Arthritis, a disease marked by joint inflammation, pain, and stiffness, doesn't currently have a cure. There are, however, several effective treatments for the many different subtypes of arthritis that exist. Medication and physical therapy are the obvious choices, but in extreme circumstances, your doctor may recommend that you undergo surgery.
There are several different types of surgeries that can help alleviate arthritis-related pain of the hip. The most common surgery is called a total hip replacement. Patients experience several benefits after undergoing a total hip replacement — including reduced joint pain and increased range of motion of the hip.
Who may be a candidate for a total hip replacement?
- Patients who are candidates for undergoing a total hip replacement tend to have moderate to severe arthritis of the hip.
- Patients with osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis are the best candidates. In fact, approximately 90 percent of patients who do get a hip replacement tend to have osteoarthritis of the hip.
- Patients who experience moderate to severe pain, even when resting, may be eligible for a hip replacement. The same goes for those suffer pain to the point that it interferes with their daily living. Examples of interference with daily living include not being able to go upstairs, not being able to bend down, and not being able to get out of chairs. Pain that affects your sleep is another factor that is considered.
- Patients may need a hip replacement if their joint stiffness severely affects their range of motion. These patients may also have a limp due to joint stiffness of the hip.
- Patients whose pain does not respond to non-surgical therapy such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, steroid injections, or the use of a cane or walker may, again, need a hip replacement.
Contraindications: Who cannot have a total hip replacement?
- Patients who are at a greater risk for suffering from surgical or post-surgical complications.
- Patients that have an existing infection or patients that are prone to getting infections. This is a serious contraindication. Infections increase the risk of a patient being readmitted to the hospital and require prolonged courses of intravenous antibiotics. In some cases, it requires removal of the artificial hip.
- Patients who are regular users of nicotine and tobacco. This is because people who consume tobacco have a higher than normal rate of medical complications as well as a higher risk for follow-up surgeries or revision surgery for hip replacement. Hence, in order to reduce the risk of complications, candidates for the surgery who are smokers are encouraged to quit or cut back.
- Patients who have osteoporosis, which is a disease in which bones are too brittle and prone to fracturing. Patients with osteoporosis tend to have bones that are too weak to properly support and adhere to the new joint prostheses. While mild or moderate osteoporosis is not a contraindication, several osteoporosis is. For patients who do have mild or moderate osteoporosis, the surgeon will likely change the way that they conduct the surgery in order to ensure the best results possible. For example, a surgeon will use bone cement over a cement-less adhesion in order to optimize the attachment of a new prostheses to the existing bone. Patients will also be encouraged to improve bone density by treating their osteoporosis.
- Patients who are unable to properly adhere or follow instructions that are required pre- and post-surgery. As an example, people with dementia are prone to falls, which is extremely dangerous for the joints immediately post-surgery. Therefore, dementia patients would not be a candidate for a successful total hip replacement. Similarly, patients that are alcoholic are also prone to falls. Hence, they might also not be candidate for a total hip replacement.
- Patients who have chronic diseases that cause severe muscle weakness, such as Parkinson’s disease. Chronic diseases are associated with a higher risk of recurrent dislocation of the prosthetic hip joint.
- People that have medical conditions that increase post-surgical complications. These medical conditions include Type II diabetes or heart disease.
- People that are obese are prone to medical complications during surgery as well as post-surgery. Obese patients can also experience wound healing complications. Furthermore, being obese or overweight can decrease how long the implant will stay viable in the patient. Therefore, while there is no upper weight limit when it comes to undergoing total hip replacement, people that are overweight or obese are encouraged to lose weight.
Whether or not you are a good candidate for the surgery, the important thing to remember is that there are several surgical techniques, one of which will be better suited to you. Importantly, there are also several non-surgical ways of controlling your arthritis. If you choose to get surgery, make sure to discuss the different surgical methods, including the pros and cons of each one, with your surgeon.