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OSTEOARTHRITIS OF HIPS

What is our Hip Joint like?

The hip is one of the body's largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.

The bone surfaces of the ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.

A thin, smooth tissue called synovial membrane covers all remaining surfaces of the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint.

Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.

What are the common causes of hip pain and loss of hip mobility?

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, Rheumatoid Arthritis, and Traumatic Arthritis are the most common forms of this disease.

  •   Arthritis or inflammation if the joint causes the surfaces to become rough, which clinically presents as impairment of daily functions including walking, climbing stairs and even arising from sitting position with or without limb length inequality.
  •   Osteoarthritis usually occurs in people 50 years of age and older and often individuals with a family history of arthritis. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.
  •   Rheumatoid arthritis is an autoimmune disease in which the synovial membrane becomes inflamed, produces too much synovial fluid, and damages the articular cartilage, leading to pain and stiffness.
  •   Traumatic arthritis can follow a serious hip injury or fracture. A hip fracture can cause a condition known as osteonecrosis. The articular cartilage becomes damaged and, over time, causes hip pain and stiffness.
  •   Avascular necrosis of head of femur, congenital anomalies, etc.
What is a total hip replacement?

Total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint are surgically replaced with artificial materials. The metallic artificial ball and stem and plastic cup socket are referred to as prosthesis.

What are various types of hip replacements?

The various types are:

  •   Cemented – Both femoral and acetabular components are fixed using bone cement.
  •   Non-cemented – IN this variety, bone is not used to few or insert the prosthesis into the central core of femur and acetabular.
  •   Hybrid: In this variety, only the femoral component is fixed using bone cement.

Many thousands of hip replacements are completed without complications every year. In order to achieve the best chance of a smooth recovery you must,

  •   Avoid bending or twisting at the hip
  •   Avoid low chairs and toilet seats
  •   Try not to cross your legs
  •   Try not to lie on your sides and
  •   Always follow the advice of your doctor.
Is Hip Replacement Surgery beneficial for you?

You may benefit from hip replacement surgery if:

  •   Hip pain limits your everyday activities such as walking or bending.
  •   Hip pain continues while resting, either day or night.
  •   Stiffness in a hip limits your ability to move or lift your leg.
  •   You have little pain relief from anti-inflammatory drugs or glucosamine sulfate.
  •   You have harmful or unpleasant side effects from your hip medications.
  •   Our treatments such as physical therapy ot the use of a gait aid such as a cane do not relieve pain.
An Orthopedic Evaluation: A Prerequisite

The Orthopedic evaluation will typically include:

  •   A medical history, in which your orthopedic surgeon gathers information about your general health, asks questions about the extent of your hip pain and how it affects your ability to perform everyday activities.
  •   A physical examination to assess hip mobility, strength, and alignment.
  •   Occasionally, blood tests or other tests such as MRI (magnetic resonance imaging) or bone scanning may be needed to determine the condition of the bone and soft tissues of your hip.
Rehabilitation after Hip Surgery

Early Hip Rehabilitation

Your recovery program usually begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement needed during the first few days after surgery

The physical therapist will begin as early as 1-2 days after surgery. They will teach you some simple exercises to be done in bed that will strengthen the muscles in the hip and lower extremity. These exercises may include:

  •   Gluteal Sets: Tighten and relax the buttock muscles.
  •   Quadriceps Sets: Tighten and relax the thigh muscles.
  •   Ankle Pumps: Flex and extend the ankles.

Your physical therapist will also teach you proper techniques to perform such simple tasks as:

  •   Moving up and down in bed.
  •   Going from lying to sitting.
  •   Going from sitting to standing.
  •   Going from standing to sitting.
  •   Going from sitting to lying.

Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and your therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device.

At Home

Following surgery, a physical therapist will help you with your rehabilitation protocol. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regular basis to further strengthen your hip muscles. An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to manage.

You must also remember to strictly follow the hip precautions and weight bearing instructions during the first few months following surgery. It is recommended that you not drive unless you have been approved by your doctor.

Long-term Hip Rehabilitation Goals

Once you have completed your rehabilitation program, you can expect to be able to perform most activities of daily living with little to no hip pain or assistance. Following total hip replacement, patients routinely are able to walk, dress, bathe, drive, garden, cook and return to work. Although final outcomes may vary from patient to patient, hip replacement surgery is one of the most successful procedures in modern medicine and most patients return to a full and active life.