US Pharm. 2023;48(10):15-16.
A Common, Fast-Growing Procedure
Hip pain caused by arthritis can be debilitating, affecting mobility and overall quality of life. Total hip replacement surgery, or total hip arthroplasty (THA), is the gold-standard treatment for individuals experiencing significant hip osteoarthritis. In the United States, among adults aged 50 years and older, more than 2% have undergone THA. It is one of the most common and fastest-growing procedures, driven by the need for increased mobility and quality of life in the aging U.S. population. Despite the high success rate of total hip replacement surgery, the recovery and the duration of effect still pose a challenge.
Replacing the Hip Joint
Total hip arthroplasty is a surgical procedure to replace a damaged or worn-out hip joint with an artificial implant. The hip joint is a ball-and-socket joint, and when it functions correctly, it allows for smooth movement, walking, and other physical activities. However, the hip joint can deteriorate over time due to various factors, such as osteoarthritis, rheumatoid arthritis, hip fractures, or other medical conditions. When the hip joint becomes severely damaged or painful, hip replacement surgery becomes a practical choice to relieve pain and restore function.
Osteoarthritis, the most common reason for hip replacement surgery, is a degenerative joint disease that causes the cartilage in the hip joint to wear away, leading to pain, stiffness, and reduced range of motion. Hip replacement surgery is typically considered when conservative treatments, such as medication, physical therapy, or assistive devices, no longer provide sufficient relief from hip pain or mobility limitations. A traumatic hip fracture, often resulting from a fall or accident, can also require surgical hip replacement to stabilize the joint.
Surgery Results in a Short Hospital Stay
Surgery occurs in the hospital or surgical center under anesthesia, typically resulting in a 1- to 3-day hospital stay. Minimally invasive surgical techniques are becoming more common in hip replacement surgery, resulting in smaller incisions and shorter recovery times. During surgery, damaged parts of the hip joint are removed, and an artificial hip implant is placed into the hip joint. Finally, the surgical incision is closed with sutures or staples. The duration of the surgery can vary, but it generally takes a few hours.
During the hospital stay, the focus will be on pain management and physical therapy. The physical therapist will teach exercises to improve hip strength and mobility. At discharge, the patient will be sent home with instructions for self-care, including wound care, medication management, and activity restrictions. Physical therapy outside of the hospital is a critical part of recovery and will continue for several weeks to months. Most patients can resume light activities like walking within a few weeks, while more strenuous activities may take several months. Since mobility will be limited for some time after surgery, it is important to ensure that the home is safe and accessible, with necessary aids like handrails and a raised toilet seat, if needed.
Medication and Physical Therapy Are Important for Recovery
As with any surgical procedure, hip replacement surgery carries some risks, including infection, abnormal wear and tear, dislocation, nerve or blood vessel damage, or blood clots.
Multiple types of medications are used to manage pain after surgery. Doctors may prescribe nonopioid medications such as nonsteroidal anti-inflammatory drugs (ibuprofen), acetaminophen, and muscle relaxers in combination for the first few weeks after surgery. If severe pain is present that is not relieved by nonopioid medicines, then opioid or narcotic medications will be prescribed. Long-term use of opioids is not recommended due to the risk of abuse or addiction.
Blood thinners, known as anticoagulants, will be prescribed for a couple of weeks to a month after surgery to prevent blood clots. Oral anticoagulants may be used, including warfarin, factor Xa inhibitors (apixaban, edoxaban, rivaroxaban, etc.), and direct thrombin inhibitors (dabigatran). Injectable anticoagulants, such as the low-molecular-weight heparin enoxaparin, may be prescribed instead.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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