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Archive for the ‘Surgery’ Category

There is nothing particularly new about hip replacements. They have been going on for nearly half a century now. Should you be in the position of needing to consider one then you may find this article of significant help and interest.

We will discuss here what the reasons are behind having a hip replacement, what to expect at the time of the operation and how to get yourself right as fast as possible after the operation.

Sir John Charnley an eminent English surgeon is considered to be the pioneer of hip replacement surgery. His early work developing the basis of the artificial hips used today was being done in the 1960s.

Over the past decades advances in surgical techniques and materials have seen a diversification in types of hip replacement. There are however two basic types, namely cemented and uncemented. Thie importance of this will be covered further on.

So When Should You consider Having a Hip Replacement?

It really is all to do with whether a hip replacement would improve the quality of your life. You may well need to discuss matters with your physician or surgeon in order to ascertain whether having a hip replacement wil help you.

Why Do People Need Hip Replacements?

The most common reason behind needing a hip replacement is arthritis of the hip, primarily osteo-arthritis. Over time the joint wears and is less able to perform its role.

Signs and Symptoms of Hip Degeneration

Sufferers of hip degeneration often walk with a noticeable limp, commonly leaning to the painful side as they take weight on the hip in question. Movements at the joint, particularly backwards (extension), sideways (abduction) and the rotary movements become painful and limited. Pain is often described as a deep ache which can be felt in the buttock, hip, thigh and knee.

Surgery

There are many variations in the actual surgery and different surgeons prefer different techniques. The basis of the surgery is the removal of the degenerate head of the femur and the to replace it with the prosthetic implant together with a new socket or acetabulum in the pelvis. This creates a totally new articular structure commonly called A TOTAL HIP REPLACEMENT or THR.

What To Expect After Surgery

After your operation it is likely that you will have drains to remove any bleeding from the hip. You are also likely be on some form of analgesia and possibly blood thinning medication.

You will likely be encouraged by your physical therapist to do soime simple bed exercises to maintain good circulation and aid your recovery very soon after your operation.Within the first two days of surgery you will normally be helped by your therapist to get out of bed and walk.Initially this is likely to be small distances but this will increase gradually over time. You will probably require crutches or even a frame initially but as you get more confident over the coming days and weeks you will be able to discard these on the advise of your therapist.

If you have an uncemented hip you will be advised to probably use your crutches to reduce the amount of weight your hip has to take for the first six weeks. A cemented hip however is able to take your full body weight the first time you can get up so it will be up to you and your therapist how long you continue with walking aids for.

After surgery you will be encouraged to walk regularly and correctly. This has for a long time been considered the very best way of rehabilitating after a hip replacement. Specific exercise regimes are not usually advocated after a hip replacement.

It is important that you avoid certain positions and actions to avoid the possibility of a dislocation of your hip. Crossing your legs or excessive bending at the hip is not advised. Both of these positions especially if they are done together and particularly so with weight on the leg are considered to be the positions most likely to result in a dislocation.

It is also possible that your operated leg will feel as if it is longer than the other one. This is not necessarily the case and this sensation will commonly disappear over the coming months.

Patients are routinely advised to wear anti-embolism stockings for the first six weeks to reduce the possibility of an embolism. Although relatively rare they can be life threatening and feeling breathless or unwell may be a sign that you are suffering form such a condition. If this is the case medical attention should be sought as an emergency.

Other than this over the coming months you can look forward to gradually increasing your walking and functional activities, You can swim as soon as your scar has healed, walk, play golf, dance and be as active as you are able. Aggressive sports of a high intensity and of a contact or jarring nature are not recommended however.

Don’t forget it can be a good few months and even up to two years in cases especially if you have had an uncemented hip before you reach your true potential again. So patience is a must.

My mother just had hip replacement surgery performed and it was not an easy procedure for her to handle. It wasn’t just the cost that was difficult but the slow and painful recovery that followed. She was also laid out for a long time as you can imagine someone who just had hip replacement would be.

My mom had her hip replaced because of a rare condition from which she was suffering. She was experiencing quite a bit of pain for months prior to receiving the news that she would need a hip replacement – weeks before she ever even had it checked out actually. She came down with avascular necrosis, but she didn’t show any of the signs of having the disease which is why I took so long to realize what her problem was.

Avascular necrosis is usually a condition which either scuba divers, alcoholics, the extremely old, or some types of athletes get, and believe me, she didn’t fit in to any of those categories. It is basically caused by a lack of blood flow to areas of the bone. The bone actually starts to die because it is deprived of life giving blood, but because it is happening inside of the bone, it is very, very difficult to diagnose. For her, the necrosis did enough damage to make her need a hip replacement. Her hip was simply all weak and rotted out inside.

Replacement procedures has grown by leaps and bounds in recent generations and that made it a lot easier. Even so, it was months before her mobility of returned, and my mom needed many rather strenuous and difficult sessions with a physical therapist to bring about the progress. She still walks with a slight limp today, but it is a marked improvement from where she was.

Her hip replacement was a success, but it will still burden her without much relief. Because of the pin in her hip, she will always set off metal detectors at airports, so she carries a doctor’s note to inform the security personnel of the situation. In addition, she is not as active as she used to be because of the hip replacement surgery. She has nowhere near the movement that she used to have prior to this condition, and can easily tire doing the smallest of things.

Finally, she has a complaint common to people who have major surgery. She can really feel it when the weather changes. Her hip replacement lets her know. Although this seems like no big deal, she can actually tell when a storm is on the horizon, she can feel sore and uncomfortable all day, and sometimes the pain persists for days on end.

What is Hip Dysplasia?

The hip joint consists of a ‘ball” on the femoral bone, and a “socket” on the hip bone. Canine hip dysplasia simply defined is when a dog’s hips do not develop normally and the ball does not fit snugly into the socket.

What Causes Hip Dysplasia?

While there is no conclusive proof of the cause of hip dysplasia, there are 2 general schools of thought about its cause – 1) genetic or 2) environmental.

These two differing viewpoints often place the dog breeders at odds with the dog owners, causing each to blame the other for the problem.

Genetic: The puppy is born with the problem

Environmental: The puppy is too heavy resulting in excessive growth and/or over or under exercising a puppy during its growth phase resulting in developmental problems.

The most common theory is that hip dysplasia is indeed genetic. Most breeders have their breeding dogs’ hips rated by the Orthopedic Foundation for Animals (OFA) or Pennsylvania Hip Improvement Program (Penn-HIP), or various other international orthopedic groups. We could discuss the merits of both theories, but it doesn’t change the facts. If your dog has hip dysplasia, you need to deal with it.

When Does a Dog Get Hip Dysplasia?

If you subscribe to the theory that it is genetic, they are born with it. Dogs that have severe hip dysplasia often begin to have problems as puppies. Sometimes, the hip dysplasia does not cause pain for the dog, so they do not show signs of it until they develop arthritis in their hip joints. Some dogs that are not as severe can live out their entire lives with few, if any symptoms.

What are the Symptoms of Hip Dysplasia?

There are a number of symptoms of hip dysplasia. Some dog owners only say that their dog didn’t walk right. Others will say they saw no symptoms at all, or just that their dog began to limp. Following is a list of common symptoms, of which your dog may have a couple and not have hip dysplasia.

Bunny Hopping: The dog tends to use both hind legs together, rather than one at a time. This occurs when the dog is running, or going up stairs.

Side Sit: Also called lazy sit, slouch or frog sit. When the dog sits, its legs are not positioned bent and close to the body. They can be loose and off to one side, or one or both legs may be straight out in front.

Sway Walk: Also called a loose walk. When the dog is walking, the back end sways back and forth because the hips are loose.

Unusual Laying Position: Legs are straight out and off to the side when the dog is laying on its stomach or legs are straight out behind the dog. (All dogs lay with their legs behind them on occasion, many dogs with hip dysplasia lay like this all the time.)

Limping: The dog may favor one hind leg or the other, and may alternate legs that it is favoring.

Quiet Puppy: Puppies who are already in pain from hip dysplasia tend to be very good puppies. They do not rough house the way that normal puppies do. They also tend to sleep for a long time after playing or going for a walk. Some owners describe their puppy with hip dysplasia as the best puppy they’ve ever had.

Dog Doesn’t Jump: Not only do they not jump on you, they seem to pull themselves up by their front end onto furniture as opposed to jumping up.

Underdeveloped Hind Quarters and Overdeveloped Chest: This is caused by the failure to use the hind legs normally and jump. The dog also may actually be shifting weight forward.

Diagnosing Hip Dysplasia

The only way to diagnose hip dysplasia is with x-rays. However, I must note here that you should treat the dog and not the x-rays. Some dogs with seemingly mild hip dysplasia are in a lot of pain, while other dogs with apparent severe hip dysplasia do not display symptoms.

What Can Be Done for My Dog?

If you have had x-rays taken of your dog’s hips at your regular vet, you may have been referred to an orthopedic surgeon. The surgeon is going to recommend various surgical options for your dog. I am going to give you a very brief overview of these surgeries. You will need to discuss your dog’s options with the surgeon. They will provide the details of each surgical option. Some people are able to treat their dog with nutritional supplements and avoid surgery. Ultimately, it will be your decision to determine the best treatment for your dog.

Surgical Options:

Juvenile Pubic Symphysiodesis (JPS) – This surgery is performed on puppies under 20 weeks of age, generally when the puppy is neutered or spayed. It shows great promise as a preventive measure, by altering the pelvic growth. This surgery has a short recovery period, but is generally done before a puppy can be diagnosed. However, once you’ve lived with hip dysplasia, it may prove to be worthwhile for a puppy considered at risk for developing hip dysplasia.

Dorsal Acetabular Rim (DAR) – This surgery consists of bone grafts being taken from other areas of the pelvis to build up the rim on the hip socket (cup). The idea is for the femoral head to have a deeper socket to fit into. It’s relatively new, so there is some question as to how a dog will do into old age – there aren’t many older dogs that have had it done.
Triple Pelvic Ostectomy (TPO) – This surgery involves cutting the bone around the hip socket and repositioning the socket for a better fit with the femoral head. The bones are plated back together so they heal in the correct alignment. This surgery is performed on young dogs before they have finished growing.

Total Hip Replacement (THR) – This surgery consists of replacing the hip joint similar to a human hip replacement. A new cup is usually attached to the hip bone, and the femoral head is cut off the leg bone and an implant is inserted into the leg bone. This surgery is done on more mature dogs that have finished growing. Due to the size of the implants, this surgery is done on larger dogs. Previously, all artificial hip components were cemented in place. More recently, cementless hip replacements are being performed.

Femoral Head Ostectomy (FHO) – Also know as femoral head and neck excision. This surgery consists of removing the femoral head of the leg bone to eliminate the pain of hip dysplasia. The dog’s body will then develop scar tissue to create an artificial hip joint. Long considered only appropriate for smaller dogs or as a salvage operation for a failed THR, it has become increasingly popular for larger dogs.

Non-Surgical or Conservative Management Option

Many people choose to have surgery performed on their dog only as a last resort. Some are able to manage their dog’s hip dysplasia with supplements, acupuncture, chiropractic care, exercise and weight management. Sometimes, the puppy will show signs of pain from hip dysplasia, and once it is done growing and the muscles are fully developed, they seem to “go into remission”, developing signs of hip problems again as the dog ages. Surgical options are still available to you if the conservative path is unsuccessful.

For additional information on hip dysplasia, please visit MyPoorDog.com.

Hip replacement surgery is no fun, especially the fifth time around. Let me explain. At first my husband had his right hip replaced. After surgery, he went to rehab for a couple of weeks and when he came home he was fairly self-sufficient. A year later he had the left hip replaced. Having been through surgery just a year prior he knew what to do to speed up his recovery. We were happy to have the surgeries behind us and glad we did them. My husband could walk without the terrible pain in his hips. We of course thought this was the end of hip surgeries.

Approximately 8 years later my husband called me from work because he had terrible chills and wanted me to bring him a sweater. By the time I got to him he was not making much sense so I took him directly to the emergency room of our local hospital. After several hours it was determined he had a serious staph infection ( not MRSA fortunately) in his left hip. The doctors still don’t know what caused it. He needed to have the left prostheses removed and be on antibiotics for 6 weeks. This surgery left him without a hip joint and he was unable to move his left leg. Also, being 8 years older than when he had his first surgery, he was not quite as strong as he was back then. He could not get around as well by himself as the first time around. We needed additional gadgets to help with every day tasks.

Getting in and out of the car was an ordeal because he had to twist and bend to get onto the seat. At first we put a plastic bag on the seat to make it more slippery but it kept crumbling up and falling on the floor. I finally discovered a seat that swivels and a handy bar gadget to put in the car door frame to hold on to as an aid in getting into the car (both inexpensive). Getting in and out of the car became easier and less painful.

After three months we scheduled surgery to get a new hip joint. Unfortunately the infection came back, and he had to have surgery again to wash out the infection and wait four more months for surgery without a hip joint.

Finally he had surgery, but had to wear a brace for 3 months which again limited his mobility. During that time I embarked on a search for inexpensive products to help improve his mobility and give me a break. I also found some entertaining things to do to maintain our sanity during nine months of constant togetherness. Today, he is walking with the use of a walker and the brace will be removed next month. Meanwhile, the arthritis in my hands is causing me some issues, so I think I need to find some nifty little gadgets to help me out!

If you have found yourself in a situation whereby you need a little bit of help with mobility challenges, please visit my website where you will find unique, inexpensive gadgets to help get in and out of the car, help in the bedroom and bathroom and some fun things to do.

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It’s important for people of all ages, especially seniors, to stay active. According to the Centers for Disease Control, being physically active can reduce your risk of dying from heart disease and decreases the risk of colon cancer, diabetes and high blood pressure. Physical activity also helps control weight:; contributes to healthy bones, muscles and joints; relieves the pain of arthritis; reduces symptoms of anxiety and depression; and can decrease the need for hospitalizations, physician visits and medications. Indeed, there’s a lot riding on incorporating exercise into your lifestyle.

There’s no better time than now to start exercising. Be sure to check with your doctor before increasing your physical activity especially if you have a chronic disease or family history of chronic disease, chest pain, shortness of breath, high blood pressure, asthma, diabetes, blood clots, infections or fever, joint swelling, hip surgery or a hernia.

Here are some tips to help you get started!

Don’t just jump into a fitness routine. First, stretch your arms, legs and back. Start off slowly, gradually increasing the pace of your exercise. Don’t do too much too soon or you will hurt yourself. For example, start with 10 minutes of walking before going to 20 and then 30 minutes. For a strength-training program using weights and machines, talk to a fitness instructor on how much weight to lift and how to use the machines properly.

Exercise should make you feel better, not worse. A little soreness, discomfort or fatigue is normal. Listen to your body, if you feel light headed, a shortness of breath, a sudden, severe headache, are sweating excessively, or have pains in the chest, stomach or anywhere else, you should stop exercising. If symptoms persist, contact your doctor.

If you are on medication or have a condition that alters your heart rate, don’t use your pulse as a judge of how fast your heart is or should be beating.

Wear the proper protective equipment for your activity. If you are biking, wear a helmet. If you are inline skating, wear a helmet as well as knee and elbow pads. Protective gear should be of good quality and fit properly. It may be expensive, but it’s an expense that is well worth it.

Watch out for the elements. If it’s hot, exercise in the early morning or early evening when it’s cooler, or stay in the shade and wear light weight clothing. If it’s cold, dress in layers, and be careful of ice and snow.

It’s especially important to stay hydrated when you are engaging in exercise that makes you sweat. Drink before, during and after exercise to prevent dehydration.

In addition to all the other benefits of exercise , the secret to a sharp mind just might lie in your feet as well! Studies show those who took a 30-minute brisk walk three days a week had sharper memories. This is what scientists refer to as “executive functions”. They are the ability to plan, organize and juggle mental tasks. Similar results exist in non-depressed individuals. Some mental decline is associated with normal aging due to reduced blood flow to the brain . Experts believe exercise may work by improving circulation to essential areas.

In a study of more than 13,000, the risk of breaking a hip was nearly 30-percent lower among those who take a brisk walk two to four times a week than in sedentary individuals. Those who went from being moderately or vigorously active to being sedentary doubled their risk.
Talk a walk!

A cool down is just as important as a warm up. Stretch your arms, legs and back to bring your heart rate back to its normal level.

Every year, nearly 200,000 Americans undergo hip replacement surgery, mostly due to arthritis. The vast majority of those surgeries are done with the traditional method, using a posterior or lateral (side) approach to gain access to the hip joint. With the traditional lateral method, the chance of dislocating your new hip is greater than with the minimally invasive anterior approach.

Hip dislocation after hip replacement surgery rarely occurs, but to reduce the risk even further it’s essential to strictly follow your hip precautions (restrictions of certain hip positions/movements) taught to you by your physical/occupational therapists. Your new hip needs time to heal in place, particularly during the first 6 weeks following surgery. During this period, your hip muscles and bones are healing up around your new hip joint to keep it securely in place.

There are usually three main total hip precautions. 1) Don’t turn your toes inward, 2) don’t cross your legs, 3) and don’t bend your new hip more than 60-90 degrees. Your surgeon will also instruct you on how much weight he wants you to place on your surgery leg while walking.

1) Don’t turn your toes inward. Where your toes go, your hip follows. If you turn your toes in on your surgery leg (pigeon-toed), your hip will internally rotate. This motion can pop your hip out of its new joint. Internal rotation can also occur while standing in place and twisting toward the direction of your new hip. Let’s say your right hip was just replaced. If you reach across your body with your left arm, maybe to answer the telephone or lay an object down on the table, you’re at risk of dislocating your new hip due to internal rotation.

2) Don’t cross your legs. Moving your surgery leg across your body’s midline can cause your new hip to dislocate. This includes sitting in a chair with your ankles crossed or reclining in bed with your legs crossed.

3) Don’t bend your hip beyond a 60-90 degree angle. The best way to know if you’re complying with this precaution is to take a look at your surgery leg when you’re sitting down. Your knee should be lower than your hip. If your knee and hip are level with each other, your hip is at a 90 degree angle. The closer you move your knee to your chest, the greater your risk of dislocating your new hip. And reaching down toward your shoes or the floor also creates this same risk of dislocation. One way to reduce the chance of hip dislocation is to straighten your leg out in front of you when you’re sitting. This reduces the bend of your hip.

While you’re in a standing position, don’t bend down to retrieve something from the floor or a low cupboard. There are devices, called “reachers”, that aid you in picking things up from the floor or getting objects from high cupboard shelves. Your occupational therapist will train you in the proper use of this equipment along with equipment to aid you in putting on your socks, shoes, and pants.

If you have low chairs at home, use pillows to add height. Chairs with arm rests make it easier to sit down and stand up. Don’t sit on a low couch. The top of your bed mattress should be 27″ from the floor. Getting on and off your toilet seat can be difficult and hazardous if it’s too low. While in the hospital, you’ll be using a raised toilet seat. You’ll also need one at home until your hip has healed. Your therapist or case manager will order one for home use before you get discharged from the hospital.

If you dislocate your hip, call 911. You want to get to the hospital as quickly as possible so your surgeon can put your hip back in place. This may require another surgery and rehab. If your surgeon is concerned about another dislocation, he can fit you with a hip brace. Once the hip completely heals, the brace may no longer be needed.

After your hip replacement, your doctor will let you know how much weight you can safely place on your leg while walking. This is known as your “weight bearing status”. It should be strictly followed, as putting too much weight on the leg can damage your new hip. Your doctor will allow you to increase your weight bearing as the hip heals. The following are some common “Weight bearing” terms:

non-weight bearing- no weight at all on the leg toe touch or toe down weight bearing- only your toes touch the floor, usually about 10% of your weight through your surgery leg partial weight bearing- toes and front part of your foot down, about 25-50% of your weight through your surgery leg weight bearing as tolerated- you’re allowed to put as much weight on your surgery leg as your pain level allows, heel down when walking/standing (heel/toe gait pattern) full weight bearing- no weight bearing restrictions, heel down when walking/standing (heel/toe gait pattern)

Your surgeon will discuss your hip precautions with you before and after your surgery. Your physical therapist will teach you how to safely get in/out of bed, transfer, walk, sit, climb stairs, and get in/out of your car while maintaining your hip precautions. Your occupational therapist plays a similarly important role in your rehab. As well as teaching you how to safely dress, the occupational therapist will also train you in bed mobility, walking, and safe toilet and shower/tub transfers. Following your hip precautions in the hospital and at home is an important part of your rehab and will greatly reduce your risk of hip dislocation.

Some of the above information may vary from patient to patient. Your doctor and physical/occupational therapists will instruct you in all total hip replacement precautions.

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