Total Hip Replacement
Total hip replacement is recommended patients with end-stage hip osteoarthritis (hip is “worn out”) or a myriad of other conditions that result in destruction of the hip joint, such as fracture, avascular necrosis, hip dysplasia or even tumor. The procedure is done by making an incision on the outside of the hip. The joint capsule is entered and the femoral neck is cut to remove the worn out femoral head (ball). The acetabulum (socket) is shaped with a reamer (like a cheese-grater) to re-create the hip socket and a titanium cup is placed with a plastic liner. The femur is then prepared for a titanium stem and a ball (ceramic or metal) is placed on the top. Finally, the hip is reduced, leg lengths and stability are confirmed. This gives a friction free, painless surface to move your hip around on.
Dr. Vaux uses both the posterolateral and direct anterior approach for hip replacement surgery. He will discuss with you which approach is best for you based on your bone anatomy, body habitus and medical risk factors.
For more information visit: https://hipknee.aahks.org/total-hip-replacement/
RISKS ASSOCIATED WITH HIP REPLACEMENT SURGERY
All surgical procedures have risks. Despite pre-operative testing and optimization, utilizing less invasive surgical techniques, and novel pain and rehabilitation management, every joint replacement is still a major surgery. Although advances in technology and medical care have made the procedure very safe and effective, these risks do exist. The risks associated with a joint replacement surgery should be considered carefully before you decide to undergo surgery. We encourage you to discuss the potential risks with your surgical team, primary care provider, and your support system (such as family or friends). Additionally, we will work with you and your medical doctors to ensure you have the safest joint replacement journey possible. Overall, complications are rare and we will do our very best to avoid the most common risks, which are listed below.
Pain after surgery
These are artificial joints and unfortunately are not as good as the joints you were born with. It is normal to have MILD discomfort even after you have recovered completely from surgery, especially with more strenuous activities. Unfortunately, we can’t give you your 18 year old hip or knee back again. Our goal when performing a joint-replacement surgery is to give you a joint that will allow better function than your current arthritis bone-on-bone joint, and only after we have tried helping your pain without surgery.
blood clots can form in a leg vein and in your lungs after knee or hip replacement surgery and at times can even be fatal. Blood clots are more common in older patients, patients who are obese, patients with a history of blood clots, those with pulmonary disease, and patients with cancer. We will evaluate your risk for a blood clot and develop a preventative treatment plan for each patient, which will include a blood thinning medication after surgery for 5 weeks. Additionally, we recommend the use of compression socks after surgery for 4 weeks. In order to reduce the risk of blood clots, we also recommend moving frequently after surgery.
Prosthetic Hip Dislocation
Your new hip is a replaced hip, not a "normal" hip. The capsule surrounding the hip joint is taken down during surgery (regardless of hip approach utilized), and although we repair it, they hip can dislocation after surgery. Please be sure to adhere to the hip precautions given to you after surgery to ensure adequate healing of the soft tissues and decrease your risk for dislocation.
Leg length discrepancy
After hip replacement, there can be a slight leg length discrepancy post operatively. This is not common, but can be necessary in order to achieve a stable hip replacement that does not dislocate. Most people are born with a leg length discrepancy that averages from ¼ inch to 1 inch. Over time your body will adapt and your gait will normalize. Occasionally, we can consider a shoe lift if needed.
Bleeding into the joint can occur either immediately after surgery or at a later time. This is accompanied by acute pain and swelling and is sometimes confused with infection.
infection can occur both in the early post-operative time period or even many years after a joint replacement. Despite doing everything in a sterile environment and giving you antibiotics at the time of surgery, infections still occur approximately 1-2% of the time. Most infections are caused by the billions of bacteria on that patient’s own skin. It is important to adhere to all the recommendations given by your surgeon and maintain good health before and after surgery to decrease the risk of infection. Patients who are diabetic, smokers, have autoimmune disease or other chronic health problems, are at higher risk of developing a post op infection. An infection can be treated successfully 75-80% of the time, but this usually requires one, and often two, surgeries along with long-term IV antibiotics to treat. Please see section on ‘revision for prosthetic joint infection for more information’.
(See section on Revision Joint Replacement for more information)
A small amount of drainage is normal to notice after surgery, but larger drainage can sometimes require a return to the operating room to stop.
Delayed Wound Healing
Sometimes the surgical incision heals slowly, particularly if you take corticosteroids or have a medical condition that affects the immune system, such as diabetes. Smoking can cause serious complications, which is why we ask you to stop smoking prior to surgery. Talk with your surgical team or your primary care physician if you need help with smoking cessation.
Nerve, Blood Vessel, and Ligament Injuries
Damage to the surrounding structures including nerves, blood vessels and ligaments, are possible but extremely rare. More commonly there is numbness in the area of the incision which usually, but not always, resolves in 6-12 months. It is not uncommon to have some small residual numbness in one or more of the areas around your incision.
Limited Range of Motion
Within a day of surgery, you will begin exercises to help improve the flexibility of your knee or hip. Your ability to bend your knee after surgery often depends on how far you could bend it before surgery. The motion before surgery can also affect the motion of your hip or knee following recovery. Even after physical therapy and an extended recovery period, some people are not able to bend their hip or knee far enough to do normal activities such as reaching your feet to put on socks or tie your shoes.
Failure of the Implants
Your new joint replacement is a mechanical device. Sometimes the metal, cement, or plastic liner can get loose or your bone – particularly weaker, osteoporotic bone – can fail to grow into the metal sufficiently. While we hope that this does not occur for at least 15 years, it can happen before that, even in the first year or so. This can require a repeat surgery to fix.
Fracture around the implants
A fracture around the implants (peri-prosthetic fracture), can occur after a trauma, fall or if there is weaking of the bone surrounding the implants. If this occurs, often surgery is required to replace the parts and reinforce the bone.
Medical or Anesthetic Complications
These can include heart attacks, strokes, pneumonia, kidney damage, or even death etc. These are VERY RARE. We will perform a number of tests and any necessary clearances before surgery to make sure you are fully optimized and that it is safe for you to undergo surgery with us, but even then, bad things can happen with any surgery.
*The risks above occur rarely. However, we want all of our patients to know ahead of time that this surgery is a major surgery, and that even for the healthiest and fittest patients, things can unfortunately go wrong. Again, despite all of the risks and potential complications, 80-90% of patients are happy they had their surgery done and consider their quality-of-life improved.