Aging Begins at 30

"Almost" New Hips For Old

The hip is a ball and socket joint. The socket is the acetabulum, literally the "vinegar pot" from its shape. The ball is the head of the thigh bone. The artificial socket is made of high density plastic and the new ball with its stem is made of strong, stainless metal. Most of these new hips are fixed with bone cement. New techniques have led to making replacements without cement, relying on bone growing into the holes made in the implant. It has been used in younger patients who will give the implant more wear and tear and who need it longer. Long-term results of replacement without cement are still pending.

Hip replacement was started in the mid 1980's and both the techniques and the replacements are continually improving. Approximately 140,000 operations are done each year at a cost of $2.5 billion. These operations are done on sixty out of every hundred thousand people, more women than men, but the men are usually younger. That is, sixty-five for men compared to sixty-nine for women.

One of my patients has been seeing me over many years with mild diabetes. His hand joints began to bother him and then his hip joints. This was an annoyance because he liked to walk several miles each day. Recently he had his left hip joint replaced. He is very happy with it and is ready to have the other one done.

A former surgical colleague of mine has had both his hips replaced by the age of sixty, but he had many minor injuries from ice hockey. He too is happy with the result.

Now Bo Jackson, the famous football and basketball player, needs a replacement at thirty and hopes to play competitive athletics afterward. Most surgeons frown on activities such as running, tennis, and heavy lifting after hip replacement. One surgeon thinks that he'd be surprised if Bo's implant is still serviceable after two years.

People with painful arthritis in hip joints may be candidates for hip replacement and for some elderly patients it maintains independence that would otherwise be lost. The new joint is never quite as good as the one you were born with. The patient has to have severe daily pain and stiffness that interferes with activities of daily living and does not respond to aspirin or other anti-arthritis drugs. The damage must be confirmed by x-ray. One important preferred criterion is that the patient should weigh less than 185 lbs because wear and tear depends on the weight transmitted through the joint. Another question is, "Is the patient otherwise healthy?" This operation is always a matter of choice and never an emergency.

After surgery, there is pain relief for at least five years in over 90% of patients. Joint replacement is not usually intended for sports or heavy labor. In 80% of patients the joint feels almost normal and in 90% there is improved movement. There can be complications, as there are with all operations, at the time of replacement or later. Clots can form in the legs, sometimes breaking off and going to the lung. Urinary tract infection, nausea and vomiting can occur and occasionally wound infection at the site of the operation. Rarely the leg is shorter or stiff. Even less often there is joint infection or a blood clot in the joint. A very few patients may require re-operation, but the second operation is never as good as the first one. In some patients the joint loosens. This happens more often with overactivity or additional weight strain. Failures requiring re-operation occur at a rate of 1% per year.

Immediately after the operation, within usually the first 6 to 8 weeks, the patient has to be cautious to avoid dislocation of the joint. Very important exercises are given to strengthen the muscles that will support the patient. There will be a need for help at home for at least two months, because the patient must avoid excess bending, sitting for longer than thirty minutes at a time, or crossing the legs. A walker or crutches are necessary for the first eight weeks, but walking can be increased as tolerated, if it is free of pain. For legal, as well as medical reasons, the patient should not drive a car for about six weeks. If at any time the patient develops a bacterial infection, such as a boil, anywhere in the body, antibiotics are needed promptly to prevent spread of infection to the joint.

Remember that many people can be returned to the active working or volunteer population and they continue to pay taxes instead of becoming disabled and in need of more and more services. Best of all the quality of lives improves dramatically. This operation requires special skill. Remember to "Choose your surgeon, not your implant."

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See related Patient Topics Bones, Joints and Muscles, Hip Injuries and Disorders or Injuries and Wounds.

See related Provider Topics Bones, Joints and Muscles or Injuries and Wounds.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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