Hip replacement can boost mobility and decrease pain
Each year, hip replacement surgery relieves pain and improves mobility for more than 120,000 people in the U.S. Successful replacement of deteriorated, arthritic and severely injured hips has contributed to enhanced mobility and comfortable, independent living for many members of the senior population who might otherwise be disabled.
New technology involving prosthetic devices for replacement of the hip joint, as well as advances in surgical techniques, have diminished the risk once associated with the operation, according to William Bugbee, M.D., orthopedic surgeon with UCSD Medical Center and clinical instructor at UCSD School of Medicine. "Total hip replacement (THR) is an option for nearly all patients with diseases of the hip that cause chronic discomfort and significant functional impairment," he said.
Common Cause
Osteoarthritis is the most common cause of hip joint failure leading to THR. Other causes include rheumatoid arthritis and uncorrected congenital conditions such as hip dysplasia. Hip fractures can also lead to THR.
In the past, patients between the ages of 60 and 75 were considered to be the best THR candidates. "Over the last decade, however, the age range has broadened to include those over 75 who may have additional health problems; or younger people, whose first implants are exposed to greater stresses that can lead to prosthetic breakdown," he said.
Dr. Bugbee explained that a surgeon will select a prosthesis based on the patient's quality and density of bone. All implants contain a ball attached to a stem, which is inserted into the thigh bone, and a socket that must be fixed to the pelvis at the other end. Implants are fixed to the bone either with bone cement or with special implant surfaces.
Recovery Period
Uncemented prostheses, or biologically-fixed prostheses, have a special porous surface into which new bone grows. "Generally speaking, uncemented prostheses require a longer recovery period but generally allow for a stronger attachment and possibly less need for revision," he said.
Although 90 percent of implants never need to be redone, implant recipients should be followed closely, Dr. Bugbee said. A safe schedule for most patients includes an exam and X-ray every year or two.
Physical therapy and exercise can help condition patients for the activities they wish to pursue and quality footwear can provide extra cushioning and support. Most surgeons encourage their patients to remain active because of the healthful benefits of exercise. The specific activities recommended for each individual patient depend on general health, fitness, motivation and familiarity with the activity. In addition, exercise must be undertaken sensibly because the implant is a mechanical device that can fail under exceptional loading conditions.
Ongoing Research
"We've learned a lot in the last 30 years since the first THR was performed," said Dr. Bugbee. "However, in order to keep up with the aging population, research is being conducted in medical facilities across the country, including UCSD Healthcare.
"THR is acknowledged as a highly successful procedure that can provide relief from pain, while enabling increased mobility and activity for thousands of people," he said. "People who are suffering from chronic hip, or other joint pain, should consult their family physician."
This column is contributed by UCSD Healthcare physicians and researchers.
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