Total Hip Replacement
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editors: Dennis Lee, MD, and Jerry Balentine, DO, FACEP
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Hip Fracture Prevention - Hip Protectors
Medical Author: William
C. Shiel Jr., MD, FACP, FACR
 Breaking the bones of the hip (hip fracture) is common in the elderly. This is a result of two major factors that affect older people: (1) an increased risk of falling because of poor stability (from a decrease in muscle, joint, and nerve function) and poor vision; and (2) weak bones that break easily because of osteoporosis.
It has been estimated that 250,000 (a quarter of a million) people in the United States suffer hip fractures each year!
A hip fracture is a terrible injury. It typically requires major surgery for repair. Operations involve either metal pinning with screws and/or plates or replacement of the hip joint with artificial parts. These operations can be complicated by infections, blood clotting, bleeding, and failure of the repair work. After such a surgical procedure, long and aggressive rehabilitation programs are necessary for optimal success. For the very frail, elderly person, ultimate recovery can be extremely difficult and long-term loss of independence, nursing-home placement, and even death can result.
Prevention of hip fractures is a key part of caring for the health of the elderly. Elderly people can take measures to decrease their own risk for hip fractures. These measures include participating in regular, proper exercise, "clearing the runway" in homes for walking and transferring, undergoing regular general and eye-health checkups, and addressing osteoporosis (bone-density exams, calcium and vitamin D intake, and osteoporosis medications when indicated).
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What is a total hip replacement?
A total hip replacement is a surgical
procedure whereby the diseased cartilage and bone of the hip joint
is surgically replaced with artificial materials. The normal hip
joint is a ball and socket joint. The socket is a "cup-shaped" bone of the pelvis called the acetabulum. The ball is the head
of the thigh bone (femur). Total hip joint replacement involves
surgical removal of the diseased ball and socket and replacing
them with a metal ball and stem inserted into the femur bone and
an artificial plastic cup socket. The metallic artificial ball
and stem are referred to as the "prosthesis." Upon inserting
the prosthesis into the central core of the femur, it is fixed
with a bony cement called methylmethacrylate. Alternatively, a
"cementless" prosthesis is used which has microscopic
pores that allow bony ingrowth from the normal femur into the
prosthesis stem. This "cementless" hip is felt to have
a longer duration and is considered especially for younger
patients.
Who is a candidate for total hip replacement?
Total hip replacements are performed
most commonly because of progressively worsening severe arthritis in the hip
joint. The most common type of arthritis leading to total
hip replacement is degenerative arthritis (osteoarthritis) of
the hip joint. This type of arthritis is generally seen with aging,
congenital abnormality of the hip joint, or prior trauma to the
hip joint. Other conditions leading to total hip replacement include
bony fractures of the hip joint, rheumatoid arthritis, and death (aseptic necrosis) of the hip
bone. Hip bone necrosis can be caused by fracture
of the hip, drugs (such as prednisone and prednisolone),
alcoholism, and diseases (such as
systemic lupus erythematosus).
The progressively intense chronic pain together with impairment
of daily function including walking, climbing stairs, and even
arising from a sitting position, eventually become reasons to
consider a total hip replacement. Because replaced hip joints
can fail with time, whether and when to perform total hip replacement
are not easy decisions, especially in younger patients. Replacement
is generally considered after pain becomes so severe that it impedes
normal function despite use of anti-inflammatory and/or pain medications.
A total hip joint replacement is an elective procedure, which
means that it is an option selected among other alternatives.
It is a decision which is made with an understanding of the potential
risks and benefits. A thorough understanding of both the procedure
and anticipated outcome is an important part of the decision-making
process.
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| Picture of total hip replacement |
Next: What are total hip replacement complications? »
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Total Hip Replacement
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