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September 2010
Hip, Hip, Hurray!
Getting Ready for Hip Replacement Surgery
Dr. Hemant Wakankar
If your hip has been damaged by arthritis or any other cause, common activities such as walking or getting in and out of a chair may be painful and difficult. You may even feel uncomfortable while resting.

Medication may control your pain for a short while, but long-term use of painkillers is not likely to do any good to your stomach. You may therefore want to consider hip replacement surgery. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can relieve your pain and help you get back to enjoying normal, everyday activities.

First performed in 1960, hip replacement surgery is one of the most important surgical advances of this century. Since then, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of this surgery.

4 Reasons for 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.
  1. Osteoarthritis usually occurs after the age of 50 years. It follows the cartilage covering and cushioning the bones of the hip wearing away. The bones then rub against each other, causing hip pain and stiffness.
  2. Avascular necrosis is a common condition leading to secondary osteoarthritis. The blood supply to the ball part of the joint (femoral head) is cut off due to various reasons and this leads to weakening of the bone and eventually, arthritis. Steroid use, warranted or unwarranted, is the most common cause in India.
  3. Rheumatoid arthritis is a disease in which the synovial membrane becomes inflamed, produces too much synovial fluid, and damages the articular cartilage. This leads to pain and stiffness.
  4. Traumatic arthritis can follow a serious hip injury or fracture. A hip fracture can also cause avascular necrosis described above.
Is Hip Replacement Surgery for You?
The decision whether to have hip replacement surgery should be a cooperative one between you, your family, and your orthopaedic surgeon. While most patients who undergo hip replacement surgery are of 60 to 80 years of age, orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability, and general health status, not solely on age. You may benefit from hip replacement surgery if:
  1. Hip pain limits your everyday activities such as walking, bending.
  2. Hip pain continues while resting, either day or night
  3. Stiffness in a hip limits your ability to move or lift your leg.
  4. You have limited pain relief from anti-inflammatory drugs.
  5. You have harmful or unpleasant side-effects from your pain relieving medications.
  6. Other treatments such as physiotherapy don't relieve hip pain.

Preparation for Surgery
  1. Medical evaluation: If you decide to have hip replacement surgery, you may be asked to have a complete medical assessment before your surgery. This is needed to assess your health and find conditions that could interfere with your surgery or recovery. This will also correct any abnormalities such as high blood pressure and can detect conditions previously undiagnosed like diabetes.
  2. Tests: Several tests, such as blood samples, cardiogram, chest X-rays, urine and stool sample may be needed for assessment.
  3. Weight loss: If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip.
  4. ental evaluation: Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Since bacteria can enter the bloodstream during dental procedures, treatment of significant dental diseases (including tooth extractions and periodontal work) should be considered before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.
  5. Urinary evaluation: A urological evaluation before surgery should be considered by individuals with a history of recent or frequent urinary infections. Older men with prostate disease should consider a urologic evaluation and treatment before having hip replacement surgery.
  6. Social planning: Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry. If you live alone, your surgeon's office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home.
Dr. Hemant Wakankar is Consultant – Orthopaedician at Jehangir Hospitals, Pune

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