10 Things To Know About Your Hip Replacement

What You Should Know Before Having Your Hip Replaced

Hip Replacements Can Last a Long Time, But Not Forever...

hip replacement implant
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Hip replacement surgery is often a solution for people with pain resulting from severe arthritis.  And while this typically solves the problem, it may not be a solution that lasts forever.  Knowing how long a hip replacement will last is a difficult question to answer.  Newer implants are designed to hopefully last longer than implants that we currently have long-term data on, but some new developments have also turned out to be less effective or no better than older implants. 

Our current thinking is the average hip replacement will last longer than two decades.  Implants tend to last longer in patients with normal weight, good muscle tone and function, and low-impact lifestyles.

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You're Never Too Old for Hip Replacement

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No one is really too old to have a hip replacement, but some people can be too sick or have too many risks to have a hip replacement.  When people have less optimal health, they can be at a higher risk for complications associated with hip replacement surgery.  Complications can include infections, dislocations, or medical problems such as heart, lung or kidney problems.

When evaluating patients prior to hip replacement, most doctors don't worry about a specific age, but are much more concerned about issues such as exercise tolerance, weight, heart function, kidney function, and other medical conditions.

Your primary care doctor and joint replacement surgeon can help you determine the risk of having surgery, and what steps you might be able take to best prepare for surgery.  

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You Can Be "Too Young"

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Many surgeons are becoming more comfortable performing hip replacement surgery in younger and younger patients.  Once reserved for elderly patients, more patients in their 50s, 40s, or even younger, are considering a hip replacement as a solution to their joint problem.

Having surgery as a younger patient does have some special considerations.  First, the likelihood you will need additional surgery is your lifetime is much higher.  Hip replacements do wear out with time, and they tend to wear out faster in younger patients.  Second, hip replacements are really designed for patients who perform gentle activities.  They may cause problems for patients who perform heavy labor activities, or high intensity sports or recreational activities.

Some surgeons use the analogy of car tires.  If you put the tires designed for a sedan on a sports car or a semi truck, they may not perform as expected.  I think this is a good way to think of a hip replacement implant that is designed primarily for moderate intensity activities. 

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There Are Risks Of Surgery

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As mentioned previously, there are some serious complications of hip replacement surgery.  The most common problems are infection, instability, blood clots, loosening, and fracture around the implants.

It's nice and reassuring to know that 90% of patients will recover function and find relief of pain following a hip replacement, however, there are patients who do not recover and who have poor outcomes.  One of the keys to preventing these complications, is understanding what the possible problems are, and what steps you can take to help prevent a problem.

Some of the risks of surgery can occur long after the procedure is over.  For example, infections can occur months or even years after replacement.  Blood clots typically occur weeks after surgery.  And periprosthetic fractures, fractures around a hip implant, can occur years after the surgery.  Patients who have a hip replacement need to be invested in their new hip for life!

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Sometimes Leg Lengths Are Unequal After Surgery

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One of the most common problems that can occur after a hip replacement surgery, and one that patients are seldom aware of, is a leg-length inequality.  Having unequal leg lengths can be a nuisance, an annoyance, or a significant problem that impedes normal activities.

The reason why leg-length are different can be varied, but is ultimately a result of a difference in the size of the implanted joint, and the size of the opposite joint.  Surgeons may knowingly implant a joint replacement that is mismatched to prevent or correct another problem.  For example, a joint may be made too long to prevent dislocation, or may be made too short to prevent a nerve from being damaged.  However, sometimes leg lengths are unequal just because the joint was not perfectly matched.

Some new technologies are being used to help prevent this complication.  For example, robotic-assisted joint replacement, and computer navigation are techniques that some surgeons use to prevent this type of leg length discrepancy.

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You Can Help Prevent Infection

Hand hygiene wash
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One of the most significant and worrisome complications of a hip replacement surgery is an infection.  Infection can require multiple surgical procedures for treatment, and patients who have an infection have worse short-term and long-term outcomes, meaning they aren't as happy with the results of their surgery.

While the risk of infection is largely controlled by your surgeon and the hospital, there are factors that are largely within your control.  Some of these include how well you take care of yourself (dental hygiene, MRSA colonization, diabetes control, weight management), and how well you manage your surgical site.  Most surgeons use a specific preoperative wash to ensure your skin is cleansed of bacteria prior to your surgery.  In addition, you can take steps after surgery to keep your incision site clean.

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Losing Weight Improves Your Chance For Success

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Body mass index can help to predict the likelihood of infection. Peter Dazeley / Getty Images

Most surgeons measure weight by body mass index, or BMI.  As BMI increases, so does the risk of major complications after hip replacement.  Even people with mildly elevated BMIs have a higher risk associated with hip replacement, however, when the BMI goes over 40, that risk become significantly higher, and a BMI over 50 means patients have a very high risk of problems.

For this reason, many surgeons will recommend that patients lose weight prior to having a hip replacement, and some will even refuse to perform hip replacement in these very overweight patients.  Often these surgeons will say that even though they can technically perform the procedure, with the risk of complications being so high, they worry they shouldn't perform the procedure. 

The upsetting part for patients, is most people would like to lose weight, especially when severely overweight, but this can be difficult.  The problems losing weight are often compounded when patients have very arthritic joints.  Furthermore, some studies indicate that even when very obese patients lose weight, they still have a higher risk of complications after joint replacement surgery.

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Surgical Techniques Vary, But May Not Be Better

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There has been a tremendous amount of interest in recent year regarding the surgical technique used to perform a hip replacement, and how this may impact the patient's recovery and risk of complications.

The most recent controversy is with surgical approach, specifically the anterior hip replacement.  This surgical approach has become much more popular for hip replacement in the last 5 years and has a few possible benefits.  Patients may recover a little faster, leave the hospital more quickly, and may have a lower dislocation risk. 

However, there are concerns about an increase chance of other complications, such as loosening and fracture around the implants, as well as a significant learning curve, meaning surgeons performing this procedure may take months or even years to get good at it.

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Sometimes Patients Go Home The Day of Surgery

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Hip replacement used to mean patients would spend a long time in the hospital.  A few decades ago, many patients entered the hospital the day before surgery, and stayed often for several weeks.  Most patients now come in to the hospital the morning of their surgery, and depart within 2-3 days.

Some surgeons are even performing hip replacement as an outpatient surgery, meaning that patients don't spend the night in the hospital at all.  This is amazing, and early data suggests it can be done very safely, but does take a lot of preparation.

The most important factor in determining if a patient can go home is the amount of preparation prior to the day of surgery.  Patients need to clearly understand their needs post-surgically, as there will be limited time in the hospital to learn how to cope on a recently operated hip joint.  In addition, your surgeon and anesthesiologist will modify their routine to ensure that patients can safely and comfortably return to their home environment.

Advocates of this procedure point not only to the convenience of having an outpatient surgery, but also avoiding the hospital environment where patients can get hospital-acquired infections. 

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Hip Replacement is a Great Surgery

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This article has presented a number of concerns related to hip replacement surgery, and some of the issues you should consider.  All that being said, hip replacement surgery is one of the most successful orthopedic procedures.  Patients who undergo a hip replacement find relief of hip pain and improvement in their ability to perform normal daily functions. 

The vast majority of patients who have this surgery report good or excellent results, and would choose to have the surgery again.  Most patients don't have complications, and most never need surgery on that hip again. 

Patients can play an important role in determining the success of their hip replacement, and part of that role is becoming educated about the surgery and some of the ways to prepare for joint replacement.  This preparation can ensure patients are emotionally ready and can ensure they are physically ready for surgery. 

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