What can I expect from my total hip replacement?

I had a total hip replacement almost a year ago. My pain is gone but I can’t really do anything more than I did before the operation. Is this normal?

Several studies show problems can continue after a total hip replacement (THR). This is true even when pain is reduced or relieved. The reason for this can be decreased muscle strength or a lack of stability on the side operated on.

Patients report reduced walking speed and difficulty climbing stairs even when there’s no pain. Part of the problem may come from weakness and deconditioning. These were present before the operation. Pain and inactivity result in this weak state.

A recent study at Texas Women’s University in Dallas, Texas, showed that exercise even as late as a year after THR can make a difference. Check with your doctor about getting back into a rehab program.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Is cold therapy used after a hip replacement?

When I had my knee replaced the therapists used cold therapy on it everyday. It really seemed to help with the pain and swelling. I just had a hip replacement. The cold treatment was never used on the hip. How come?

Cold therapy, also known as cryotherapy is thought to help joints that are closer to the surface of the skin. The knee doesn’t have much soft tissue, fat, or muscle covering the joint. The cold can get down into the joint easier.

Large muscles and at least one layer of fat cover the hip. It’s always been thought unlikely that the cooling action would reach deep into the hip joint.

However a new study from Japan may prove this idea wrong. They used cryotherapy with a group of 23 total hip replacement patients. The group was compared to another group who had a hip replacement but without cold therapy afterwards.

The researchers report good success with the cold therapy. Patients got pain relief faster. They used fewer pain medications. They could begin rehab sooner. Based on this study, the use of cold after hip surgery may become more popular in the months and years ahead.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

How young is too young for a hip replacement?

I’m 40-years old and in need of a hip replacement. My doctors says I must wait until I’m at least 50 because the implants don’t last more than 15 0r 20 years. Is there really that much difference in the results between patients my age and older patients?

Only a few studies have been done to look at age differences with total hip replacements. Since most patients do wait until age 50 or older, finding out how younger patients fare isn’t easy.

Doctors at the Anderson Orthopaedic Research Institute in Virginia have given us some answers. They looked at 561 hip replacements done over a period of 20 years. All patients were 50 years old or younger. This group included 256 hips in patients who were 40 years old and younger.

The authors were surprised to find no difference in wear rates between the two groups. They followed the patients for five, 10, and 15 years. Wear rates were calculated using repeated X-rays over the years. They found implants lasted five years in 97 percent of patients under 40. This is called the five-year survivorship rate.

The 10-year survivorship rate in the same group was 85 percent. And at 15 years the survivorship rate was 54 percent overall. That last figure means about half the implants had failed by 15 years, but the researchers found only part of the implant failed. The whole implant didn’t need to be replaced. Revision surgery could be done just to replace the worn part.

Studies like this are very encouraging. Your chances of an earlier operation may improve as more information is reported.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

How can I avoid dislocating my replaced hip?

I am having hip replacement surgery. How can I decrease my chances of dislocating my new hip?

Be careful about where you have the surgery–and who does it. A recent study looked at the results of 59,000 Medicare patients 90 days after surgery. The number of hip replacements done by hospitals and surgeons made a difference in patients’ results. Patients were less likely to dislocate the new hip when they had surgery in hospitals that did a lot of hip replacements. Patients whose surgeons did a lot of hip replacements also had fewer dislocations.

There is no “magic number” of surgeries per hospital/surgeon that will guarantee your new hip. The number of complications goes up as the number of surgeries goes down. Happily, dislocations are rare (three percent in one study). Talk with your doctor about the measures you need to take after surgery to protect your new hip.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Does a surgeon’s volume affect quality of work?

I am having a hip replacement. My surgeon has good training but said he doesn’t do a lot of these procedures. Should I be worried?

Research has shown that patients have better outcomes from hip replacement when their surgeons do many of these procedures per year. This may be especially important in smaller hospitals, where there are fewer hip surgeries overall.

A recent study looked at 59,000 Medicare patients who had hip replacements. Researchers examined the results 90 days later. Complications were rare. But patients whose hip replacements were done by surgeons who did more than 50 procedures a year had fewer dislocations than those operated on by surgeons who did fewer than five procedures a year. Patients with “high load” surgeons also had less infection and pulmonary embolism.

It’s important that you’re comfortable with your surgical care. Talk with your doctor about your options.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Does a hip replacement affect a pregnancy?

I’ve had a hip problem since birth called congenital hip dysplasia. The hip socket was not formed completely, and my hip slips in and out of the joint. This causes a lot of pain and affects my walking. My doctor is advising me to have the hip replaced, but I’m only 26 years old. If I have a hip replacement, should I not get pregnant?

Improved materials and technology have made it possible for younger women to have hip joints replaced. In 1996, 138,000 total hip replacements were done in the United States. Three thousand of them were in women under 45 years of age.

It appears safe to have one or more pregnancies after a hip replacement. In the small group of women studied, no damage to the replaced hip was observed after pregnancy.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Is it possible to kneel after a hip replacement?

I am going in to have hip replacement surgery. Will I be able to kneel down to work in my garden once my hip heals? What about getting on my hands and knees in the garden?

If your doctor does your surgery from the back part of the hip, called a posterior approach, you need to avoid bending your hip more than 90 degrees. You can kneel down, but try to avoid kneeling directly onto the operated side. If you must kneel, keep your weight even on each side. While kneeling, avoid bending too far forward at the hip because you could bend your hip past the safe limit of 90 degrees.

Do not get onto your hands and knees. This position immediately puts your hip at a 90-degree angle, and the added pressure of your body weight on your hip could force the hip to dislocate out of the socket.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Is there any way that I can squeeze a few extra years out of my hip replacement?

My orthopedic surgeon says to expect 10 to 15 years out of my new hip replacement. That doesn’t seem like much since I’m only 65 and longevity runs in the family. If my parents are any indication, I could live well into my 90s. Is there any way I can squeeze a few extra years out of my hip replacement?

Your surgeon is giving you the typical average lifespan of a joint replacement. For some people, it’s less while for others it can be longer. There are more than a few cases where people report excellent results 20 to 25 years later!

But the truth is that even with today’s modern improvements in hip replacements, active adults and overweight patients have a greater chance of creating wear and tear on the implant resulting in its eventual failure. Sometimes, it’s just a matter of replacing the liner — that can be a fairly simple revision surgery. There is a polyethylene (plastic) liner that goes inside the hip socket. The head of the femur fits into the liner. The liner or insert helps absorb impact on the implant so it must be as durable as possible.

Extensive wear of the liner or insert can result in failure of the entire implant, the release of debris into the joint, and osteolysis (bone loss). Too much wear of the liner or insert can result in the need for a revision surgery to remove the worn liner or insert and to replace it with a new liner or insert. Liner wear is one of the most common problems.

Other complications include heterotopic ossification (HO) (formation of bone in the muscles and soft tissues around the joint), hip dislocations, bone fractures around the implant, infections, and deep vein thrombosis (DVTs or blood clots).

Any of these complications can put you at risk for early implant failure.How can you squeeze out a few more years? Stay active but don’t overdo. Running marathons (or other similar repetitive motions) will definitely increase the risk of wear and tear on the implant. It’s not indestructible.

If you are overweight, take measures to lose a few pounds. Your surgeon may be able to offer other suggestions based on the type of implant you have and the surgical technique used to insert it. Don’t hesitate to ask him or her this same question.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

I am in rehab after a total hip replacement. What should I use to gauge my progress?

I am in rehab for a total hip replacement. I confess I’m a type A person. Even though I try not to compare myself to others, I always end up checking to see how I’m doing based on how others are doing. What should I really be using to gauge my progress?

You’ll be relieved to know that the most common question patients have after hip replacement surgery is: “How am I doing compared to everyone else?” This seems to be the result of a natural human tendency not necessarily based on how competitive you are. Most patients ask their surgeon or physical therapist this question sometime during the postoperative period. With information from a new study on recovery following a total hip replacement, there are some ballpark answers to this question.

For example, it appears there are two phases to recovery. The first occurs during the 12 to 15 weeks following the procedure. Rapid change occurs in the first three months and then starts to slow between 15 and 20 weeks.

By the end of four months, most patients have been discharged from treatment. They are well on their way to resuming all physical activities and exercise they are interested in.

Thirty (30) weeks (seven and a half months) later, patients experience another leveling out as they are now able to walk again at a normal pace. Physical function involving the legs continues to improve though at a much slower pace than early on. Balance and postural stability seem to take longer to recover.

If you continue to follow the exercise program prescribed by your physical therapist, then by the end of 12 months (one full year), you should be fully recovered. At that point, hip muscle strength, joint motion, and leg function should test within normal limits for your age.

Patients who quit doing their exercises too soon often have muscle weakness and report falls two years after hip replacement. The therapist can use several tools to measure how you are doing. A popular (valid and reliable) test of physical activity is the six minute walk test (6MWT). In this test, how far you can walk (and how fast) in six-minutes is measured.

For both men and women after total hip replacement, the peak distance walked occurs around that 30-week postoperative timeframe. Women don’t walk as far as men and their early recovery time is a little slower but in the end (a year later), walking ability evens out between the sexes. Other measures may include whether or not you still need a walking aid (e.g., walking sticks or cane), your pain level, and how much medication you are still taking for pain. How well you can go up and down stairs is a functional skill of importance. Your ability to carry out daily activities may also be examined closely. You can use these known guidelines to establish your own goals and check your recovery against the average.

More physical therapy with a supervised rehab program may still be needed if you have not experienced good improvement or the results you expected.Setting too high of expectations can discourage you — especially in those early weeks of recovery. Just compete against yourself rather than against others who may be ahead or behind you for specific (individual) reasons. Adopt a “can do” attitude, follow your therapist’s and surgeon’s advice, and give yourself the time you need to recover.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

I’m having my third hip replacement. What’s changed recently?

As my father used to say, “Here we go again!” I’m having my third(!) hip replacement. The first two have been great but I’ve worn one of them out. It was put in 20 years ago, so I’m doing a little research to find out what’s changed since that time and what I should look out for.

Probably the thing that has changed the most in the last 15 to 20 years is the shift from cemented to cementless implants.

Around about 1995, the National Institutes of Health (NIH) said the research showed using a hybrid implant with one part cemented in and one part cementless was the way to go. Gradually, with improved designs, materials, and surgical techniques, surgeons are now using completely cementless joint replacements in up to 90 per cent of all cases.

Sometimes bone loss from osteoporosis and/or deformities dictate the use of a specific type of implant design and cemented fixation. But otherwise, there are six basic designs to choose from and all have equally good results.With your previous surgery, these two factors (condition of the bone and alignment) may be critical or important enough to guide a specific implant choice. Your surgeon will be able to make that determination based on physical examination, X-rays, MRIs and/or CT scans.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.