Types of surgeries, progress of the surgery, what a patient can expect immediately after the surgery, complications, repeated surgeries and other information.
Transplantation of the hip or knee joint are common surgical procedures. The affected part of the hip or knee joint is removed and replaced with new, artificial parts. These parts are called endoprostheses.
The purpose of joint replacement is to improve joint mobility, reduce pain, and ultimately strengthen and improve its functioning.
Who can undergo hip or knee replacement?
The most common cause of joint replacement is osteoarthritis (coxarthrosis). Other possible causes are: rheumatoid arthritis (a chronic inflammatory disease of the joints causing pain, stiffness and swelling), avascular necrosis (destruction of the bone caused by insufficient blood supply), hip fracture, and bone tumor.
Before recommending surgery, the doctor usually attempts to improve the patient’s condition with conservative, non-invasive means to aid mobility: such as use of a cane, prescription medication, and physiotherapy. But these methods are not always effective to reduce pain and improve joint mobility. Hip or knee replacement surgery is recommended when the patient suffers from constant pain and lack of mobility. Before the doctor can determine the need for joint replacement, he will assess the degree of joint destruction by means of X-ray images.
In the past, hip or knee replacement was offered mainly to people over 60 years old. Usually, older patients are less active and therefore have less stress on the artificial joints than younger physically active people. In recent years, doctors have found that joint replacement can also be very successful for younger people. New technologies have improved implants allowing them to withstand the much greater loads and stresses of a more active lifestyle.
Another important factor determining the success of the hip or knee replacement is a general state of health and physical activity of the patient.
For some people, joint replacement can be quite problematic. For example, patients who suffer from severe muscle weakness or Parkinson’s disease, compared to healthier people, are much more likely to damage or dislocate the artificial joint. People who have poor general health, a high risk of infection, and lack of optimism for a positive outcome have the worst chances for successful surgery. They cannot be recommended to have surgical treatment.
What is the alternative to hip or knee replacement?
Before the final decision is made to replace the hip or knee, your doctor may try other treatments such as physical therapy and/or medication. A special training program can personally be tailored to the patient’s need to strengthen muscles in the injured area. For example, in the case of a hip replacement, a training plan can be devised to realign the position of the femoral head in the joint and reduce the associated pain.
The doctor may also try to suppress inflammation in the joints using NSAIDs (non-steroid anti-inflammatory drugs), e.g. aspirin or ibuprofen. Many of these drugs are available without prescription, but doctors usually prescribe them at higher doses than can be obtained without a prescription.
In some more rare cases, the doctor may prescribe steroids such as prednisone if other medications do not reduce pain. Steroids, like prednisone, reduce inflammation of the joints and are often used for the treatment of rheumatic diseases such as rheumatoid arthritis.
Steroid drugs may not always be a therapeutic option because they can cause future bone loss in the joint. Some people experience side effects of steroids such as increased appetite, weight gain, and decreased resistance to infections. Doctors should carefully monitor the patient receiving treatment with steroids. Since steroids disrupt the natural production of hormones in the body, patients cannot stop taking them abruptly: it is critical that a patient follow the doctor’s instructions throughout the gradual cessation of treatment.
If physical therapy and drugs do not reduce pain and improve joint mobility, doctors may suggest corrective surgery, which is less traumatic than a complete replacement of hip or knee. This is called an osteotomy. This is a surgical restoration of the normal position of the joint by removing the damaged portion of the bone and tissue. The purpose of this operation is to place the joint in a proper position to help redistribute the weight on the joint surfaces more evenly. For some people, the surgery reduces the pain. Recovery after this surgery takes from 6 to 12 months.
What does hip replacement include?
The hip joint is located between the upper end of the femur and pelvic bones, called the acetabulum. The femur looks like a long rod with a spherical head on the top. The acetabulum is a cup-shaped structure on the inner surface of the pelvic bone which is inserted onto the femoral head. Together they form a semi-spherical hinge system. The cup and head moving inside it allow the hip joint to perform a wide range of movements including sitting, standing, walking, and other types of ordinary physical activity.
During joint replacement, the doctor removes the affected areas of bone and articular cartilage. Healthy bones remain intact. The surgeon then replaces the femoral head and the acetabulum with new artificial parts – implants – that are made of materials that allow natural sliding motion in the joint. Hip replacement surgery typically takes 2 to 3 hours.
What does knee replacement include?
The knee joint is located between the femur and the tibia, the heads of which slide on each other by a layer of cartilage tissue. During arthroplasty, both articular surfaces are removed and replaced on both ends of the bone with implants taking over the function of the remote joint. The operation can take 1.5 – 2 hours.
What can be expected immediately after hip or knee replacement surgery?
After surgery, the patient is allowed very limited movements of the affected joints. When the patient is in bed, the thigh or the knee are typically elevated by pads or held comfortably in place with special tools to ensure the correct position for healing. The patient may receive intravenous fluids to compensate for loss during surgery. Additionally, a drainage tube may be installed in the wound area, and a urinary catheter may also be necessary until the patient is able to walk to the bathroom. Painkillers are usually prescribed to reduce pain and discomfort.
The day of – or following – the surgery a physical therapist gets the patient up and moving and shows him or her specific exercises that can facilitate recovery. The physical therapist asks the patient to breathe deeply, cough or blow into a special device that measures lung volumes. These exercises reduce fluid retention in the lungs after surgery.
Usually after surgery, patients remain in the hospital not longer than 10 days, with a trend to shorter stays. They may be sent home with physical therapy equipment to assist with getting around the house, prior to being released for work, with restrictions. Full recovery takes 3 to 6 months, depending on the type of the surgery, patient’s overall health and success of rehabilitation treatment.
What are the possible complications of hip or knee replacement?
According to the American Academy of Orthopedic Surgeons, of the world’s 2 million operations for endoprostheses of large joints every year, only a small percentage required repeated surgery. New technologies, improved design of prostheses, and the evolution of surgical techniques significantly reduce the risk of repeated surgeries.
The most common problem that can happen soon after the hip replacement is dislocation of the hip. Since the artificial femoral head and the acetabulum are smaller than natural, the head may exit the bone at the junction where the thigh is at its central position. The most dangerous is the position in which the knees are pulled up to the chest.
The most common late complication is an inflammatory reaction in the body caused by certain parts of the artificial joint gradually breaking away from the joint and dissolving in surrounding tissues. Inflammation can activate special cells that destroy bone tissue, causing the separation of the transplanted bone from the joint. For the treatment of this complication, doctors use anti-inflammatory drugs or recommend repeated, revision, surgery.
Medical scientists are constantly developing new materials that last longer in the body and cause fewer inflammatory reactions.
Rarer complications include infection, the formation of blood clots, and the formation of spurs outside the normal shape of a bone.
When the second surgery is required?
Hip and knee joint replacements are two of the most successful surgeries in orthopedics – more than 90 percent of people who have had a transplant will never need a second operation. However, after 15 to 20 years of post-surgical wear, repeated surgery to the joint replacement is required. Repeated surgery is more technically complicated than the first, and the results are usually less successful. Therefore, it is important to use all available non-surgical therapeutic possibilities before opting for re-surgery.
Doctors usually offer the second surgery in two cases: if prescription medications and lifestyle changes do not reduce pain or improve movement, or if an X-ray reveals the destruction of the artificial joint requires correction before it is too late to carry out a second operation. This surgery is usually done when there is a loss of bone area, or severe damage to the articular surfaces that weaken the joint. Other possible reasons for re-operation are fractures, dislocations of the artificial joint parts, and infection.
What types of exercise are best suited to people who have had hip or knee replacement?
Appropriate exercise can reduce pain and stiffness, increase joint mobility, and build muscle strength. People with an artificial hip joint can ask their physiotherapist to develop a suitable exercise program for them. Typically, these programs start with gentle, limited movements of short duration that train muscle strength.
A doctor or physical therapist decides when the patient is able to engage in more serious forms of physical activity. Many doctors recommend avoiding dangerous, competitive, high impact or prolonged activities such as basketball, singles tennis or jogging. These activities can cause re-injury or damage to the new joint by causing premature wearing of its parts. Some recommend low impact activities such as cross-country skiing, swimming, walking on foot, or bicycle training. These exercises can increase muscle strength – as well as exercise the cardio-vascular system – without damaging the new joints.
The article is provided by the team of Hipjointpain.info, portal that provides full information on hip pain and its treatment.