Orthopedic

Orthopedic (2)

Orthopedics focuses on injuries and diseases of your body's musculoskeletal system. This complex system includes your bones, joints, ligaments, tendons, muscles, and nerves and allows you to move, work, and be active. Our affiliated orthopedic surgeons offer the latest surgical and non -surgical techniques for all orthopedic issues and will discuss your diagnosis and available treatment options with you to help you select the best plan to help you to live an active and functional life.

Tuesday, 01 June 2010 23:59

Total Hip Replacement

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You or someone you love is thinking about a total hip replacement. Hip replacement is an important decision because it is an elective surgery. The benefits of increased freedom of movement and pain-free movement are important benefits, and this information is designed to help you make that decision.
What is a total hip replacement?

A total hip replacement is a type of surgical procedure where the hip joint is surgically replaced with an artificial joint. The diseased bone and cartilage of the hip joint is removed during the surgery.
The hip joint is a type of joint called a "ball and socket" joint. The "socket" for the hip is a cup-shaped part of the pelvis, known as the acetabulum. The "ball" part is the head of the femur (thigh bone). In a total hip joint replacement, the injured or diseased "ball and socket" are replaced with an artificial ball (with a stem) and inserted into the femur bone. The artificial ball fits in a "socket" made of plastic. The artificial ball and stem are referred to together as the "prosthesis." A type of cement (methylmethacrylate) is sometimes used to "glue" the stem into the femur. More recently, a prosthesis has been developed which has tiny microscopic pores and allows the bone to grow into the prosthesis. This newer type of prosthesis is believed to last longer and may be a better choice, especially for younger patients.

Am I someone who would benefit from a total hip replacement?

Generally, candidates for a total hip replacement are people for whom other, conservative treatments have not helped. The surgery is usually considered when pain becomes so severe that it affects your daily activities even when using anti-inflammatory and pain medications. Because a total hip joint replacement is an elective procedure (meaning it is one option, but not the only option) the decision to have one should be made with the potential risks and benefits in mind.

What are some of the reasons to have a total hip replacement?

Hip joint replacement is most commonly done in people older than age 60. Younger people do get hip replacements, but tend to need another replacement at some point because strain on the artificial hip tends to wear it out. The most common reasons why a hip replacement may become necessary are:
  • Severe arthritis (osteoarthritis) of the hip. This is a disease associated with aging primarily, but is also associated with congenital abnormalities of the hip joint (a birth defect in the bone structure) or with a history of injury to the hip joint.
  • Fractures of the hip joint
  • These may be caused by falls, osteoporosis, medications (both recreational and prescription) and by some diseases such as systemic lupus erythematosus (SLE). Certain transplant patients (particularly kidney patients) are also at a higher risk of hip fractures.
  • Rheumatoid arthritis
  • Aseptic necrosis of the hip bone
  • Tumors of the hip joint

What does the artificial hip look like?

There are four main parts of the artificial hip joint:
  1. A new metal socket to replace your old hip socket.
  2. A plastic liner for the socket. Some liners are made of ceramic or metal. The liner is the surface which will allow your hip to move smoothly and efficiently.
  3. A ball usually made of metal or a ceramic material. This will replace the rounded top of your thigh bone.
  4. A metal stem. This stem will be attached to the long portion (the shaft) of the thigh bone. The stem is used to make the new joint more stable.

Can you describe the operation?

Total hip replacement surgery is done under general or local anesthesia. In general anesthesia, you will be asleep and unable to feel any pain. For local anesthesia, you will be awake, though pain-free and sedated. The surgery usually takes 1 to 3 hours.
After the anesthesia has started working, your surgeon will make an incision, or cut, usually over your buttocks. The following steps will then happen:

  • The top or "head" of the thigh bone will be removed.
  • Your hip socket will be cleared of any loose or diseased material including diseased cartilage and bone.
  • The new hip socket will be placed
  • The metal stem will be inserted into your thigh bone.
  • All the new replacement parts will be "glued" into place with special cement.
  • The incision is closed.


Your new hip will last longer if you lose weight and you don't stress the joint. If you are older than 60 when you have joint replacement surgery, the artificial joint should last the rest of your life.

Anyone who has any prosthesis, such as an artificial hip, will need protect to themselves against infection. You may need antibiotics before any dental work or any invasive medical procedures to help prevent these infections. You should also carry a medical identification card letting health care professionals know that you have had a hip replaced.

How should I prepare for the surgery?

Before the Procedure
Before any surgical procedure, make sure you tell your doctor or nurse what drugs, herbs and supplements you are taking.

  • Get your home ready for your recovery. Think about where to have your bed, whether you will need help getting to and from the toilet, who will be available to help you with preparing food and so on. Keep in mind you shouldn't move around too much after surgery--prepare your house for when you get home.
  • There is the possibility of losing blood during the procedure. You may want to ask about donating your own blood (an autologous donation) to be used for transfusion during the surgery if it becomes necessary.
  • You will undergo a preoperative evaluation--this generally includes a listing of all medications, supplements and herbs being taken by the patient. For the 2-week period before surgery, you may need to stop taking some drugs that make it harder for your blood to clot. These may include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). If you are taking warfarin (Coumadin) or clopidogrel (Plavix), ask your doctor about these and any other prescription medications.
  • Other preoperative labs include complete blood counts (CBC), electrolytes, kidney and liver tests, a urinalysis, a chest x-ray, EKG, and a complete physical examination.
  • Let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery. If you have any conditions such as diabetes, heart disease, alcoholism/addiction or any other medical conditions, make sure you tell your surgeon.
  • You may want to get a referral or visit a physical therapist to learn which exercises to do before and after surgery and perhaps to practice using crutches or a walker.

On the day of your surgery: Generally, do not eat or drink anything after midnight the night before. Rinse your mouth with water if it feels dry, but be careful not to swallow. Take only the drugs your doctor told you to take with a small sip of water.

What will happen after the surgery?

A large bandage will be place over the incision along with a drainage tube to remove excess fluid. You will also have an IV tube in one of your veins so that you can get fluids and any required medicines.Sometimes, you might have a catheter (tube) placed in your bladder to drain urine until you are able to get to the toilet. It is usually removed within 3 days of the surgery.You will have a pair of special compression stockings to wear. These stockings reduce your risk of blood clots and improve your blood flow. Most people will also take blood-thinners such as Coumadin to reduce the risk of blood clots more.You may be encouraged to cough and do deep breathing exercises. This helps reduce the risk of pneumonia. You may be given a spirometer or a "blow tube" to help keep your lungs functioning properly.You will likely be prescribed some pain medication as well as prophylactic antibiotics to minimize the risk of infection.

When can I start moving around or walking?

You will be encouraged to start moving and walking as soon as the first day after surgery, starting slowly and moving more and more every day after the surgery.On the first day after surgery, you will start by dangling your legs over the edge of the bed. You may be encouraged and helped to get out of bed to a chair. You may be asked to try walking.When you are in bed, move as much of your body as you can, especially bend and straighten your ankles often. Other leg exercises can also help prevent blood clots. You should ask about learning these exercises as soon as possible. Ask about the best positions for your legs and hips--what chairs to use, how and what types of exercise are best, how long should each walk be and so on. You are your own best advocate! You will be encouraged to be independent as much as possible. But, you should always have help nearby.

How long will recovery take?

The length of the hospital stay is usually 3 to 5 days. Full recovery can take from 2 to 3 months to a year. Always remember to take it easy, be patient and be kind to yourself! Physical therapy will start immediately after the surgery and is extremely important for your recovery. Some of the goals of the physical therapy are:

  • To prevent contractures, or scarring around the joint.
  • To strengthen your muscles around the new hip joint using exercises.

You will be taught how to minimize any strain at the hip joint. You will also be taught how to hold your body, how to sit and how to best use the toilet. You will be given home exercise programs to strengthen the muscles around the buttock and thigh and will likely be asked to attend an outpatient physical therapy program.

What will my life be like after the hip replacement?

People with hip replacements generally have very good to excellent results[2]. Most of your pain and stiffness will be greatly improved and you can return to many of your chosen activities, whether they are walking, playing golf, riding a bike or just sitting comfortably in a chair reading a good book or having dinner with friends! There are lots of websites with stories of successful procedures. Visit them and read about other people like you!

There are some activities--like running, jumping and playing certain sports that may not be recommended by your doctor. Talk to your doctor about these types of activities.There are some people who may have problems with loosening or the joint, an infection or a dislocation of the joint. Talk with your doctor about how to minimize those risks.Over a long time, the artificial hip may loosen a bit and it may be enough to require a second replacement. This usually takes about 10-20 years.Some younger and more active people may wear their hip out. It may need to be replaced before the 10-20 year period. You will want to be aware that the metal in your new hip may set off security alarms. Tell the security attendant that you have had a hip replacement.





Tuesday, 01 June 2010 23:49

Hip Resurfacing

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What is hip resurfacing?

Hip resurfacing differs from a total hip replacement because the head of the femur is cleaned and "re-surfaced" instead of being totally removed.
The hip joint is a type of joint called a "ball and socket" joint. The "socket" for the hip is a cup-shaped part of the pelvis, known as the acetabulum. The "ball" part is the head of the femur (thigh bone). In hip resurfacing, the head of the femur is cleaned off but is not removed. Instead, after the surface has been cleaned, it is fitted with a metal "cap". The hip socket is also cleaned and fitted with a cup-like metal surface. In general, hip resurfacing leaves more original bone in place and is considered a better option especially for younger people who have hip problems. It is a more complicated surgery and has somewhat higher risks associated with it than a total hip replacement, but it preserves healthy bone and has fewer problems with dislocations than does the total hip replacement procedure.

Am I a candidate who would benefit from hip resurfacing?

Generally, candidates for a hip resurfacing are younger, and their hips are less damaged than those considering a hip replacement. The surgery is usually considered when pain becomes so severe that it affects your daily activities even when using anti-inflammatory and pain medications. Because it leaves most of the hip bone intact, a total hip replacement is still possible years later, if it does eventually become necessary. The resurfacing procedure gives you an extra option. It is often recommended for:
  • Younger, more active patients with generally strong bone structure.
  • Patients with osteoarthritis or rheumatoid arthritis

Can you describe the operation?

  • The hip resurfacing surgery is done under general or local anesthesia. In general anesthesia, you will be asleep and unable to feel any pain. For local anesthesia, you will be awake, though pain-free and sedated. The surgery usually takes 2 to 4 hours.
  • After the anesthesia has started working, your surgeon will make an incision, or cut, usually over your buttocks. The following steps will then happen:
  • The top or "head" of the thigh bone will be cleaned of diseased tissue and bone. The head of the thigh bone will be "capped" with a metal cap.
  • Your hip socket will be cleared of any loose or diseased material including diseased cartilage and bone and a metal cup will be placed into the existing socket.
  • All the new parts will be "glued" into place with special type of cement.
  • The incision is closed.

How should I prepare for the surgery?

Before the Procedure

  • Before any surgical procedure, make sure you tell your doctor or nurse what drugs, herbs and supplements you are taking.
  • Get your home ready for your recovery. Think about where to have your bed, whether you will need help getting to and from the toilet, who will help you with preparing food and so on. Keep in mind you shouldn't move around too much after surgery--prepare your house for when you get home.
  • There is the possibility of losing blood during the procedure. You may want to ask about donating your own blood (an autologous donation) to be used for transfusion during the surgery if it becomes necessary.
  • You will undergo a preoperative evaluation--this generally includes a listing of all medications, supplements and herbs being taken by the patient. For the 2-week period before surgery, you may need to stop taking some drugs that make it harder for your blood to clot. These may include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
  • If you are taking warfarin (Coumadin) or clopidogrel (Plavix), ask your doctor about these and any other medications.
  • Other preoperative labs include complete blood counts (CBC), electrolytes, kidney and liver tests, a urinalysis, a chest x-ray, EKG, and a complete physical examination.
  • Let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness during the time leading up to your surgery.
  • If you have any conditions such as diabetes, heart disease, alcoholism/addiction or any other medical conditions, make sure you tell your surgeon.
  • You may want to get a referral or visit a physical therapist to learn which exercises to do before and after surgery and perhaps to practice using crutches or a walker.

On the day of your surgery

  • Generally, do not eat or drink anything after midnight the night before. Rinse your mouth with water if it feels dry, but be careful not to swallow.
  • Take only the drugs your doctor told you to take with a small sip of water.

What will happen after the surgery?

  • A large bandage will be place over the incision along with a drainage tube to remove excess fluid. You will also have an IV tube in one of your veins so that you can get fluids and any required medicines.Sometimes, you might have a catheter in your bladder to drain urine until you are able to get to the toilet. It is usually removed within 3 days after surgery.
  • You will have a pair of special compression stockingsto wear. These stockings reduce your risk of blood clots and improve your blood flow. Most people will also take blood-thinners such as Coumadin to reduce the risk of blood clots more.
  • You may be encouraged to do deep breathing exercises and cough. This helps reduce the risk of pneumonia. You may be given a spirometer or a "blow tube" to help keep your lungs functioning properly.
  • You will likely be prescribed some pain medication as well as prophylactic antibiotics to minimize the risk of infection.

When can I start moving around or walking?

  • You will be encouraged to start moving and walking as soon as the first day after surgery, starting slowly and moving more and more every day after the surgery.
  • On the first day after surgery, you will start by dangling your legs over the edge of the bed. You may be encouraged and helped to get out of bed to a chair. You may even be asked to try walking.
  • When you are in bed, move as much of your body as you can, especially bend and straighten your ankles often. Other leg exercises can help prevent blood clots. You should ask about learning these exercises as much as possible. Ask about the best positions for your legs and hips--what chairs to use, how and what types of exercise are best, how long should each walk be and so on. You are your own best advocate!
  • You will be encouraged to be independent as much as possible. But, you should remember to always have help nearby for the first few days after the procedure.

How long will recovery take?

  • The length of the hospital stay is usually 3 to 5 days. Full recovery can take from 2 to 3 months to a year. Always remember to take it easy, be patient and be kind to yourself!
  • Physical therapy will start right away after the surgery and is extremely important for your recovery. Some of the goals of the physical therapy are:
  • To prevent contractures, or scarring around the joint.
  • To strengthen your muscles around the new hip joint using exercises.
  • You will be taught how to minimize any strain the hip joint. You will also be taught techniques of how to hold your body, how to sit and how to best use the toilet. You will be given home exercise programs to strengthen the muscles around the buttock and thigh and likely be asked to attend an outpatient physical therapy program.

What will my life be like after the hip resurfacing?

  • Most people with hip resurfacing generally have very good to excellent results[2], [3]. Most of your pain and stiffness will be greatly improved and you can return to many of your chosen activities, whether they are walking, playing golf, riding a bike or just sitting comfortably in a chair reading a good book or having dinner with friends!
  • There are lots of websites with stories of successful procedures. Visit them and read about other people like you!
  • There are some activities--like running, jumping and playing certain sports that may not be recommended by your doctor. Talk to your doctor about these types of activities.
  • There are some people who may have problems with some loosening or the joint, an infection or a dislocation of the joint. Talk with your doctor about how to minimize those risks.
  • Some younger and more active people may wear their hip out. It may need to be replaced. The advantage with the hip resurfacing procedure is that hip replacement, if and when it is necessary, can still be done.
  • You will want to be aware that the metal in your new hip may set off security alarms. Tell the security attendant that you have had hip surgery.

The main benefit of the hip resurfacing procedure is that the majority of patients are able to resume, painlessly or nearly pain-free, their normal daily activities. They are able to walk, drive, sit, get-up, climb stairs and sleep as they used to. If you love biking, golf, swimming or dancing, you can begin to do those things as well. Your new hip will last longer if you lose weight and you don't stress the joint. If you are older than 60 when you have joint replacement surgery, the artificial joint should last the rest of your life.



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