What is osteoarthritis and why my hip hurts?

In the hip there is a layer of smooth cartilage on the head of the femur that articulates with the pelvis and there is another layer in the cavity of the acetabulum of the pelvis. This articular cartilage works as a shock absorber and allows the circular movement of the hip. Osteoarthritis is the gradual consumption of this cartilage. At the end of this mechanical consumption the underlying bone is brought to collide with the opposite acetabular side of the basin and, therefore, bone rubbing against bone causes pain, swelling and articular limitation.

 

What is the total hip replacement?

Total hip prosthesis is a surgical operation that removes the consumed layers of the joint, both on femoral and acetabulat side. These articular layers are replaced by two prosthetic surfaces which are fixed with or without cement both in the femur and in the basin. The new artificial articular surfaces, of polyethylene, metal or ceramic depending on the case, recreate a new hip painless articulation.

 

Why should I have surgery for hip replacement?

Your orthopedic surgeon will decide if you are a candidate for surgery and this will be based on your medical history, on radiographic and clinical examination. Of course, if you can still control articular pain with simple painkillers and occasionally with physical therapies and maintaining a proper weight and a good muscle tone, you will still have to wait. If, instead, your social life is greatly limited by your hip pain because of your functional limitations, and your quality of life is severely compromised by the progressive immobility caused by osteoarthritis of the hip, it will be easier to decide for surgery.

 

I’m too old for surgery?

There is no age absolute contraindication to total hip replacement surgery; an elderly but active patient will have a greater ability to withstand the prosthetic implants and shall heal with better functional outcome compared to a young but severely obese or not sufficiently motivated patient. It may be the case to hear even your family doctor to get his advice about your general condition and your ability and compliance to achieve a good result with surgery.

 

How long can my hip replacement last, and will it be possible to remake the prosthesis if it loosens?

Normally total hip replacement last 10 to 15 years, but in 10% of cases they may last less and a second implant may be required, especially in those who do not have good muscle tone or who are overweight.

 

Why does sometimes surgery fail?

In cases of failure of hip replacement, when there is no infection complication (which is rare, but possible), early or late failures can be attributed to progressive mechanical loosening of the implant, both in its femoral side (stem of the prosthesis) and in basin side (acetabular cup).

Implants may be cemented or not cemented, and this is due to the intraoperative choice frequently linked to bone quality (in patients with rheumatoid arthritis, for example, the poor quality of the bone sometimes compels to cement the implant). But, regardless of the presence or less of the cement, the interface between the prosthesis and the bone is the critical point of the implant: time after time, this relationship between bone receiving the prosthesis and prosthetic implant inevitably tends to worsen.

Factors affecting this deterioration are body weight, muscle tone, physical activity; on the contrary metabolic conditions of the bone, which of course in the elderly slowly deteriorate, operate in the same way osteoarthritis has determined the necessity of surgery.

 

What are the major complications of hip replacement surgery?

There are interventions without risk. Infection and venous thrombi and emboli in the postoperative period are the risks that concern us most. To avoid such complications, we use prophylaxis with antibiotics and antitromboembolic drugs. Our operating rooms have very high sterility in order to reduce the bacterial environment. The percentage of risk of infection in the operating room is about 1%, but you cannot break it down completely. Another possible complication is early dislocation of the hip, so we’ll talk about it along with your physical therapist, in order to avoid risky movements for a reasonable period of time.

 

Do I have to make exercises before doing the surgery?

Certainly. You must discuss with your physiotherapist exercises to do in order to get to the intervention with the best muscle tone possible and the best hip joint movement, although it is still present the osteoarthritis we want to eradicate with the implantation of hip replacement.