Anatomy of the Hip
As the meeting point between the lower and upper body, the hip is largely responsible for much of the stability involved in daily movement. At this point the thigh bone meets the pelvis and forms what is known as a ball-and-socket joint – where the rounded end of one bone nests into a smooth gap in another.
As a ball-and-socket joint, the hip is made up of two main components:
- Femoral head – the globular end of the top of the thigh bone (femur)
- Acetabulum – the “socket” portion of the hip into which the femoral head nests
These two bones are held together with bands of tissue known as ligaments which stabilize the interactions between the two components and form what is known as a joint capsule. This capsule is filled with a thin, membranous lining known as synovium which helps lubricate the joint and provide smooth interaction between the two bones.
In addition to the synovial lining, fluid filled sacs known as bursae provide a cushion to ease the friction between the tendons, ligaments, bones and muscles which provide the hip motions we are so used to.
Of course, hip movement would not be possible without the muscle groups which surround the ball-and-socket joint. These muscles include:
- Gluteals – the buttocks muscles which are located at the back of the hip
- Adductor muscles – the inner thigh muscles which help to close and extend the gap between the legs
- Iliopsoas muscle – the muscle which begins at the back and forms a tight bond with the upper femur of each leg
- Quadriceps – the primary stabilizing muscles of the hip, four of them run from the hip to the knee to help provide forward movement as well as stability
- Hamstrings – the muscles at the back of the hip which run to just below the knee
With so many components acting together under extreme weight-bearing pressure, the hip is easily one of the most problematic joints in the body. The major nerves and blood vessels which run throughout the hip can easily become damaged and cause painful reactions to those who suffer hip injuries.
Additionally, the daily stress of movement can degenerate cartilage, rupture the synovial lining, or harm the bursae which can lead to major complications overtime. These soft tissues provide necessary cushioning throughout the hip and as they wear away, it becomes much easier to damage the muscle and bone found throughout the hip. As these issues become aggravated, invasive treatments may be necessary.
Stages of Diagnosis for Hip Replacement
Hip replacement is a highly invasive procedure, taking the time to try alternatives and talk with your doctor about your options should always be the first steps you take before jumping to total hip replacement. But, when hip pain is so severe that it interferes with your daily activity, you may start to consider hip replacement as the only worthwhile option.
Hip replacement only really becomes an option after less invasive approaches have been attempted thoroughly. Once medication, physical therapy, and the use of a walking aid no longer provide enough relief from hip pain, surgical intervention will become the next thing doctors recommend.
To get an accurate depiction of the condition of the hip and whether hip replacement would be suitable, typically your doctor will send you to an orthopedic surgeon for a special evaluation.
The surgeon will perform a thorough analysis of the hip by analyzing X-rays, CAT scans, and MRIs after a physical examination. They will ask you to describe your pain, how severe it can become, how thoroughly you’ve attempted other methods and whether you suffer from other pain near the hip. In these cases, it may help the surgeon if you’ve kept a log of your hip pain throughout the past several weeks.
If X-rays have shown changes in shape and size or indicated any unusual structures within the hip, surgeons may proceed with recommending hip replacement. If MRI’s have detected early signs of degenerative illness, this may also indicate it is time for a replacement.
Other signs and symptoms that it may be time to replace your hip include:
- Increase in severity or duration of bouts of pain
- Mobility issues which interfere with your functional goals
- Hip pain or sensitivity due to changes in environment – rain, higher elevations, colder climate
- Hip pain which interferes with sleep cycles
- “Grating” sensation experienced in the bones of the hip during motion
- Previous injury to the hip which did not heal properly
If these symptoms persist and are affecting your everyday functionality, hip replacement may seem like a viable option in order to return to normal activity levels.
Making the Decision
For major surgeries such as hip replacement the decision ultimately falls on the patient. It is up to them to decide whether they are ready to deal with the lifestyle invasion that hip replacement surgery would involve and the possible consequences the surgery may have afterwards. Financial status, age, success rate of surgery and possible side-effects should all be taken into account before deciding to opt for hip replacement.
Once the decision has been made, there are several preparatory steps a person should take before going under the knife. It is best to talk to your doctor about what surgery will look like before, during, and after and discuss each possible scenario thoroughly with loved ones before proceeding.
Hip Replacement Surgery: A Timeline
The trajectory a particular hip replacement surgery takes varies with each patient. The following is a brief overview of some of the critical points in time for a typical hip replacement surgery, and though these may not reflect your exact procedure, they will give you a good idea of what you can expect.
These principles are intended to help aid patients in the decision-making process and allow them to understand some of the most common outcomes. Take these notes with an err of caution and make sure to ask your doctors and surgeons questions as they arise.
- Preparing for Hip Replacement Surgery: Successful surgeries begin with adequate preparation. These preliminary steps help ensure patient safety and may be critical in determining the outcome of the hip replacement.
- A patient should schedule blood work to mitigate outside risk factors, arrange for rides to and from the hospital, request time off work, and prepare a small parcel of luggage to last through the days after surgery.
- Follow your doctors order to a tee. If they give a timeline to refrain from eating or drinking, it is important to follow these guidelines as anesthetics may interfere with the body’s natural digestive processes leading to complications during surgery.
- Maintaining an adequate sleep schedule can help boost the body’s resilience to post-surgical pain and may amplify its healing processes as well.
- Though doctors will take this into account before surgery, it may be wise to uncover which type of anesthetic will be applied. Patients may find that the type of anesthetic administered interferes with a previously undisclosed ailment.
- You may want to look at donating some of your blood in the weeks leading up to surgery as hip replacement may require a blood transfusion. Consult your doctor to see if this may be an option.
- Once all preparatory steps are complete, make sure to check into the hospital in a timely manner to ensure doctors have enough time to go through their pre-surgical procedures.
- The Procedure: Hip replacement typically takes several hours. Once the surgery is finished, doctors will monitor the patient as they come off anesthesia before moving them to their hospital room.
- Whether you opted for traditional or minimally invasive surgery, each procedure will begin with the application of anesthetic in order to relax the muscles and put you into a deep sleep.
- While you are under, the surgeon will make an incision along the side of the hip, moving the muscles connected to the top of the femur in order to expose the hip joint.
- With the hip exposed, the femoral head is removed with a saw and an artificial one is grafted on using a special cement-like material to ensure it holds.
- The socket of the hip joint is then cleaned to remove damaged cartilage and synovial lining and the artificial femoral head is inserted back into the cleaned socket. Doctors may insert a drain to ensure excess fluid has an escape route.
- Finally, the doctor reattaches the moved muscle and closes the incision.
- The doctor then prepares the surface of the hipbone — removing any damaged cartilage — and attaches the replacement socket part to the hipbone. The new ball part of the thighbone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.
- If there has been substantial blood loss, doctors may perform a blood transfusion in order to ensure patient stability and health.
- First Few Hours After Surgery: Anesthetic will be applied routinely throughout the first few hours after the surgery. Doctors will monitor vital signs to ensure the surgery was successful and check that excess fluid is withdrawing properly from the drain which may have been placed during surgery.
- 1-2 Days After Surgery: Recovery for hip replacement surgery is typically short. While regular functionality isn’t immediate, patients will be asked to move within 1-2 days after surgery.
- A physical therapist will be assigned to you and begin a routine of light exercise to ensure the new hip “takes”.
- Moving to the edges of the bed, assisted standing, and walking may be asked of you during these sessions immediately following surgery.
- In some cases, patients may be asked to perform these light tasks on the same day of their surgery.
- One Week Post Operation: Patient activity levels will gradually be increased and the patient will be released upon approval by the physical therapist.
- Once the patient is home, they will be asked to follow the routines their physical therapist taught them as well as apply any medication the doctors have prescribed.
- Creams, ointments, and medication should be taken as routinely as the doctors have prescribed and activity levels should be moderate.
- Simple physical therapy such as massage and hot/cold treatments can be applied if medication and rest does not help alleviate post-surgical pain. Consult a doctor if pain becomes excruciating or if you suffer hip injury immediately following replacement surgery.
- One Month Post Operation: Light activities can resume and physical therapy may intensify.
- At this point the surgical wounds have still not fully healed, but normal activity levels should resume, albeit with minimal pain and discomfort.
- Extended use may cause flare-ups of pain, but these bouts of pain should wane overtime until the wounds fully recover.
- One Year Post Operation: By this time the surgical pains should be gone, and normal activity levels should return. While pain and discomfort may be inevitable, these pains should not be so excruciating that they prevent functionality.
Hip Replacement Recovery and Regenerative Medicine
Hip replacement surgeries are typically very successful, though the recovery process can be time consuming and highly invasive. Between routines of medication and physical therapy as well as the mundanity of low activity levels, many people turn to regenerative therapies in order to boost the body’s natural healing processes to speed recovery after hip replacement surgery.
Regenerative therapies such as stem cell and platelet rich plasma (PRP) therapy are injections of processed adult tissue such as blood, fat, and bone marrow which are meant to create an environment suitable for repair of damaged tissue.
By isolating the platelets in the blood, PRP therapies use the platelet’s natural release of chemical impulses to draw fresh tissues to the site of an injury. Additionally, these platelets latch onto the injury and use these fresh tissues to help reduce post-surgical symptoms such as inflammation and stiffness.
Stem cell therapies work much the same way. Extracting fat or bone marrow from a patient and processing these tissues in such a way that they begin to behave like pseudo-stem cells, then reinjecting these processed tissues directly at the site of the surgery can help boost a patient’s healing responses. Once inside the body, these stem cells help to nourish the surrounding tissues and provide an environment free from corrosive elements which may slow the recovery process.
By using these therapies in unison, many patients have found relief from post-surgical symptoms and found that their recovery processes take much less time.
If you would like to learn more about how regenerative therapies can help you recover from hip replacement surgery more quickly, contact the CELLAXYS offices today to set up a consultation.