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Living with prothesis


When the hip beginsto show problems

When pain and numbness in your hip prevent you from enjoying your diary activities, you may be in need of a total hip replacement. Development for this operation began over 40 years ago. Nowadays, over 180.000 people in the U.S. undergo a total hip replacement surgery to diminish the pain and stiffness, and restore mobility.
The most frequent cause of hip pain is arthritis. It is believed that 40 million people in the U.S. suffer from some type of arthritis. This means that one in seven people, a family in seven families suffers from arthrosis. Among the hundreds of types of arthritis, the following three are the most common cause of joint damage.
Osteoarthritis is a disease that provokes deterioration of the tissue that allows joints to move with ease. The cartilage and the synovial get damaged and worn out, leaving the close-by bones unprotected against the wearing off produced by the rubbing of the bones. Osteoarthritis affects primarily people over 60 years old.
The arthritis rheumatoid is a systematic disease that can affect any articulation in the body. It affects women much more than it does men, and it can manifest itself in old and young people alike. When the arthritis rheumatoid appears, the body's immunologic system produces substances that attack and destroy the coating or synovial envelop that surrounds the joint capsule, as well as the articular surface cartilage, causing pain, swollenness and loss of mobility.
Arthritis related to trauma, which occurs when the joint is injured, is the third most common kind of arthritis. This one also causes damage to articulation, pain, and loss of mobility. When the conservative treatment methods do not provide enough relief, then a total hip replacement is suitable.
If your x-rays show destruction of the joints, you and your surgeon shall decide if the amount of pain, damage and loss of mobility are severe enough to consider the intervention.
Nowadays, your surgeon can replace the hip that is troubling you, thanks to the developing of total hip implants, which have proven to be a way of relief in the long run. The total hip replacement is an extraordinary successful operation that has changed the lives of many people, allowing them to remain active and free of pain.




The hip articulation

A joint is the place where two or more bones meet. The hip joint is formed where the superior part of the femur meets the acetabulum - where the femur fits in the pelvis -. The superior side of the femur is round-shaped and fits perfectly in the cavity formed by the acetabulum.
The hip joint bones are covered by a soft, shiny layer of cartilage, which cushions and protects the bones while allowing for smooth movement. Surrounding the hip joint is the synovial coating, which produces a lubricant that moisturizes and diminishes the degree of friction.
Strong, fibrous laces called ligaments connect the joint bones and maintain them in place, while adding strength and elasticity for movement. The muscles and cords also play an important role in keeping stable an articulation.



The total knee replacement

Total knee replacement - TKR - or "arthroplasty”, is the replacement of both femoral head and hip joint acetabulum with artificial pieces called prosthesis. There are two main components used in a total knee replacement. The femoral component is made entirely of metal and it replaces the head. The acetabular component, on the other hand, replaces the cavity and is made of a high endurance plastic called UHMWPE polyethylene. It can also be made of a mixture of metal and polyethylene, in which case the polyethylene cup is set inside the metallic hulk. The acetabular component is then fixed in the pelvic cavity.
The femur's superior end - thigh bone - is eliminated during surgery and the inferior part - the channel - is drilled and widened enough for the femoral component to fit in smoothly. The pelvis cavity is also expanded with a special surgical instrument to make room for the new artificial component. The femoral component is inserted in the enlarged thigh bone channel. The acetabular component is placed inside the prepared cavity. Head and cavity are placed together and stabilized along with the ligaments and muscles surrounding them, exactly the same as the original hip.

Your hip evaluation

An orthopedic surgeon specializes in problems that affect bones and joints. Your hip evaluation will begin with a detailed questionary. Also, your medical history is very important in establishing if surgery is absolutely necessary. It helps the surgeon understand your pain, your active limitations and the progress of the problem in your hip. After finishing with your clinical history, a physical exam will take place. Your hip and knees mobility range is measured and the strength of your muscles will be evaluated. The surgeon will observe the way you walk, sit, incline and move.
X-rays will be performed on your hip joint. It is highly recommended you bring with yourself any hip x-rays you have had in the past. These will help the surgeon through the surgery planning and to evaluate the size of your new hip prosthesis. By means of a puncture, a small amount of hip articulation fluid can be extracted to detect any possible infections. After your initial orthopaedic evaluation, the surgeon will discuss possible alternatives for surgery. If the x-rays show very severe joint damage, and no other treatment has given relief, then a total hip replacement may be recommended.



Before the surgery

You may be asked to consult with your head doctor or an intern medicine specialist for a more in-depth medical evaluation. In order to get ready for surgery, you will be asked to deal with certain matters. If you are overweighed, you will be required to lose some weight. If you smoke, it is important that you stop doing so two weeks before the surgery. If you are taking aspirins or certain arthritis medicine, inform your surgeon. You will need to stop these medications two weeks before the surgery. If you are taking estrogen - I.e. Premarin - your surgeon will probably advice you to stop taking it a month before the surgery. Maybe your doctor will ask you to donate some blood in anticipation for a possible transfusion during surgery.



The operation day


You will most likely be avowed in the hospital in the morning. You cannot eat nor drink anything after midnight the day before the intervention. That day you will be taken to the operation room around half an hour earlier. For medicine purposes and blood transfusions, an intravenous line - IV - will be set. The anesthesiologist will chat with you before the operation and comment on the kind of anesthesia that will be used.



The recovery room


After the operation, you will wake up at the post-anesthesia recovery room. You must remain there until the anesthesia effects wear off, your breathing is normal, and your blood pressure and pulse are fully stable. It will seem to you like you only left your room for a few minutes. If by chance you experience some pain, medicine will be available to counter it.



What to expect after the surgery


Probably, exiting your surgical bandage there will be a probe connected to a draining device. This system provides a soft, continuous suction in order to eliminate any blood residue that may accumulate in the surgical area. The probe will be removed some days after the operation, and your bandage will be switched to a smaller one.
You shall be able to move your unoperated leg as soon as you have awakened. While lying on your back, flexing the hip that wasn't operated will reduce pain in your inferior back. The nurse will help you find a comfortable position. You will be able to turn around with a pillow between your legs. The nurse will encourage you perform ankle exercises every hour as a protection against blood clots. An intravenous probe will remain in your arm for several days to supply antibiotics and any other medication you may need. This helps prevent the infection and will give you an adequate nutrition until you can eat and drink without difficulties.
You will start ingesting food and liquids under the directions and supervision of your surgeon.
To prevent problems in your lungs, you will receive an incentive spirometer after the operation, to help you cough and breathe deeply. This is used every hour while you are awake.
It is normal to feel uncomfortable after the surgery. Inform your nurse if you start feeling pain, and medications will be made available for you.
You hip rehab program begins immediately after the surgery, and is ordered by your surgeon. The isometric exercises - which maintain muscular tone without moving the articulation - will begin while you are still on bed. You will be instructed to exercise a number of times a day while being awake. The physical therapist will encourage you to move your ankles and other joints to keep your strengths.
These exercises will help you regain your strength and mobility. The physical therapist will teach the safest ways to enter and exit the bed, sitting in a chair and going to the bathroom. You will be taught what to do and what not to do during your joint replacement recovery.
The day after the operation, you will probably begin to walk and perform exercises that include hip joint movement. The therapist will initially assist you in exiting your bed and standing next to it with a walker's help. During your entire stay at the hospital, you will probably have to walk with help from a walker or crutches for
at least two times a day under a therapist’s supervision. The distance you need to walk will gradually increase.
The physical therapist will be pending daily on your progress and keeping your surgeon informed. You will be able to take pain medications before starting your physical therapy if you wish so.





A usual stay at the hospital during hip joint replacement is from three to five days. You will gain independence quickly after surgery. You won't be allowed to sit in an angle surpassing the 90º, for hip protection issues. To make the sitting process easier, there will be an elevated chair and a high stool for when using the bathroom.
This will allow your hip to stay elevated or at knee level when you are sitting down. An elevated stool for bathroom purposes will be ordered for you to place in your house, as well as a firm chair with an armrest.
The therapist will teach you how to dress, get out of bed without help and using a walker or crutches. You will continue exercising to regain your strength, while getting ready to return home.
It is extremely important that you guide yourself by your doctor's instructions and follow adequate positioning techniques throughout the whole rehab process. By the time you leave the hospital, you should be recovering your full mobility and stability. If the stitches cannot yet be removed when you take your leave, you will be informed on who will remove them and when. The complete recovery period normally lasts from three to six months.
Shortly before you are discharged, you'll receive instructions about your home recovery. Until you get to see your surgeon for your monitoring visit, you must take certain precautions when performing your activities.
As soon as you arrive home from the hospital, make a doctor's appointment. Check if there have been any changes around your injury zone. Get in contact with your surgeon if you have developed any of the following:


1 • Draining and/or bad smell coming from the incision area.
2 • Fever - temperature close to 101º F or 38º C for over two days -.
3 • Swollenness augment, sensitivity, reddening and/or pain.


Take your time to readapt to the surroundings of your home. It’s normal to feel frustrated, but these feeling will soon pass away. Take it easy.
If you are working in a counter, you will need a high stool.



Getting back in your everyday activities


Depending on the physical requirements of your job, you will be able to resume it when your surgeon authorizes so.
Usually you'll drive again once you can withstand your full weight on your hip. Make sure you are comfortable with your body resistance. Practice driving in a safe zone. Once you are comfortable with your mobility, you will be able to drive wherever you want to.
Sexual relations can be resumed in any moment while keeping in mind every precaution regarding your hip. We recommend staying active to control your weight and muscular tone. It will take from three to four months before you can resume your low-impact aerobic activities such as walking, riding a bike and swimming.
Jogging, higher impact aerobics and some sports should be avoided. Keep in mind your new hip is artificial, and, although it is made of extremely durable materials, it is exposed to wearing off and break.
Since your rehab is an individual activity, we recommend you seek your surgeon's advice for future activities.



Medicines/pain control


It is normal for you to feel some discomforts. You will probably receive a painkiller medicine recipe before you return home. If you need more medicines please contact your surgeon's nurse a few days before you run out of them. Get in touch with your surgeon if the unrest or pain increases in any way.



Special indications


You will be examined again past six weeks, then after five months and finally after twelve months past the surgery. You may be required to check with your surgeon once a year after the first year, even if you aren't having any troubles, just to check your new hip joint condition.




Any infection should be immediately treated with the adequate antibiotics since the infection can extend from an area to the other through the blood current.

Every possible effort must be made in order to prevent an infection in the artificial joint. You should always inform your doctor or dentist that you possess an artificial articulation. If you are planning on performing a dental job, please contact your surgeon before this. He will prescribe you some kind of antibiotic. Antibiotics must be used before and after any medical or dental procedure. This precaution must be made for the rest of your life.