PATIENT EDUCATION TOTAL HIP REPLACEMENT

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1 PATIENT EDUCATION TOTAL HIP REPLACEMENT WHY ORTHO DEVELOPMENT? Ortho Development is passionate about making the best, clinically proven, high-performance orthopedic devices in the world. All of our implants are designed and manufactured with pride in the United States using the most advanced materials and technologies available, and with a strong commitment to quality. Ortho Development products are being used by hundreds of surgeons throughout the United States and Japan - at world-renowned orthopedic hospitals and teaching universities, as well as in a widespread number of regional and community hospitals. The employees of Ortho Development strive for excellence and work with integrity, respect, accountability and attention to results. We collaborate with skilled orthopedic surgeons to develop products that can help restore mobility, enable faster recovery and produce the best clinical outcomes. In short, we are passionate about improving lives and are committed to providing the best customer experience in orthopedics. We think you will notice the Ortho Development difference.

2 HIP JOINT ANATOMY AND FUNCTION The hip is a ball-and-socket joint and is one of the largest joints in the body. The hip joint is designed to support the weight of the body while withstanding repeated motion. Aside from the hip joint allowing a variety of leg movements, this joint also plays an integral role in retaining balance and providing a solid base to reinforce the body s center of gravity. This ball-and-socket joint consists of two main parts: the acetabulum (the hip socket in the pelvic bone) and the femoral head located on the top of the femur (thighbone). The articulation between the acetabulum and the head of the femur is what enables the hip joint to move in a fluid motion. This joint is connected by tough, fibrous tissue called ligaments. These ligaments work with the muscles, bones, and tendons to allow movement of the hip. The inside of the acetabulum and the femoral head are covered with articular cartilage, a flexible tissue, that cushions the bones helping to prevent friction as the hip bone moves smoothly in its socket. Finally, the remaining surfaces within the hip joint are surrounded by a thin tissue called synovial membrane. The synovial membrane produces a small amount of synovial fluid that provides lubrication to the cartilage and helps eliminate friction during movement. ILLIUM (PELVIS) ACETABULUM (HIP SOCKET) FEMORAL HEAD ARTICULAR CARTILAGE FEMUR (THIGHBONE)

3 CAUSES OF PAIN Despite the durability of the hip joint, there are several factors that can cause chronic hip pain and disability. The cartilage, muscles, tendons, or bones in the hip joint can experience wear or damage from an array of factors including injuries and disease. INJURY An injury to the hip can take place from playing sports, trauma, overuse of the joint, or from falling. The most common injuries of the hip include: STRAIN: As a result of repeated daily activities, strain can be placed on the muscles, tendons, and ligaments that support the hip joint. This strain causes inflammation in the hip joint and results in pain. Symptoms of a strain include muscle spasms, swelling, and pain during movement. BURSITIS: A bursa is a small, fluid filled sac that cushions and lubricates the muscles and tendons in the hip joint. When a bursa becomes inflamed, usually from the overuse of a joint or as a result from an injury, it causes pain in the hip and on the outside of the thigh. Symptoms of bursitis include swelling and joint pain. DISLOCATION: A dislocation occurs in the hip joint when the femoral head of the thighbone (femur) slips out of place from the hip socket (acetabulum). This type of injury typically takes place as a result from an automobile accident or a severe fall. When dislocation takes place in the hip the ligaments within the joint are often damaged. Symptoms of a dislocation include an inability to move the leg and severe pain. FRACTURE: A fracture is a break in a bone that is a result of falls, sports injuries, automobile accidents, or low bone density. A hip fracture can occur at any age but hip fractures are most common in people age 65 and older (1). Women with osteoporosis, a disease that weakens bones, are more susceptible to hip fracture. DISEASE One of the most common causes of hip pain is arthritis. Arthritis leads to inflammation of the hip joint and causes the cartilage to wear down. As the cartilage of the hip joint slowly wears away, the bones become exposed and rub against each other resulting in pain, swelling, decreased mobility, and stiffness. There are over 100 different types of arthritis that exist but the most common types that affect the hip joint include: OSTEOARTHRITIS: Osteoarthritis is known as wear-and-tear arthritis and typically occurs in people who are 50 years of age or older. Common risk factors for osteoarthritis include age, previous injuries, overuse of the joint, obesity, or genetics. Currently, there are about 27 million people in America that suffer from osteoarthritis

4 (2). Symptoms of osteoarthritis develop gradually over time and include joint pain and stiffness. RHEUMATOID ARTHRITIS: This form of arthritis is an autoimmune disease where the body s immune system mistakenly attacks the joints in the body. The abnormal immune response causes inflammation that can in turn cause damage to the body s joints and organs. Some of the key symptoms of rheumatoid arthritis (RA) include fatigue, pain, and swollen joints. About 1.5 million people in the United States suffer from RA with nearly three times as many women having the disease as men (3). OSTEONECROSIS: After an injury to the hip has occurred, such as a fracture or dislocation, the blood supply to the femoral head may be deprived. The lack of blood supply to the bones is called osteonecrosis or avascular necrosis. When there is a loss of blood to the bone, particularly the bones near a joint, it often causes a collapse in the joint surface. Symptoms of osteonecrosis include joint pain, limited range of motion, and in severe cases loss of joint function (4). UNDERSTANDING HIP PAIN A healthcare provider will perform a physical examination to assess and determine the proper treatment for your hip pain. Typically, a physical examination will focus on the joint s range of motion, ability to walk, pain levels, and joint swelling or tenderness. A radiological examination (X-ray) may be completed to determine if there is a loss of joint space in the affected hip. Blood, and other imaging tests, such as magnetic resonance imaging (MRI) may also be required to complete the pain assessment. TREATMENT Nonsurgical options are often the first-line approach for treatment in the early stages of hip pain. There is a wide range of nonsurgical treatment options available to help alleviate hip pain, increase function and mobility, and reduce symptoms. The choice of treatment should be a mutual decision made between the healthcare provider and the patient. NONSURGICAL OPTIONS Some of the nonsurgical treatment options that may be suggested by the healthcare provider include: REST: Rehabilitation and rest of the hip joint is a common treatment option that can help relieve hip pain. The general care to follow includes rest, ice, compression, and

5 elevation for the affected hip joint. The short-term rest and rehabilitation may help to subside inflammation of the joint. In some cases, cold or heat therapy may also be included as part of the rest and rehabilitation treatment based upon the cause of the hip pain. EXERCISE AND DIET: The stress of the weight-bearing hip joint may be reduced through the management of diet and exercise. Based upon the condition of the affected hip, a therapeutic exercise program may be designed to include strength and flexibility as well as the incorporation of a balanced diet. Exercise may help restore function to the hip joint, increase range of motion, and help strengthen the muscles in the hip and leg. Research has shown that a 5-10% reduction in body weight can dramatically reduce joint pain and also improve exercise tolerance (5). PHYSICAL THERAPY: In conjunction with a therapeutic exercise program, the healthcare provider may recommend visiting a physical therapist. An evaluation is conducted by a physical therapist that includes gathering information about the history of the hip pain, past medical problems, aggravating and relieving factors, and a physical examination. The physical examination may consist of a walking assessment and measurements to determine the joint s range of motion, hip strength, and swelling. A treatment program will be developed based upon the condition of the affected hip and often includes exercises that help strengthen and improve mobility within the joint. The overall goal of physical therapy is to help eliminate hip pain, gain optimal use of the hip joint, and learn skills to avoid future injuries or pain. In addition to exercises, a physical therapist may use other methods to reduce pain including alternating cold and heat therapy, use of ultrasound machines to increase blood flow and to stimulate muscles, or the use of a supportive walking aid such as a cane or brace. (4) (5). MEDICATIONS: A healthcare provider may recommend medications to help make hip pain more manageable. Over-the-counter (OTC) pain medications are typically the first line of treatment while prescription medications are usually reserved for more severe hip pain. Acetaminophen helps to alleviate mild to moderate pain and since acetaminophen does not contain anti-inflammatory ingredients another medication may be needed to reduce swelling. A Non-Steroidal Anti-Inflammatory drug (NSAID) may be recommended to help address swelling or inflammation of the hip joint. NSAIDs are available OTC and include ibuprofen and naproxen sodium products. A healthcare provider may have the patient try several NSAIDs to determine which medication works best to relieve pain. Topical analgesics or pain relievers may also be used to help make hip pain more manageable. Topical medications are available in the form of creams, patches, or lotions. Topical medications can help provide short-term relief to a specific area of the hip joint.

6 INJECTIONS: Corticosteroids are powerful anti-inflammatory agents that are related to cortisone and are used to reduce inflammation. Cortisone can be injected directly into the hip joint. The effects and relief from cortisone injections are short-term and can sometimes provide relief immediately after the injection is completed or within the first two to three days (6). JOINT SUPPLEMENTS: For temporary pain relief patients may consider joint fluid supplements to be injected into the affected hip joint. Some of the types of supplements that can be injected include glucosamine sulfate, chondroitin sulfate, steroid, and hyaluronic acid. Joint supplement injections can help to reduce swelling, provide lubrication to the hip joint, and alleviate hip pain. The results of these injections are temporary and typically only last between six to 12 months (7). SURGICAL OPTIONS Surgery may be recommended after all nonsurgical treatment options fail to provide relief from pain symptoms. Several surgical options include: ARTHROSCOPY: Arthroscopic hip surgery is a procedure that involves the use of fiber optic technology to view inside the hip joint. Arthroscopic surgery repairs or removes damaged structures within the hip joint. Some of the reasons to perform arthroscopy include the removal of bone and cartilage or to repair torn cartilage in the hip joint (8). TOTAL HIP REPLACEMENT: A total hip replacement (or arthroplasty) is one of the most common and successful joint replacement procedures performed. During a total hip replacement the damaged bone and cartilage is removed and replaced with prosthetic components. The prosthetic components are typically made of medical grade metal, ceramic, and plastic. Together the components mimic the functionality of a healthy hip joint. The surgical techniques and components of total hip replacements have evolved over the years to provide long-lasting results and superior functionality. TOTAL HIP REPLACEMENT PROCEDURE The decision to have total hip replacement surgery should be a mutual decision between the patient and the surgeon. The recommendations to move forward with a total hip replacement are based upon a patient s pain and disability. The majority of patients who have a total hip replacement are between the ages of 50 to 80.

7 More than 90% of patients who have total hip replacement surgery experience a significant improvement in the ability to perform normal daily activities and also experience a dramatic decrease in pain (9) (10). EXPECTATIONS The complication rate following a total hip replacement is low, with serious complications such as infection, occurring in fewer than 2% of patients (11). Some of the complications that may occur following surgery include: infection, blood clots, hip stiffness, dislocation and implant complications PREPARATION Prior to a total hip replacement surgery, a complete physical examination may need to be completed to ensure that the patient is healthy enough to have the surgery and complete the recovery and rehabilitation process. Patients who have chronic medical conditions such as heart disease may also be evaluated by a specialist prior to surgery. Other preparation items include: TESTS: Several tests may be needed to plan for surgery such as blood and urine samples and an electrocardiogram (EKG). MEDICATIONS: It is important for the patient to notify the surgeon about current medications as some medications shouldn t be taken prior to surgery. DENTAL PROCEDURES: The incidence of infection is very low after hip replacement surgery but an infection can occur if bacteria enters the bloodstream. Major dental procedures, such as periodontal work, should be completed prior to surgery to reduce the risk of infection. POST-SURGERY ASSISTANCE: To help make the recovery easier the patient should consider who will assist them with normal daily tasks at home whether it is family, friends, or a social worker. If a patient does not have someone available to assist post-surgery then an inpatient rehabilitation center may be an option. Since the typical recovery time is around six weeks, the patient should also consider making modifications to their environment by incorporating adaptive equipment, such as secure handrails along stairways, to make the recovery easier. PROCEDURE The day of the total hip replacement surgery, the patient will be admitted to the hospital and will be evaluated by a member of the anesthesia team. There are different types of anesthesia that can be used during the surgery including general, spinal, epidural, or regional nerve block. The anesthesia team will determine which type of anesthesia is best for the patient.

8 A total hip replacement surgery typically takes 1-2 hours. During the surgery the damaged cartilage and bone will be removed and the implants will be positioned to help restore alignment and function to the hip joint. The affected femoral head is removed and replaced with a metal stem that is placed into the center of the femur (thighbone) and a metal or ceramic ball is then placed on the upper part of the femoral stem. The affected cartilage surface of the hip socket (acetabulum) is replaced with a metal socket or an acetabular component. A spacer is then inserted between the new femoral head and the acetabular component to provide a smooth articulating surface. Once the surgery is complete, the patient may be moved to the recovery room and will remain there for several hours. While in the recovery room the patient s anesthesia is monitored. The patient may stay in the hospital post-surgery to manage pain properly, actively prevent blood clots from occurring, and begin physical therapy. Most patients will begin exercising their hip the day after surgery. POST-OPERATIVE It is important to restore normal hip motion and strength after a total hip replacement. The recovery and rehabilitation process play a crucial role in helping the patient resume an active, pain-free lifestyle. Within the first 24 hours after surgery, a physical therapist will monitor the strength and flexibility in the hip and will also provide instructions and goals for the patient to complete in the hospital and at home. A gradual return to everyday activities along with exercise can help restore normal hip motion post-hip replacement surgery. During the early stages of rehabilitation it may be recommended to exercise two to three times a day for minutes. It is important for the patient to be committed to the recovery and rehabilitation goals as the patient s commitment during this process can greatly improve the chances of longterm success. An example of suggested goals for a post-operative rehabilitation timeline is below: 1-3 WEEKS Normal walking motion with assistive device such as crutches or walker on level surfaces Increase muscle strength of entire hip girdle Completion of daily exercise program focusing on gait, endurance, and mobility Active range of motion should be degrees

9 4-6 WEEKS Safe and independent use of crutches or walker without deviation of normal walking motion Ability to balance for a short time on affected leg Continue daily exercise program focusing on gait, endurance, and mobility Ascend and descend stairs with alternating feet and use of cane or handrail 3 MONTHS Normal walking motion on all surfaces without a limp Ascend and descend stairs with alternate feet and no support Ability to carry out functional movements with good control and without pain No pain or swelling with joint movement 6-12 MONTHS Stay active with exercise and low-impact activities or sports Continue to improve muscular strength and endurance Work toward little or no pain or swelling with joint movement Maintain a healthy weight Complete required follow-up appointments to track progress FREQUENTLY ASKED QUESTIONS HOW DO I KNOW IF I NEED A TOTAL HIP REPLACEMENT? If you have tried nonsurgical treatments and are still experiencing hip pain or if your pain is preventing you from performing daily normal activities then you should discuss a total hip replacement with your healthcare provider. Your healthcare provider can assess your current diagnosis and determine if a total hip replacement is a good option for you and your lifestyle. HOW OLD IS THE AVERAGE PATIENT THAT HAS A TOTAL HIP REPLACEMENT? Most patients who undergo total hip replacement surgery are between the ages of with the average patient being over 65 years old (12). HOW WILL I BENEFIT FROM A TOTAL HIP REPLACEMENT? After surgery and rehabilitation, the benefits of a total hip replacement may include: Reduction in joint pain and stiffness Greater range of motion Increased hip stability

10 HOW LONG WILL MY HIP REPLACEMENT LAST? Around 90-95% of patients who have a total hip replacement can expect to have their hip functioning normally at 10 years and around 85% of patients can expect to still have their hip functioning normally at 20 years. The implant can loosen or experience wear based upon the lifestyle of the patient and the demands on the implanted joint (13). WILL MY HIP REPLACEMENT SET OFF METAL DETECTORS? It is unlikely, but possible, that your hip replacement will set off a metal detector. To take precaution, alert the appropriate security staff that you have a hip replacement. DO I NEED TO TAKE PRECAUTIONS TO PROTECT MY HIP REPLACEMENT? To protect and extend the life of your hip replacement you may want to: Participate in recommended exercise to maintain strength and mobility Avoid falls and injuries Alert all doctors, including dentist, that you have a total knee replacement (do not complete dental work in the first three months after surgery or as recommended by your healthcare provider) Complete routine follow-up examinations with your healthcare provider

11 The information presented here is for educational purposes only. The information does not replace the advice or counsel of a doctor or healthcare professional. Ortho Development assumes no liability related to your decision to pursue joint replacement surgery based upon any information provided here. Ortho Development strives to provide information that is accurate, timely, and complete however, Ortho Development does not make any guarantee in this regard. Always consult your doctor or healthcare professional for medical advice, diagnosis, or decisions. Each patient will experience a different postoperative activity level based upon his or her clinical condition(s). Your doctor will counsel you about how to best maintain your activity level to help prolong the lifetime of the device. The lifetime of a joint replacement device is not infinite and varies based upon each individual. Sources 1) Hip Injury, common and some not-so-common injuries of the hip joint. Arthritis Foundation. Arthritis Foundation, n.d. Web. 28 July ) Osteoarthritis. Arthritis Foundation. Arthritis Foundation, n.d. Web. 28 July ) Rheumatoid Arthritis. Arthritis Foundation. Arthritis Foundation, n.d. Web. 28 July ) Osteonecrosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d. NIH Publication No , January NIAMS. Web. 28 July ) Cluett, Jonathan, M.D. Does Weight Loss Help Symptoms of Arthritis and Joint Pain?. About.com, 30 June Web. 30 July ) Baker, Ray, M., M.D. Hip Joint Infections for Pain Relief. Spine-Health, 23 August Web. 30 July ) Cole, Andrew, M.D. Hip Osteoarthritis Treatment. Arthritis-Health, 9 September Web. 30 July ) Hip Arthroscopy. Medline-Plus, 12 August A.D.A.M, Inc. Web. 30 July ) Cluett, Jonathan, M.D. Considering Hip Replacement Surgery?. About.com, 27 May Web. 30 July ) Total Hip Replacement. AAOS.org, December Web. 30 July ) Total Hip Replacement. AAOS.org, December Web. 30 July ) Crawford, R.W. and Murray, D.W. Total hip replacement: indications for surgery and risk factors for failure. ard.bmj. com. Annals of the Rheumatic Diseases, The Eular Journal,Volume 56, Issue Web. 30 July ) Crawford, R.W. and Murray, D.W. Total hip replacement: indications for surgery and risk factors for failure. ard.bmj. com. Annals of the Rheumatic Diseases, The Eular Journal,Volume 56, Issue Web. 30 July Ortho Development Corporation odev.com S Business Park Drive Draper, Utah /fax Copyright Ortho Development 2014, All Rights Reserved.

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