may begin driving after 2-3 weeks, depending on how you progress.

 

OSPI offers the top hip specialists in Arizona, specifically the East Valley. Hip replacements done by the anterior approach need an expert to be done well. Call OSPI today, most insurance is accepted!

Do I need a Total Hip Replacement?

A total hip replacement is one of the most successful surgeries of modern medicine. This procedure is very effective for improving range of motion and relieving pain. The orthopedic surgeon in Chandler AZ follows certain guidelines to determine of you are ready for a total hip replacement.

The main goals of hip replacement are to stabilized the hip and offer pain relief. Leg-length equality is a Hip painpriority after the first two goals are established. Hip replacement parts in the U.S. are most often press-fit into the bone. To limit small cracks in the bone, the surgeon uses special implants and techniques.

Conservative Treatment Measures

Patients with hip arthritis or injury are often managed with conservative treatments. The orthopedic specialist will not perform a total hip replacement unless you have failed with these measures:

  • Physical therapy – Used to strengthen weak hip muscles and improve hip function, physical therapy involves strategic exercises. Many patients with hip arthritis often respond to physical therapy.
  • Corticosteroid injections – The doctor can injection the hip joint with an anti-inflammatory corticosteroid solution. These injections are usually given in a series of 3, which are spaced 3-4 months apart.
  • Anti-inflammatory drugs – Acetaminophen is the gold standard drug for arthritis. Anti-inflammatory drugs, such as ibuprofen and naproxen, can help alleviate the pain associated with inflammation.

Candidates for Total Hip Replacement

The Arizona orthopedic surgeon will decide if or not you are ready for a total hip replacement. Candidacy is based on:

  • Groin, hip, buttock, and knee pain – Patients with serious hip arthritis often have pain deep down in the groin region. This pain is relieved with a hip replacement. In addition, knee pain can occur because nerves that supply the knees run by each hip. When affected by inflammation, the nerves canstockphoto13092914can cause knee pain. Buttock and hip pain also can occur.
  • Bone-on-bone arthritis – The orthopedic surgeon will take some x-rays to see if the bone ends of the hip are touching. Pain occurs when the femur ball (thigh bone) does not fit properly in the socket.
  • Marked interference with daily activities – Surgery is considered when you have marked interference with daily activities. Patients will have trouble climbing stairs, putting on socks and shoes, and may need a cane for walking.
  • Trouble sleeping – Hip pain can affect ability to sleep, despite the use of pain medications.
  • Ability to participate in recovery – The patient having a total hip replacement must be able to participate in the rehabilitation program. Recovery takes around 3-6 weeks, and involves intense exercises and strengthening maneuvers. The doctor will consider a person’s ability to participate in the recovery process.

Total Hip Replacement Candidates

In years past, orthopedic surgeons in AZ reserve hip replacement surgery for persons age 60 years and older. This was because older people are less active and will not put stress on the artificial hip as a younger person would. In recent years, doctors have found that total hip replacement is useful for younger persons as well. New technology has improved surgical techniques and prosthetic components, allowing the new hip to withstand more strain and stress.

Hip replacement surgery involves a new hip that can last for as long as 20 years. A person’s overall health status and activity level are important in predicting the success of total hip replacement. A recent study shows that people who choose to have this surgery before advanced joint deterioration occurs tend to have an easier time with recovery.

The top orthopedic surgeons in Arizona at OSPI offer hip and knee replacements which are top notch. Often they are outpatient, allowing for rapid recovery getting people back to work and recreational activities fast! Call us today.

Resources

National Institute of Arthritis and Musculoskeletal Diseases (2016). Questions and answers about hip replacement. Retrieved from: http://www.niams.nih.gov/health_info/hip_replacement/

 

Recovery after Partial Knee Replacement

After a partial knee replacement, you are monitored in the recovery room for a few hours. After you wake from general anesthesia, you are moved to a hospital room. Most patients stay 2-4 days in the hospital after knee replacement.

Hospital Recovery

  • Deep breathing – To avoid lung and airway congestion, you should take several deep breaths every hour. This moves mucus from the airways and expands the lungs.Knee pain 3
  • Compression stockings – You will wear elastic or plastic compression devices to prevent formation of blood clots in your legs. This is done to improve circulation and prevent clot formation.
  • Physical therapy – Soon after you move to your hospital room, you will meet with the physical therapist. Physical therapy is used to prevent complications, improve mobility, and strengthen knee muscles. You will work with the therapist 1-2 times each day.
  • Continuous passive motion (CPM) – A CPM machine bends the knee in normal range of motion on a continuous level. This is used to keep the knee from getting stiff and prevent blood clots.
  • Physical activity – A nurse will help you move to and from the bathroom, and the physical therapist works with you on walking using a cane or walker. Physical activity is encouraged immediately after surgery.

Recovery at Home

Once you go home, you must continue with your recovery. This involves:

  • Preparation – Before going home, you must arrange to have someone drive you. In addition, you may want to have help around the house for a few days. Have some gauze, tape, and ice packs available, and stock up on frozen meals and canned foods. You need to have a raised toilet seat, a shower Unicompartmental knee replacementchair, and handrails on stairways before you go home.
  • Incision care – You will have sutures or staples along your incision at the front aspect of the knee. These are usually removed within 10-14 days. You may have bandages on the knee as well. You must keep the area clean and dry, and avoid soaking in a tub or pool until wounds are healed.
  • Physical activities – You are not permitted to drive for 3-6 weeks, so arrange to have someone drive you home and help at home for a few days. You are encouraged to move about your home using an assistive device. Avoid falling by removing all loose rugs and cords from walkways.
  • Physical therapy – A therapist will come to your home daily after your knee replacement. You must work with the professional to walk, climb stairs, and perform activities. The therapy is used to strengthen leg muscles and improve range of knee motion.

Same Day Discharge

It is possible that the Gilbert orthopedic surgeon discharges you on the same day of surgery. This depends on your existing health conditions, current health status, and surgeon’s choice. In a pilot study used to investigate discharging patients within the day of surgery, researchers evaluated patients undergoing knee replacement. Of the study participants, all had a partial knee replacement through a short incision, and no dislocation of the patella was involved. All patients were in the accelerated recovery program.

Follow-up assessments were performed at 1, 2, and 6 weeks after surgery. The average pain score for the first couple of weeks was a 2 on a 1-10 scale. In addition, knee flexion was 125 degrees for all patients at 6 weeks, and all patients could walk independently at the 6-week follow-up appointment. Researchers found that the fast-track recovery protocol was safe and effective for people undergoing partial knee replacement.

OSPI in Gilbert AZ offers the top knee specialists in AZ. They offer both total and partial knee replacements, often allowing patients to go home the same day! This allows for rapid recovery, with less downtime than if traditional methods were used. Call today!

Resources

Bard DJ, Murry DW, Rees JL, et al. (2002). Accelerated recovery for unicompartmental knee replacement–a feasibility study. Knee, 9(3), 221-224.

 

How does Surgical Approach to Hip Replacement affect Recovery?

Anterior hip replacement is an approach to surgery used to improved patient outcomes. Thousands of hip replacement surgeries are performed each year, but only 20% of surgeries in the United States are done using the anterior approach. The other 80% of surgeries are performed using the posterior or lateral approach.

Advantages of the Anterior Hip Replacement

Supporters of the anterior hip replacement approach believe it offers the following canstockphoto10503438advantages:

  • Less damage to major muscles – The orthopedic surgeon avoids cutting and manipulating major muscles during the anterior hip replacement. The surgeon works between the front muscles rather than severing muscle fibers or detaching muscle from bone.

 

  • Less post-operative pain – Because anterior approach does not require manipulation and cutting of muscles, the patient has less post-surgical pain and requires less medication.

 

  • Faster recovery – After surgery, the patient can bend at the hip and bear weight sooner. Most anterior hip replacement patients use walker or crutches soon after surgery. In a recent study researchers found that anterior hip patients walked unaided 6 days earlier than those who had the posterior surgery.

 

  • Decreased risk for dislocation – With the anterior surgery, the hip is not at risk for dislocation because soft tissue structures are not moved.

 

  • Improved range of motion – Patients can bend over, sit with legs crossed, and perform other movements without risking hip dislocation.

 

  • Shorter hospital stay – A patient who undergoes anterior surgery will not stay in the hospital as long as with the traditional approach.

 

Advantages of the Posterior-Lateral Hip Replacement

In a recent study comparing posterior and anterior approaches to hip replacement, researchers found that both groups had improvements in pain and range of motion, with no observable differences in gait or dislocation. Advantages to the posterior approach can include:

 

  • Less technically demanding – The posterior approach to hip replacement is easier to canstockphoto24182699perform. Anterior approach requires considerable training, skill, and experience by the orthopedic surgeon.

 

  • Simpler and easier – Many Gilbert orthopedic surgeons believe the posterior approach is the simplest and easiest, therefore providing the greatest safety margin for patients.

 

  • Minimal risk of femoral fracture or implant problems – Due to ease of this surgery, there is less risk to the patient for femoral fracture or poor positioning of the prosthetic component.

 

  • No special surgical equipment required – This procedure does not require the use of high-tech, specialized surgical equipment.

 

Disadvantages of the Anterior Hip Replacement

There are a few limitations associated with anterior hip replacement. These include:

  • Not suitable for obese or large patients – Muscular, overweight, or obese people are not good candidates for the anterior procedure.

 

  • More technically demanding – The Arizona orthopedic surgeon must be very experienced in performing the anterior hip replacement. This surgery is known to be quite technically demanding.

 

  • Potential for nerve damage – The lateral cutaneous femoral nerve runs down the front of the pelvis and past the hip to supply the thigh. There is more potential for damage to this nerve with the anterior approach.

 

  • Delayed wound healing – Some studies show that wound healing is delayed using the anterior approach, with 1.4% of patients having a wound complication compared to 0.2% with the posterior approach.

 

Disadvantages of the Posterior-Lateral Hip Replacement

  • Higher post-operative dislocation rates – Some studies show higher rates of dislocation with the posterior approach. However, with improved technology, these rates have declined.
  • Longer recovery – The posterior approach to hip replacement is associated with longer hospital stays and recovery. However, with full participation in physical therapy and rehabilitation, the recovery time has shortened.

OSPI offers state of the art approaches for hip replacement which minimize hospital stay and complications, while improving outcomes. Most insurance is accepted by the Gilbert and Mesa orthopedic surgeons, call today!

Resources

Kennon RE, Keggi JM, et al. (2013). Total hip arthroplasty through a minimally invasive anterior surgical approach. Journal of Bone and Joint Surgery, 85-A:39-48.

Petis S, Howard JL, Lanting BL, & Vasarhelyi EM (2015). Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg, 58(2), 128-139.

Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, & Ong A (2014). Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons, 22:595-603.

Taunton MJ, Mason JB, Odum SM, & Springer BD (2014). Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. pii: S0883-5403(14)00340-4. doi: 10.1016/j.arth.2014.03.051.

 

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Recovery after Total Knee Replacement in Arizona

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Each year, thousands of people undergo total knee replacement (TKR) surgery. This procedure is done to replace damaged portions of the knee, including cartilage and bone ends. The most important part of surgery is the recovery.

Hospital Recovery

  • Bandages/drains – The knee will have a bulky elastic bandage dressing on it. Depending on the situation, some patients have a small drain inserted at the surgical site to remove excess blood and fluid that accumulates. The bandage is removed 1-2 days after surgery, and the drain is usually removed within 3 days of surgery.

 

  • Incisions – The incisions must be kept clean and dry. Sutures or staples are removed in 7-14 days.

 

  • Continuous passive motion (CPM) – A CPM machine is used to move the knee in physical therapy1regular motion. This helps the knee regain flexion.

 

  • Activities – Nurses will help you get out of bed and back in bed while in the hospital. You are encouraged to walk to the bathroom using a walker, crutches, or cane.

 

  • Deep breathing – After surgery, you must perform deep breathing exercises to rid your airway and lungs of mucus. This involves taking several deep breaths every hour.

 

  • Physical therapy – The physical therapist works with you to improve range of motion and strengthen muscles. The therapist assists with sitting at bedside, transferring in and out of bed safely, climbing stairs, walking with a cane or walker, and performing exercises without the CPM.

 

  • Pain management – The nurses will administer pain medicine to keep you comfortable.

 

Home Recovery

  • Preparation – Before going home, you need to arrange for a ride home, and have someone available to help you for a few days. It is a good idea to have plenty of gauze and tape ready, as well as pre-made meals, ice, and water. You will need to have a recliner or an ottoman so you can elevate your leg. In addition, you should remove all loose cords and rugs from walkways.

 

  • Physical therapy – The therapist continues to work with you after you go home. As the days progress, you will increase your frequency and distance of walking. Most patients are on a straight cane within 3-5 days of surgery.

 

  • Pain management – To control pain, take prescribed medications before pain gets too severe. In addition, avoid any alcoholic beverages while you are taking these medicines. We recommend taking pain medicine at least 45 minutes before physical therapy sessions, so the medicine will take effect.

 

Dos and Don’ts after Knee Replacement Surgery

 

  • Do position the knee comfortably as you perform daily activities.
  • Do use an ice pack if swelling occurs.
  • Do walk and perform range of motion exercises each day.
  • Do elevate the leg often to reduce swelling.
  • Don’t twist the knee.
  • Don’t jump or put any sudden stress on the knee.
  • Don’t put a pillow under the knee.

 

Fast-Track Recovery Protocol

 

During the last decade, many medical facilities have implemented fast-track protocols for total knee replacement. A fast-track protocol will reduce the length of hospital stay.

 

In a recent study involving fast-track recovery, researchers evaluated patients during the first 6 weeks after total knee replacement. They found that 28 of the 30 study participants were satisfied with a short hospital stay. It was determined that quality of life at 6 weeks discharge was the same for fast-track patients as those who stayed longer at the hospital.

OSPI in Gilbert AZ offers top knee replacement surgeons providing rapid recovery procedures. Most insurance is accepted, call today!

Resources

Van Egmond JC, Verburg H, & Mathissen, NMC (2015). The first 6 weeks of recovery after total knee arthroplasty with fast track. Acta Orthop, 86(6), 708-713.

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Overview of Partial Hip Replacement

Partial Hip Replacement in Gilbert AZ

 

With a partial hip replacement, also called a hemiarthroplasty, only the patients femoral head (top of thigh bone) is replaced. The prosthetic component will rotate in the natural hip socket. This procedure is used for patients who do not need replacement of the joint ModularEndoprosthesissocket (acetabulum).

How is the partial hip replacement different from total hip replacement?

The partial hip replacement surgery is less invasive than total hip replacement. With the partial procedure, only the ball of the femur must be replaced, and the joint socket is left alone. This surgery is used for patients who require replacement of the femoral head.

What are the reasons for a partial hip replacement?

Breaking or fracturing a hip can lead to breaks through the femur, which often displaces the femoral head. When the fracture occurs within the hip joint, it is called a femoral neck fracture. The upper portion of the femur is surrounded by muscle, and it has better blood supply than the neck. The partial hip replacement is used to repair damage that occurs after these injuries. A fracture of the femoral head or neck can lead to significant pain and loss of normal function.

Usually, patients who are good candidates for a partial hip replacement are those who have no significant underlying arthritis and people with healthy cartilage. A partial hip replacement is seldom used for patients with serious hip damage. Another use of a partial hip procedure is to repair damage in patients who already have a total hip replacement.

Can elderly people have this procedure?

uncemented-bipolarIntracapsular fractures of the femur account for the majority of fractures in older patients. The goal of surgery is to return the patient to his/her pre-fracture functional state. Partial hip replacement was studied in older people in a recent clinical study. Researchers found that all study participants returned to their pre-fracture level of activity after the procedure. In addition, they found that hemiarthropasty was a viable option for people age 70 years and older.

How do I prepare for surgery?

Before hip surgery, you need to arrange someone to drive you home from the hospital, and have someone ready to stay with you for a few days. You will need to prepare your home for discharge. Some things to do include:

  • Remove all loose cords and rugs from walking areas.
  • Secure safety handrails in bath/shower and along stairways.
  • Have pre-made meals and drinks available.
  • Have a firm recliner chair or chair with ottoman.
  • Purchase a raised toilet seat.

What can I expect during recovery?

After a partial hip replacement, a nurse monitors you in the recovery room for 45-75 minutes. Once you are stable and awake, you will be moved to a room or discharged home. Discharge depends on your unique situation, your health status, and the surgeon’s preference. You may need to stay in the hospital for 1-2 nights. You will begin passive range of motion exercises with the help of a physical therapist, and nurses administer pain medications to ease postoperative pain.

Once you are home, you must keep the incisions clean and dry, and avoid soaking in a tub or pool until wounds are healed. Expect to use a walker or crutches for a few days. Physical therapy is used to improve hip strength, flexibility, and range of motion. The Mesa orthopedic surgeon encourages frequent movement to prevent blood clots and improve recovery.

The top orthopedic surgeons in Arizona are at OSPI, serving Mesa, Gilbert, Chandler, Tempe, Queen Creek and surrounding areas. Call today!

Resources

Marya SKS, Thurkral R, & Singh C (2008). Prosthetic replacement in femoral neck fracture in the elderly: Results and review of the literature. Ind J Orthop, 42(1), 61-67.

FAQs on Total Hip Replacement

If you suffer from hip pain, stiffness, and limited physical activities, you may need a total hip replacement. When the hip is damaged from a fracture, long-standing arthritis, or other conditions, the cartilage wears away and pain occurs. Hip replacement surgery is a successful surgery for improving functionality.

What are the reasons for getting a hip replacement?

The decision to have a total hip replacement (THR), also called total hip arthroplasty (THA), is made by you in conjunction with your primary care doctor, your family members, and your orthopedic surgeon. There is no age or weight restrictions for canstockphoto13092914this procedure, and most patients are 50-80 years old. This surgery may be for you if you have:

  • Hip pain that affects everyday activities, such as bending or walking.
  • Hip pain that occurs at rest, and often interferes with sleep.
  • Hip stiffness that affects the ability to move or lift the leg.
  • Pain that continues in spite of usual therapies (medicines, physical therapy, and injections).

What causes hip pain?

The most common causes of chronic hip pain and disability are:

  • Osteoarthritis – This involves wearing away of protective cartilage that covers the bone ends. Without adequate cartilage, the bones rub against one another, which leads to stiffness and pain.
  • Rheumatoid arthritis – This autoimmune disease causes synovial membrane (joint lining) inflammation and damage to the cartilage. The recurrent inflammation permanently damaged the joint.
  • Post-traumatic arthritis – After a hip fracture or injury, the cartilage is damaged, which leads to chronic hip pain.
  • Avascular necrosis – Any injury to the hip can limit blood flow to the head of the femur (thigh bone). A dislocation or fracture can lead to avascular necrosis, where the lack of blood causes the bone to collapse.
  • Childhood hip disease – Some infants are born with hip problems. While the hip conditions are treated during childhood, they may cause arthritis later in life.

What happens during the total hip arthroplasty?

During the hip replacement procedure, the damaged cartilage and bone are removed and replaced with artificial components (called prostheses). The steps include:

  • Replacing the femoral head – The damaged upper portion of the femur is removed and replaced with a metal stem. The prosthesis is placed into the center of the femur and either “press-fit” into the bone or cemented there. A metal or ceramic ball is used to replace the femoral head.
  • Replacing cartilage surface of socket – The hip socket is called the acetabulum, and it is removed and replaced with a metal socket. Screws or cement is used to hold this component in place.
  • Inserting the spacer – A ceramic, metal, or plastic spacer is positioned between the new femoral head (ball) ad socket. This allows for a smooth gliding motion.

What home planning should I do?

Before having a total hip replacement, you should arrange to have someone drive you home from the hospital. In addition, you may need someone to stay with you for a few days. The following items can help you with activities after surgery:

  • A raised toilet seat
  • Securely fastened handrails in bath or shower
  • Handrails along stairs.
  • Reclining chair or stable chair with ottoman
  • Long-handled sponge
  • Shower hose
  • Shower chair
  • A “reacher” that lets you grab objects
  • Firm pillows

What can I expect during recovery?

You may need to stay in the hospital 1-3 nights. The nurses will work with you to control pain, and a physical therapist starts to work with you to help you learn exercise to improve hip flexibility and mobility. The orthopedic surgeon wants you to get up and walk around (with help) as soon as possible. You should be able to resume normal activities within 3-6 weeks after surgery. Sutures or staples will be removed 7-14 days after your surgery. You must avoid getting wounds wet, and use bandages to prevent irritation to the wounds.

Do THA procedures work?

Total hip arthroplasty has been proven to decrease pain and increase function in persons with severe hip arthritis. In one clinical study, researchers evaluated THA in people who are in their 80s. They found that 80% of study participants were pain-free after recovering from surgery, and could walk without assistance at the follow-up. They concluded that total hip replacement was safe and effective for elderly people.

The top hip replacement doctors in Arizona are with OSPI. They offer anterior approach procedures that are available outpatient or next day going home. Call us today!

 

Recovery after Carpal Tunnel Surgery

carpal tunnel syndrome2

One of the most common operations done today is carpal tunnel surgery. The goal of surgery is to relieve pressure on the median nerve. For many patients, improvement is noticed right away. For other patients, the pain stops, but full recovery of sensation is not always possible.

What will my sensation and strength be like after surgery?

Most patients describe a tingling or numbness after the carpal tunnel procedure. The return of sensation depends on severity of nerve compression, duration of symptoms, general health, age, and circulation. In severe cases, decompressing the nerve may not help gain full recovery of sensation. There are many reasons why the hand with carpal tunnel does not feel as strong as the other hand. This is often related to decreased sensation, which improves after carpal tunnel release. While some muscle recovery is likely after surgery, it is not always possible to regain full function.

What can I expect immediately after surgery?

After carpal tunnel surgery, you will be in a small surgical dressing with a piece of plaster splint in place along the wrist. Most of the palm and fingers are free, however. A nurse monitors you in the recovery room before you are discharged home. You will feel some soreness and numbness of the affected region. You will return to the doctor’s office in 4-7 days to have the surgical dressing removed. If sutures are present, they are also removed.

What happens to the cut ligament after surgery?

After carpal tunnel surgery, the cut ligament heals, filing in the gap with new tissue. By preserving normal palmar tissue, less new growth of tissue fills in, which makes your palm feel normal.

Can I use my hand right away?

After your carpal tunnel surgery, you are encouraged to use your hand immediately, especially your fingers. You will have a dressing on the area, which must be kept clean and dry. For showers, you should cover the area with a plastic bag.

How long does it take to heal?

The time of healing varies from patient to patient, as no two people are alike. However, most people can perform light activities in 1-2 weeks, and heavy activities within 4-6 weeks. Most people only are off from work for 5-10 days. While you may feel better early on, it is advisable not to overdo it, as this may delay a full recovery.

Will I be in a lot of pain?

Many people report that recovery from carpal tunnel surgery is not painful, and they get by taking only over-the-counter pain medicine, such as Advil or Aleve. However, the surgeon will give you a prescription for pain medicine to ease your discomfort. If you take care of your hand and wrist, your pain will be minimal.

Will I need physical therapy?

Physical therapy is used to relieve palm stiffness and discomfort. The therapist works with you through range of motion exercises and helps you perform flexibility and strengthening activities.

What can I expect immediately after surgery?

After carpal tunnel surgery, you will be in a small surgical dressing with a piece of plaster splint in place along the wrist. Most of the palm and fingers are free, however. A nurse monitors you in the recovery room before you are discharged home. You will feel some soreness and numbness of the affected region. You will return to the doctor’s office in 4-7 days to have the surgical dressing removed. If sutures are present, they are also removed.

What can I do to relieve pain and recover sooner?

Hand exercises with a stress ball are important in the first few days after surgery. Be careful to not overdo this, however. Gradually increase your tolerance for squeezing and gripping, and move your finger often to avoid stiffness and tendonitis. You may benefit from use of a cool splint, which protects the area while providing reduction of swelling.

OSPI offers top orthopedic surgeons in Gilbert AZ who offer all types of general orthopedics, carpal tunnel release, joint replacement and more. Call us today!

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