Summer is just about over and we can start looking forward to all the neat things the upcoming holiday season will bring.

You’ll recall that last month I wrote an article dealing with knee joint replacement. It focused mainly on the standard, traditional “total knee replacement” procedure rather than expounding on some of the variations such as partial replacements. We will cover those issues in upcoming articles.

Similarly, hip joint replacement procedures are typically performed on patients with a diagnosis of severe, end-stage arthritis of the hip. This column will cover the basics so that you’ll have a better understanding of what the procedure is, what it entails and what you can expect throughout the process. I also going to throw in some bits and pieces of information surrounding a patient’s experience with hip replacement and what led to the surgery, how she handled it and how she’s doing at this point.

First, let’s discuss the hip joint. The hip is a “ball-and-socket” joint with the ball being the head of the femur, or thigh, bone and the “acetabulum,” or the “socket.” This joint allows for your hip to move in many directions and supports a tremendous amount of weight and stress. For any number of reasons – aging, injury, disease, genetics and simply wear-and-tear, hips wear out over the years, some faster than others.

Like the knee joint, the ball and socket of the hip are covered with a layer of specialized cartilage called hyaline cartilage. Think of it as tread on a tire. Tread wears down over time. When this joint cartilage degenerates to a point where severe inflammation and exposed bone occur, pain can become severe and mobility limited. In the more severe cases, even simple things like standing up, using the bathroom and walking, can be difficult or even impossible. True hip pain is most often felt in the groin area. It can occasionally radiate to the buttock, but groin pain is the most revealing symptom.

So, what constitutes a hip replacement? Hip replacement surgery involves the surgical removal of the diseased femoral head, or “ball,” hollowing out a short segment the femur (thigh bone) in such a way as to accommodate a metallic “stem” implant and scraping and re-shaping the socket (acetabulum) to allow for a tight fitting “cup” or artificial socket to be inserted.

The stem is metallic and often comes with a special “coating” on the surface to stimulate your own bone to “heal” to the implant. Other types of stems require the use of a special “bone cement” to hold it in place.

The replacement socket consists of a metallic “cup,” which is a spherical shaped shell that is inserted into the prepared socket in your pelvis. These implants are also coated for bone growth fixation. The socket can either come with a plastic insert that allows the metallic, or sometimes ceramic, ball to move within the cup, or can actually be a special “metal-on-metal” configuration.

How long is the surgery?

The procedure can last somewhere between just under an hour to 1-1/2-2 hours, depending on many variables: surgeon speed, difficulty factor (i.e. large patient or severe deformities in the hip) and whether this is a primary (first time) replacement or a revision procedure.

The typical length of stay in the hospital is three days, with discharge on day three.

More often than not, patients are restricted from bending at the waist greater than 90-degrees for several weeks to prevent dislocation of the hip during healing. The manner in which the procedure was performed will determine what, if any restrictions there will be in place.

Depending on the progress of recovery, some patients will, upon discharge, move on to spend some time in a rehab facility to regain strength and stamina. Others may go straight home.

Actual  case history

Someone close to me and my family, we’ll call her Marilyn, recently underwent a total hip replacement procedure for end-stage arthritis. Over the previous six months, her pain became so severe and relentless that she was rendered almost totally wheelchair-ridden. The x-ray revealed a totally destroyed hip joint. Because of other health issues, the surgery would be riskier than most, so there was much trepidation surrounding the decision to proceed.

The procedure went flawlessly, taking about an hour. She had a spinal anesthetic, which made her comfortable not only during, but after the procedure for several hours as well. Because of the medical issues, a stint in the ICU was mandated, which typically isn’t necessary for hip replacement patients. After satisfactory recovery, she returned to where she now lives and is receiving in-home therapy. The severe pain is history and she has a much better quality of life. All that, and she’s only two weeks out from surgery.

The amazing thing here is, as much a people worry about bad things happening during or after surgery, in this case the chronic severe pain was more of an assault on her physical condition than the surgery itself.  

My wife has a hip replacement and she will tell you it has given her a new lease on life. So too, with my own mother. We’re becoming a “bionic” family, I guess.

That being said, hip replacements are not without potential hazards. As with any other major surgery, you, the patient, must be aware and understand all the positives and negatives of such an undertaking. Surgeries and anesthetics are safer now than ever before, but none of this is foolproof. There are risks and you need to know and understand.

If you are having pain similar to what has been described here, consult your physician. If you are told you might be a candidate for a hip replacement, you can:

(1)Visit www.bone-and-joint-pain.com to learn more about joint replacements.

(2)Contact Compass Care Management LLC; www.healthcare-advocates.org to learn how they can help you find the right specialist, help educate you on all things important involving hip replacement and be there for you and your family from start to finish as your own Personal Patient Advocate.

Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. For more information on orthopedic-related topics, visit www.bone-and-joint-pain.com. Submit questions or comments to Ken at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

CUTLINE:
HIP ARTHRITIS
Hip joint replacements are typically performed on patients with a diagnosis of severe, end-stage arthritis of the hip. (Photo courtesy of Assenmacher Orthoedics)

CUTLINE:
HIP IMPLANTS1
The hip is a “ball-and-socket” joint, with the ball being the head of the femur, or thigh, bone and the “acetabulum,” or the “socket.” Picture courtesy of drfoxortho.com.

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