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How can I find out if I need a hip replacement?

The orthopaedic surgeon will perform a very meticulous recon on your hips, which may include physical exams, x-rays analysis and a study of your clinical history.
The surgeon will ask you to describe your pain and may ask questions to determine whether you have any other problems in your articulations, and find out if you have had any other blow which may have injured your hip. They will ask you as well to detail how you have treated the pain, for example, if you have done physiotherapy or taken medications.
The surgeon will evaluate the strength and width movement of your joints, by closely watching your movements and checking if there is any issue in your walking and body movement.
The x-rays will provide your surgeon images of your hip joints, revealing if they have changed shape or size, or if there is any special circumstance that can help him decide that surgery is the best option. If this alternative happen to be the best suited for you, x-rays can help pick the size and adjustments of your new hip.
According to the results of this exam, the surgeon shall determine if you are a candidate for a total hip replacement. Although it is practiced regularly, total hip replacement is a major surgical intervention that should not be taken lightly and must be considered only when there is no other alternative treatment.
There are much more conservative treatments that you and your surgeon must evaluate, for example, oral medication or pain injections, physiotherapy and other kinds of surgery.
The final decision on whether you should carry out a total hip replacement or not is entirely up to you, therefore, it is really important for you to understand the risk this operation entails. There are complications that may present themselves during or after surgery, among these they are; infection, blood clots, pneumonia, dislocation, prosthesis loosening and nerve damage. Your surgeon will answer any specific question you have about these risks.




What implies having a total hip replacement?

Before the surgery:

If both you and your surgeon decide that a total hip replacement is suitable, a fixed date will be set. It could be necessary to make several preparations for the surgery.
For example, your surgeon may ask you to go through a check with your primary attention doctor. Also, it is advised to settle any dental work you have unsettled, in order to prevent germs in your mouth to enter your blood current and infect the articulations. If your prefer so or a surgeon deems wise, you may donate blood beforehand in order to reduce the possibility of your body reacting negatively to the transfusion.


During surgery:

The date of the surgery, you will have an intravenous probe placed in your arm, to supply all the medications and liquids necessary during the operation. Then you will be taken to the operating room where they will anesthetize you.
The operation usually takes about two to four hours. The exact duration depends on the arthritis gravity in your hip. In the OR they shall place a urinary catheter, which will be there for one or two days. You will be fixed with compression tights and pneumatic handles on both legs.
The procedure is carried out through a practiced incision on the side of your hip. The aspheric end of the femur is cut -the thigh bone- and in its place the new metallic sphere and the stem are placed, which later on are stabilized with or without cement. The natural cavity's damaged surface is smoothed in preparation for the insertion of the artificial cavity, and then the sphere is joined with the cavity.
When you are satisfied with the prosthesis adjustment and function, the surgeon closes the incision and covers it with dressings. Some small draining tubes will be left on your hip, just to drain away the liquid exiting the wound.


After surgery:

You shall be moved to the recovery room and, as the anesthesia effects start to wear off, you shall regain consciousness slowly. A nurse will accompany you, who may ask you to cough or take deep breaths to help clear the lungs. You will be given some painkillers and they may place have a foam wedge or some pillows between your legs to help maintain your new hip in position. When you are fully awakened, you will be moved again to your hospital room.



What can I expect after the surgery?

When you return to your hospital room, you will enter a soft rehab program to help strengthen the muscles surrounding your new hip and recover movement width. The day of the operation, you may be asked to sit on the edge of the bed and let your feet hanging out; you will also learn what you must do to protect your new hip while you perform your everyday activities.
As soon as possible - generally in the subsequent 24 hours - your physiotherapist will help you start walking a few short steps at a time. As you start healing, you will move on from walking with a walker, to using crutches, and finally begin walking with a cane. Before you can leave the hospital, an occupational therapist will show you how to carry on your everyday chores at home while getting used to your new hip. For example, you will be taught on how to go to the bathroom, dress yourself, sit down and stand up, picking up objects and performing several other activities.
After two to four days, or whenever your surgeon decides you have rested enough, you will be discharged from the hospital. Maybe they will move you to a nursering center for a few more days, if your surgeon deems best.
By the time you return to your home, you will have to keep on taking your regular medicines and performing the exercises your surgeon or physiotherapist has required of you. Walking, staying active and doing the necessary exercise are the fastest ways to fully recover. Six week later, you will meet again with your surgeon in the hospital in order to evaluate the recovering process.
In most cases, a successful total hip replacement should relieve your pain and stiffness, and will allow you to perform many of your diary regular activities. But even after having recovered completely from the surgery, you will still face some restrictions. In everyday activities, contact sports or hip-forcing movements are not embodied. Although it is possible to substitute your artificial hip, the second implant may be less efficient and place even more limitations in your personal activities. It is highly recommended that you direct all questions you need answering to your surgeon.



Why does my hip hurt?

In a healthy, normal hip, spinning, turning and straightening movements are absorbed by the cartilage. This elastic tissue allows the sphere - the femur end - to slide freely within the cavity, without producing any pain whatsoever.
However, the cartilage can wear off or become injured over time, which causes bone friction and rubbing. This wearing off is responsible for a great deal of both the pain and stiffness that patients suffer from.
Although articular pain is mostly associated to an injury or hip fracture, other factors that may cause damage to this joint include; disintegration of the cartilage - osteoarthritis -, swollenness and stiffness of the cartilage - arthritis rheumatoid or drop - as well as bone degradation due to long usage of alcohol and steroids - necrosis -.



What does the total hip replacement consist of?


In a total hip replacement surgery, painful, damaged parts of an articulation are replaced by a prosthesis - an artificial device used to complement the hip -. The prosthesis has three components: a cavity, a sphere, and a stem. The exterior layer of the cavity usually is made of plastic, but there are some cavities which are made entirely of plastic material. When the metallic sphere is inserted in the cavity, the new hip allows for ease of movement, practically without any friction.



This booklet is destined to give a general description of the total hip replacement, and doesn't in any way intend to promote this type of intervention, nor does it intend to instruct about the pre-surgery preparations or the post-surgery process.