Conservative Treatment of Arthritis
There are many non-operative treatment options for the pain caused from hip and knee arthritis but it’s important to know none of these modalities will cure the arthritis. Some treatment options include; activity modification, physical therapy, the use of an assistive device (cane or walker) and weight loss. Weight loss is very important because your hips carry up to 10 times your body weight. Losing 30lbs can decrease the forces your hips see by 300lbs. Another mainstay treatment option for hip and knee arthritis is anti-inflammatory medicines like motrin, ibuprofen and naproxen. If these medicines fail there are also prescription anti-inflammatories that can be attempted to treat your pain. Some patients can also get some relief from the use of glucosamine/chondroitin sulfate. The long-term benefits from these drugs have not been established. Another option that can be offered is an intra-articular hip or knee injection with cortisone using imaging for the injection. Physical therapy (PT) is another conservative treatment modality. PT can be used to help strengthen the muscle around the hip or knee, stretch the soft tissues and try to control the pain.
Total Hip Replacement
After a patient has failed conservative treatment modalities the next step in treatment maybe total hip replacement (total hip arthroplasty). Total hip replacement surgery is a very successful procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities. There is no "right age" for a hip replacement but younger patients may wear through their hip replacement faster and need a second surgery during their life.
When a total hip replacement is performed the surgeon removes the femoral head off the top of the femur (thigh bone) and then places the femoral component down the inside of the canal of the bone and then places a ball on the top of this implant. The ball is normally made of metal or ceramic. In addition the surgeon also removes the cartilage from the socket and places a metal shell with a special plastic liner into the socket of the patient. Most hip replacements today are done using uncemented, bone in-growth components but in some instances cemented prosthesis are appropriate. In the cementless technique the components are press fit into the bone initially and later the bone will then normally grow into these implants.
Our total joint surgeons use a multi-modal pain control approach to help patients have a better post-operative experience. Our surgeons use the anterior approach, anterior lateral approach and posterior approach for exposure to the hip joint. The Hana table is used in the anterior approach.
Anterior Hip Replacement
Anterior hip replacement surgery is approached from the front of the hip so the hip can be replaced without detaching muscle from the pelvis or femur. This leaves the gluteal muscles that attach to the pelvis and femur undisturbed during surgery, resulting in a much shorter healing process.
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Younger patients with advanced arthritis of the hip may be candidates for hip resurfacing. With hip resurfacing the ball is not cut off but instead reshaped and a metal cap is placed on the superior portion. The socket is also replaced in similar fashion to a total hip replacement. Hip resurfacing is an alternative to total hip replacement and may conserve bone stock for the younger patients who may need more than one replacement on their lifetime. The risk of dislocation may also be lower in hip resurfacing because of the large ball and socket sizes that are utilized. Hip resurfacing has similar risks to total hip replacement but there are also some additional risks that have been raised. These include femoral neck fracture and metal ion risks. Both are theoretically low but may occur.
Total Hip Revision
Over time if you begin to experience increasing discomfort in your hip, pain, multiple dislocations or other problems, you may need to have your total hip replacement evaluated. Hip replacements may last 10 to 30 years with no problems but some can fail earlier. There are many ways that your hip can fail including; infection, loosening, polyethylene wear, dislocations (instability), fracture around the implants, implant failure or other.
If one of these problems occurs you may need a revision or redo surgery to correct the problem. To evaluate your problem we may need to obtain new X-rays, blood work or other imaging to identify the problem. Revision total hip replacements are much different from the first surgery because they can be very complex problems. These surgeries can take a lot longer and do have increased risks associated with them.
Partial Knee Replacement
Your knee arthritis may be limited to one part of your knee and a partial knee replacement may be recommended. Instead of your entire knee joint being replaced by artificial components, only one compartment may be replaced, such as the medical compartment (inside part of the knee joint), the lateral compartment (the outside part of the knee joint), or the patellofemoral compartment (the front of the knee joint).
Total Knee Replacement
For severe arthritis in the knee, you may require total knee replacement surgery, where the entire knee joint is replaced with artificial components. Typically, your surgeon will remove sections of your damaged knee joint, or the ends of your femur (thighbone) and tibia (shin bone). The new femoral and tibial components are placed with a spacer in between to allow for joint motion.
Total Knee Revision
Knee joint revision surgeries may be necessary for younger individuals who demand a lot from their knees or for patients with older knee implants that may have worn down significantly over time through mechanics or by friction. If the implant used in your knee replacement loosens, wears, or becomes infected, the affected knee joint may become swollen and painful. When this occurs, a total knee revision procedure may be recommended to remove the old implant and replace it with new components.
Complications of Joint Replacement
Despite being a very successful surgery, there are still surgical risks that can occur either during the surgery or post-operatively. These risks include but are not limited to infection, blood loss needing a transfusion, nerve injury, blood vessel injury, muscle damage, heterotopic ossification, fractures of the bone, stiffness, dislocation, leg length discrepancy, bone loss, anesthesia complications, urinary tract complications, blood clots, pulmonary embolism, loosening of the components, implant wearing out, failure of components, and need for revision for multiple reasons.
Blood clots or deep vein thrombosis (DVT) can occur after any surgery. Blood clots can travel to your lungs and cause a pulmonary embolism. Although this is extremely rare, it can occur and could cause serious medical problems. Infection can also be a very serious complication that may need lead to an extensive revision. Risks of infection increase with obesity, diabetes, kidney failure, liver failure and others.
Dislocation in hips is the most common complication after total hip replacement occurring in 0.5-1.0%. Although it’s rare it usually occurs after the patient places their hip in a position they should not. The risks of dislocations do increase after a revision surgery.