What is Hip Replacement

Also called total hip arthroplasty, hip replacement surgery might be an option for you if your hip pain interferes with daily activities and nonsurgical treatments haven’t helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement.

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Key Decisions of Hip Replacement Surgery

A typical patient with osteoarthritis of the hip would be somebody in their late ‘50s, and sometimes older, sometimes younger.

But let’s take somebody in their late ‘50s with hip osteoarthritis. They would start to feel some hip pain that would gradually get worse and worse, to the point that they might think that they need to see an orthopedic surgeon.

A very common question is when should someone have a hip replacement? Should they wait? Should they have it right away? Is it better to wait? Surgery is not without risk, even though a hip replacement is one of the most successful operations that we do.

And therefore, the recommendation is to always wait as long as possible, as long as there’s not a huge interference with the activities of daily living and the patient’s ability to work and function in a family unit or a social unit, or whatever it is.

So there is never, is it necessary to have a hip replacement. It is, is it desirable by the patient to have a hip replacement? And there’s where you have to weigh out the risks and the benefits, and the patient and their surgeon can then decide this is the right time to do it, or I’m better off waiting for the surgery.

If a patient is diagnosed with significant osteoarthritis of the hip with significant pain that is not responding to non-operative treatment, which includes medications, the use of a cane and staying active and fit, then the consideration is that of a hip replacement.

There are different ways of doing a hip replacement. There are not only fixation options. In other words, cementless versus cemented hip replacement, but there are also different bearing surfaces such as metal on plastic, ceramic on plastic, ceramic on ceramic, and metal on metal. And then there’s also the option of hip resurfacing.

Once a decision has been made to perform the hip replacement, the patient should discuss the various treatment options for hip replacement with the surgeon.

Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

Local Practitioners: Orthopaedic Surgeon

Quiz: Do You Understand Hip Replacement?

Test your knowledge by answering the following questions:

Questions
True
False
1

An artificial hip joint may contain ceramic and/or metal but never plastic.

Explanation:
During hip replacement surgery, the surgeon removes the painful joint and replaces it with an artificial hip joint made from plastic, ceramic and/or metal.
2

Your healthcare provider will likely recommend that you wait as long as possible to have hip replacement surgery.

Explanation:
A very common question patients ask is when should I have a hip replacement? Your healthcare provider will likely recommend that you wait as long as possible to have the surgery. Typically, hip replacement surgery is done when other arthritis treatments don’t work. At this point, patients have noticed their pain has gradually gotten worse, even when they're resting or sleeping.
3

The hip replacement procedure involves the femur.

Explanation:
The hip replacement procedure involves replacing the ball at the top of the femur (thigh bone) and the hip socket. The surgeon will either cement the artificial hip joint to the bone or use a part with a porous coating that the bone grows into.
4

Loosening of the new hip joint is not a risk of hip replacement surgery.

Explanation:
The success rate of hip replacement surgery is high, but there are some risks, including infection, blood clots, dislocation and loosening of the new hip joint.
5

You may take blood thinners before your surgery, but you won't be prescribed them following the procedure.

Explanation:
Following your surgery, you may wear compression stockings or take blood thinners to prevent blood clots. You will begin physical therapy in the hospital, and should continue with a physiotherapist once you leave.
(Answer all questions to activate)

Hip Pain from Injury and Labral Tear

Another reason that is now commonly identified for hip pain, particularly after injuries, is a so-called labral tear.

So the labrum is very similar to the cartilage in the knee. And cartilage tears in the knee have been around for many, many years, and people know about them and associate them with many injuries.

But it’s more commonly now known in the hip that you can injure the labrum, which is a piece of cartilage that extends all the way around the rim of the socket. So with an injury, be it a bad fall, or a car accident or any direct impact loading you can tear that labrum.

And now we have ways of diagnosing it and treating it and that can cause hip pain as well without having arthritis.

Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

Local Practitioners: Orthopaedic Surgeon

Gordon Bohlmann, BSc (PT), CGIMS, OMT, BSc HMS, Physiotherapist, discusses joint replacement therapy.

Dr. Bassam Masri, MD, FRCSC, Orthopaedic Surgeon discusses diagnosis and treatment of hip replacement.

Dr. Bassam Masri, MD, FRCSC, discusses diagnosis and treatment of key decisions in hip replacement.

What is Joint Replacement Therapy?

As we age the weight-bearing joints, particularly of the lower limbs such as the hip and the knee, become worn and torn or wear out basically as a result of the loads that are put on them during our lives.

And as this happens joints will become painful and swollen, the range of movement will become restricted. And if you get to the point where the pain and the dysfunction from this wear and tear process gets and stops you from being able to live your life, then your surgeon who’s an orthopedic surgeon will tend to think about a joint replacement.

Joints that are commonly replaced are the hip and the knee joints. Less commonly we need to have intervention in the lumbar spine, but very common are hip and knee replacements and when we’re talking about the knee joint we’re talking about having the weight-bearing surface of the knee replaced.

So the lower part of the leg is called the tibia and this is the femur. The important things to consider are that once the joint surfaces that are arthritic have been replaced you’ll be left with a knee that is very functional in terms of the joint, but what will be needing rehabilitation is the muscle system.

So we talk about the quadriceps muscle, which run down the leg and attach into the knee cap or the patella. We talk about the hamstring muscles which come down the backside of the leg and attach below the knee, as well as the calf muscles which run down the lower part of the limb to the foot.

And so joint replacement surgery is a very good way to being able to being more functional and have less pain. But because knee replacement and hip replacements only last for 10 to 15 years it’s very important to make sure that you see a physiotherapist to determine what exercises are applicable for you, both before surgery to strengthen the muscles of the quadriceps and the hamstrings which would be at the back, as well as the calf muscles, as well as post-surgically you would need to learn how to use that new joint in the optimal way

It’s very common for patients to develop means of compensating with an arthritic painful joint so, perhaps walk differently or learn to weight bear differently, and so it’s a physiotherapists responsibility to educate them about these dysfunctions and help them to become more functional and lead a pain-free life again.

A common concern for patients considering joint replacement surgery is what the activity levels will be like post surgery and so it is possible to participate in many different types of sport. Usually the considerations that the physiotherapist will need to take into consideration are things such as overall body condition and muscle strength around the joint that’s being replaced.

So it’s a really good idea for you to discuss this with your local physiotherapist and determine an action plan to get you back to the sport that you love.

You might visit a physiotherapist for information on what is, conditions, side effects, symptoms and treatments related to joint replacement therapy, joint replacement surgery, arthritis exercises and home rehabilitation exercises.

Find more info on hip pain caused by different factors.

Presenter: Gordon Bohlmann, Physiotherapist, Vancouver, BC

Local Practitioners: Physiotherapist

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