Hip Replacement Risks
Before and during hip surgery, we take a number of steps to limit infection. The University of Maryland is a leader in the prevention and treatment of joint replacement infection. Overall, infection is very uncommon. However, infections do occur, and when they occur, treatment is disruptive for the patient.
When infection occurs around the hip replacement, the hip replacement parts usually have to be removed. After the hip replacement is removed, the patient walks around with a temporary antibiotic hip for 3 months. The hip replacement is then redone (three surgeries in all). As you can imagine, infection is very disruptive to the patient's life, and although it occurs very infrequently around a hip replacement, patients should be aware that this is a risk.
Hip replacements are not as stable as native (natural) hips, and dislocation (the ball popping out of the socket) is a possible risk. At the University of Maryland, we use specific techniques to prevent this and have an extremely low dislocation rate.
For most patients, we do not have any specific long-term limitations to hip movement. However, the hip replacement implants are slightly more prone to dislocation than the native hip joint.
Differences in Leg Length
Most patients with hip arthritis have one leg that is shorter than the other. The shorter leg is usually on the side with the hip arthritis. During hip replacement surgery, we use multiple techniques to equalize the leg lengths as closely as possible.
It is not possible to get them exactly laser-line equal, but in the vast majority of cases, it is possible to get them similar enough in length that the patient does not notice any difference between the two legs.
The one exception to this is if the hip with the arthritis seems longer than the other hip before surgery. In general, it is very difficult to make a hip shorter at the time of hip replacement because the hip would no longer be stable. If the hip that has the arthritis feels longer than the other hip before surgery, it will feel that way after surgery.
At the University of Maryland, we use specific approaches and methods for measuring leg length and do everything we can to get your legs as close to being equal as possible. However, the main goals of hip replacement are stable hip implants and pain relief. Leg-length equality is a priority only after these first two goals are established.
Therefore, it is not always possible to make patients’ legs equal in length after hip replacement.
Fracture around the Hip Implants
Hip replacement parts in the United States are most often press-fit into the bone at the time of surgery. Either during surgery or after surgery, it is possible for cracks to develop in the bones where the implants are pressed into place. If this occurs at the time of surgery, it can be addressed at that time.
However, sometimes the cracks develop after surgery. To limit these problems, we use special implants and techniques that avoid fractures.
In addition, we ask that patients use some form of assistive device, either a walker or a crutch or a cane, for 6 weeks after hip replacement surgery to provide additional support to prevent twisting or falling that could produce a fracture around the hip implant.
Hip replacement can temporarily worsen any existing medical condition. The most frequent medical complication after hip replacement is the occurrence of blood clots. We take specific steps to prevent blood clots during and after hospitalization, but they can occur. If they do, they require treatment.
In addition, patients who have heart or lung disease note worsening of those conditions, including heart attacks, problems with breathing or stroke after joint replacement. Although these complications are very rare, they do occur, and it is important to work with your primary care physician to optimize your health before undergoing hip replacement surgery.
Signs That It May Be Time to Consider Hip ReplacementWith the above risks in mind, when is it time to consider hip replacement? If patients have tried the nonoperative treatments and are still suffering, below are some indications that it may be time for hip replacement.
Most of the time, patients with substantial hip arthritis have pain deep down in the groin, and this is the pain that is effectively relieved by hip replacement. In addition, many patients with hip arthritis also have knee pain because the nerves that supply the knee run past the hip and are affected by the inflammation.
Hip arthritis can cause knee pain when there is nothing wrong with the knee! Most of the time, both the groin pain and the knee pain associated with hip arthritis are dramatically improved with hip replacement.
Buttock pain, although it may be coming from the hip, can also be coming from the back. Pain that is being caused by low back problems can persist after hip replacement. Therefore, patients with primarily buttock pain should maximize nonoperative treatment and have us evaluate the back before considering hip replacement.
In general, it is best to wait until the arthritis progresses to a point at which the bones are touching each other as shown on x-rays. Groin pain in a patient with bone touching bone on x-rays is reliably relieved by hip replacement.
Some patients with a femoral head (the ball part of the ball and socket) that is no longer round benefit from hip replacement, but this is on a case-by-case basis. Patients who have hip pain from arthritis but do not have bone touching bone on an x-ray should maximize all nonoperative treatments before considering hip replacement.
Marked Interference with Daily ActivitiesBefore proceeding with hip replacement, the hip arthritis should markedly impact your activities of daily living. Patients who have inability to climb stairs, inability to put on shoes and socks or the need to use a cane should start considering hip replacement. Also, patients who markedly change their activities or avoid social outings because of hip pain should consider hip replacement.
Interference with SleepPatients who have hip pain at the end of the day that keeps them from sleeping despite the use of pain-relief medications should consider hip replacement.
Hip replacement surgery is an extremely successful operation. In the vast majority of cases, patients do not experience any complications. In weighing whether hip replacement is right for you, it is important to know the complications that can occur and the alternatives for treatment, and we are more than happy to discuss them with you.
Most of the time, hip replacement is an entirely elective operation and can be done with no rush. Knowing the risks, benefits and options will help you to be part of the care team and get the most out of your hips.