Hip replacements are highly successful


January 22, 1991|By Dr. Simeon Margolis

Q: My doctor has recommended a total hip replacement. I would like to know more about that procedure. How long will it take me to get back on my feet and what is the long-range outcome?

A: The hip joint is made up of a cup-shaped cavity (acetabulum) in the hipbone into which fits the head of the thighbone (femur). During total hip replacement surgery, the head of the femur is removed. The acetabulum is enlarged and a layer of special plastic is inserted. A metal sphere attached to a stem is inserted into the remaining part of the femur as a replacement for the discarded femoral head.

Hospitalization now averages nine to 10 days, and rehabilitation progress varies. When bone cement is used to fix the artificial components to the femur and hipbone, two crutches are generally used for six to 12 weeks. Most people then gradually make the transition to walking without a cane or crutches over the next one to two months. It takes about three to five months to return to full strength and energy.

About 90 percent of patients have good or excellent results from total hip replacement. About 5 percent have serious complications, though even with the best results the reconstructed hip joint is not "as good as new."

Pain is usually greatly reduced and the range of motion is good enough for such activities as sitting, walking, climbing stairs, swimming, golf and bicycle riding. Jogging, tennis and other more vigorous activities must be avoided or limited because of the danger of loosening the connections between the normal bone and replaced components.

Gradual loosening of these components is a frequent, long-term adverse outcome of total hip replacement. After 10 years, the rate of reoperation is 10 percent to 30 percent.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for academic affairs at the school.

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