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Take Action:Health - Wellness - Exercise - Reflections:What to Expect from Total Hip Replacement Surgery
By Dorothy Foltz-Gray, August 13, 2011
Your doctor says you need total hip replacement surgery -- and your painful hip says it too. Worried as you may be, there's little down side to this common operation: Hip replacements are faster and safer than ever with new materials and surgical procedures. Find out about the recent innovations and what to expect as you recover...
When a hip joint is damaged by arthritis, the pain can be unbearable. That's the time to talk to an orthopedic surgeon about hip replacement, says Geoffrey Westrich, M.D., director of joint-replacement research at the Hospital for Special Surgery in New York City.
"Once people have hip pain that affects their daily lives -- climbing stairs, getting up from a chair, difficulty walking – it's time for a consultation," he says.
Close to 200,000 Americans choose this joint pain treatment every year, according to the American Academy of Orthopaedic Surgeons.
The success rate is high: Only about 2% of patients have surgical complications such as joint infection.
"Hip replacement surgery is one of the safest surgeries we perform," Westrich says.
And now it's getting even safer. Incisions are smaller, recovery time faster, and there are more surgical options to choose from.
The newer operations, called minimally invasive surgeries, no longer require incisions of 6-9 inches, which were necessary in the past, Westrich says.
"Now we make relatively small incisions of about 3 inches," Westrich says. "And we've designed [smaller] instruments to use during surgeries."
These techniques cut through less muscle and soft tissue, so recovery time is faster.Not only is the surgery less invasive, but pain-management methods also are safer. More surgeons use spinal anesthesia, which numbs from the waist down, instead of general anesthesia.
"Regional anesthetics lower blood pressure, so there's less bleeding," says Bradley Gerber, M.D., chief of total joint replacement surgery at South Nassau Communities Hospital in Long Island, N.Y., who does 300-400 joint replacement surgeries a year.
"They also reduce the risk of infection or a blood clot in the leg."
Another less-invasive joint pain treatment is hip resurfacing, which has fewer post-operative limits, Gerber says.
"We don't cut away bone," he says. "Instead, we reshape the head of the femur and place a cap on it." That fits into a socket, similar to those used with other hip-replacement surgeries.
"Good hip-resurfacing candidates are under 50, have good bone quality and participate in athletic activities," Gerber says.
If someone waits and has more pain and disability before surgery, there's a greater risk for problems later, he adds.
Types of Hip Replacements:
In traditional approaches to total hip replacement surgery, a surgeon cuts away damaged bone and cartilage, then places a metal stem with a ball on top into the center of the femur (leg bone). A metal socket fits into the hip bone you were born with, allowing the ball to move. The socket's liner can be made out of plastic, metal or ceramic.
"We typically use metal or ceramic in younger, more active patients – in their 50s and 60s – because those materials are less likely to wear out than plastic," Gerber says.
Metal replacements also may have a porous covering, so that bone can grow into the new hip, naturally holding the parts in place after six weeks.
Cement, which doesn't last as long, is often used for older patients in their 70s and 80s, Gerber says. Cement is less expensive but doesn't work as well in obese patients.
Rehab and Recovery:
Most hip replacement patients are hospitalized for about three days, says Lisa Konstantellis, section manager of the Joint Mobility Center at the Hospital for Special Surgery. A day after surgery, a physical therapist reviews precautions for the next six weeks.
Plan on using a crutch or cane for the first 4-6 weeks, says Charles Kim, M.D., a rehabilitation specialist and clinical instructor at NYU Langone Medical Center in New York City.You may also have to give up work for one month to six months or more, depending on job activity. Most people with desk jobs can return to work in a month or so.
"You're not allowed to bend your hip more than 90°," Konstantellis says. "That means if you're sitting in a chair, your knee should be lower than your hip. "
And forget driving, which is one of the worst hip positions, Kim adds. "You should plan to have someone drive you around for several months."
The therapist will also ask you to avoid crossing your legs until the replacement sets solidly in place. Crossing legs "could dislocate the new hip," Konstantellis warns.
From day 1, you'll be doing a lot of exercises. For example, the therapist will ask you to push the back of your knee into the bed mattress, tightening your thigh muscles.
"We ask patients to do 10 repetitions of each exercise every hour they're awake," Konstantellis says.
Some patients may work with a physical therapist at home. You'll learn how to use a shower bench and raised toilet seat to make bodily functions easier and safer. A therapist will also teach you how to get in and out of bed, stand and walk.
"A lot of these people have been limping for a long time because the hip is in pain from arthritis, so we have to teach them how to stand straight and not favor that leg anymore," Konstantellis says.
At about six weeks, most patients return to the surgeon for X-rays to see how they're healing. The doctor may prescribe outpatient physical therapy for 6-8 weeks, 2-3 times a week.
"The therapist will focus on whatever's difficult for the patient, working on stretching, strengthening and balance," Konstantellis says. "The patient will also have a home exercise program to do 3-4 times a week."
Kim suggests sleeping with a foam wedge (or adduction pillow) between your legs for three months to stabilize the hip. It's available online or at surgical supply stores.
"Three months is typical for good recovery. But most full recovery takes a year," Kim says.
Managing Pain:
Your arthritis pain will likely be gone right after total hip replacement surgery, says Kim. But you may have surgical pain for two to four weeks. How bad it will be is tough to estimate.
"One person's pain can be a `2,' while another patient is an `8,'" Kim says.
Some patients can get by with over-the-counter acetaminophen (Tylenol). The Food and Drug Administration (FDA) regards 2,000 milligrams -3,000 milligrams (mg) per day as safe – but to avoid the risk of overdose, Kim recommends only 1,000-1,300 mg per day.
"For those who are elderly or have liver problems, I'd only recommend 1,000 mg a day," he says.
"But most people need something stronger, like Vicodin [acetaminophen and hydrocodone], for about a month afterward," Kim adds.
How fast you heal depends on your health.
"If you don't have other conditions, like diabetes, recovery is usually quicker," Kim says. "And as you build new muscle and the replacement area firms up, you can do more."
If you haven't moved your hips for years before surgery, you may never return to a full range of motion, warns Westrich.
"It's not just the hip but the muscles around it that are affected," he says. If they haven't been used, they atrophy.
New Hip, New Life:
Hip replacement is hardly fun. But the results can be.
"Most people can't believe the pain is gone," Konstantellis says. "They can start doing things that they haven't been able to do for years. Most people see progress every week after surgery."
Most hip replacement patients can't return to high-impact sports like running, but they can play golf and do yoga.
"And s-x is fine," Konstantellis says. "Just not within the first six weeks."
- Update: DADT has been repealed. President Obama has kept his promise!
- Boycott Bill O'Reilly and FOX News and their advertisers. Bill discussed a French commercial by McDonalds that was meant to show that McDonalds is Gay Friendly. Bill said what is next? Is McDonalds going to be Al-Qaida friendly as well? Imagine - Bill O'Reilly compares Gays to Al-Qaida! In conclusion, O'Reilly expressed out-right Hatrad of the LGBT Community.
- Boycott Arizona the home of "hater" - U.S. Senator John McCain. Arizona's Hateful anti-Immigration Law - encourages racial profiling and increases hatred towards minorities. A remedy: Demand Republicans to support Immigration Reform (The Dream Act). Further, Senator McCain voted against ending DADT and Blocked Immigration reform!
- Boycott Target, Best Buy, Gold's Gym - for donating money towards anti-gay political candidates/organizations. Update: (12/26/2010): Target is continuing to donate to anti-gay groups/causes/politicians. Update 03/08/11 - Lady Gaga Ends Target Partnership, Reportedly Over Target's Poor LGBT Stance. Update 3/25/2010 - Target displays their hypocrisy and Sues California Gay Rights Group for Lobbying Outside Stores. Target is attempting to block the LGBT right of free speech! STOP SHOPPING AT TARGET!!!!!!!!!!!!!!!!! Update 4/8/2011: Target lost its case to stop the LGBT from canvassing in front of their stores. A huge PR Disaster for TARGET! Perhaps Target should go out of business as they betrayed their investers and customers. Target contributed massive funds to a politician who would like to exterminate gays. Now, Target can not stop us from Boycotting them, nor picketing, nor talking to customers near their stores; although, Target allows a anti-gay company such as the Salvation Army to stand outside their door and speak with customers and raise money. Isn't this a double standard? Perhaps TARGET would better understand the issue if they cared about David Kato - Uganda, who was slain because he is gay! That is because Uganda wants to kill gay people. Again, TARGET invested in a political candidate that would Kill the Gays!
- End DOMA (Defense of Marriage Act). Prevents Federal employees and Gays in the Military from gaining equal benefits. Prevents Gay Partners from gaining equal benefits.
- Pass ENDA (Employee Non-Discrimination Act). ENDA would prevent employment discrimination of LGBT workforce.
- Boycott Salvation Army as they will not hire Gays! "DO NOT DONATE TO THEM."
- BOYCOTT "Chick-fil-a" for donating to anti-gay marriage groups.
- BOYCOTT KOCH INDUSTRIES PRODUCTS- to include their products: Angel Soft toilet paper / Brawny paper towels / Dixie plates, bowls, napkins & cups / Mardi Gras napkins and towels / Quilted Northern toilet paper / Soft 'n Gentle toilet paper / Sparkle napkins / Vanity fair napkins / Zee napkins / Georgia-Pacific paper products & envelopes / All Georgia-Pacific lumber & building products (INVISTA Products) / Lycra / Stainmaster Carpet. The billionaire - Koch brothers are ultra republican - tea bag founders/supporters that do not support causes of the LGBT community.
- Boycott WALMART - The National Gay and Lesbian Task Force, force criticized Wal-Mart for denying employee benefits to same-s-x partners and for failing to prohibit discrimination based on gender identity. By comparison, the group said two other chain stores with a strong presence in New York, Costco and Walgreens, did much better.
- NEW: "Tune Out Trump", Boycott all Trump Hotel, casinos, holdings, The Apprentice and NBC Network! At CPAC, Trump said he is considering a run for president as a Republican. In a interview with the Des Moines Register, Trump added that he opposes all forms of legal recognition for gay couples, not just marriage. "They should not be able to marry," he said. So why does NBC keep the Apprentice when Donald Trump has stated he may run for president? After making racist remarks about Obama and recv'g public backlash, Trump decided not to run for president after NBC renewed his awful TV Show. How can NBC renew the clown's show after he pulled all such low-class shenanigans? Boycott NBC! Boycott advertisers of The Apprentice and Trump's other business's. Don't shop at any bullding with Donald Trump's name to include Trump Hotels, Casinos, Condo's, Offices, Shops! The Donald has expressed extreme Hatred towards gays and blacks with his birther remarks and anti-gay rhetoric. Remember how poorly Trump treated Rosie O'Donnel? Now we know why he did that! It was hate against a lesbian as we now know he is biget. Unforgiveable! Dump NBC because they re-newed Donald Trump's "The Apprentice"! NBC, Really? Update June 1, 2011: Trump now claims that Obama's long form, original birth certificate is fake. And NBC keeps this hater? NBC, You Kidding Us?
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This group is called "Peckers Pics." The English - slang definition of "pecker" is to pluck at the truth. Therefore, we peck at items such as Gay Men's Health, Male Fitness, Gay (LGBT) Politics & Issues. In this section you may peck at each photo in order to decide the winner of the "war of the fittest!" Whereas, who is the model that may inspire you to exercise and "get fit?" Warning: This may stoke you!
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