Osteoarthritis of the joints What makes OA so special? We can help
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Practical Tips for Artificial Hip Joints

For many years now, artificial hip joints have been implanted with long-term success. What can you do yourself to ensure that your new hip lasts a long time? How can you prepare for the operation, and what can you do afterwards to protect the new joint and keep it healthy for years to come? In the previous issue of ARTHRITIS INFO we introduced some basic tips which are important for the hip joint and which we would like to recommend once more. On the following pages, we offer some additional recommendations that may be very useful. We appreciate the support of our experts who have reviewed these tips.

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1. With or Without Cement?

Essential to the success of early hip joint replacement was the development of a strong bonding agent. This so-called bone cement made it possible to implant the prosthesis in such a way that it would stay in place for many years. Today, some prostheses can be implanted with less cement, or none at all. Currently, about 40% of all hip replacements are performed without cement; 40% with cement only on the shaft (“hybrid type”); and 20% with cement on both the shaft and the socket. Your surgeon can explain whether bone cement is necessary in your case.



2. Model I: Metal Ball

More than 1,000 different hip joint models are available around the world. One of the most commonly-used hip joints has a metal ball or “head.” The socket is either made entirely of plastic, or has an inner layer of plastic (“inlay”) that makes contact with the ball. The advantage of the metal-plastic contact is the low level of abrasion, because the contact between metal and plastic produces very little friction. Whether prostheses with metal on metal contact are even more durable is still being investigated.



3. Model II: Ceramic Ball

Often, prostheses are used in which the head consists not of metal, but of ceramic. In these joints, the socket is either made out of plastic, as in model I, or it has an inlay made of plastic and ceramic. Whether the “hard” pairing (ceramic ball with ceramic inlay) shows greater durability is still being examined. Recently, new and better types of plastic have been developed as well (cross-linked polyethylene).



4. Minimally Invasive Surgery

Minimally Invasive Surgery (MIS) is also performed for total hip replacement in about 10 percent of all patients in the US. Patients need to be of normal weight and in very good physical condition. Usually an incision of 6 or 7 centimeters (two-and-a-half inches) is used, which is much smaller than the traditional one. Patients can often leave the hospital within 24 – 48 hours.



5. How Long Do Artificial Hip Joints Last Today?

Today, 95% of artificial hips last longer than 10 years, and 85% are still functional after 15 years. This is a great success. It is important to keep in mind that the life span of the artificial joint can be increased considerably through wise and careful use.



6. Hip Replacement at 30?

Patients as young as 30 or even younger can be eligible for hip replacement if they already suffer from severe osteoarthritis (e.g. as the result of an accident or a birth defect). This operation may allow them to  live a “normal” life for many decades. However, the younger the patients are, the more they have to take special precautions and practice restraint both at work and during recreation. Though they may feel as good as new, younger hip replacement patients must nevertheless treat their new joint with particular care to ensure its durability.



7. Can Both Hips be Replaced at the Same Time?

Many patients suffer from severe osteoarthritis in both hips. Today it is possible to have operations performed on both hips at the same time. But in the vast majority of cases, the more painful side is replaced first. This first operation sometimes leads to a significant improvement in the condition of the other side, so that the second operation can be delayed for some time. However, if you suffer from severe pain and signs of serious osteoarthritis are visible in your x-rays, it is best not to wait too long for the second operation.



8. Can the Operation be Repeated Several Times?

An important rule says: “Hip replacement can only be repeated once or twice.” With each redo surgery, the surrounding bone becomes thinner and weaker. After two operations, some patients are left with very little bone to which a new prosthesis could be attached. That’s why it is necessary to be extremely cautious after redo surgery. In those cases, it is often best to stop participating in certain sports entirely. The artificial joint should also be examined every 1-2 years, to check for any early signs of loosening.



9. Which Furniture Should You Avoid?

When sitting or lying down there are a few rules to remember:

(1)  Avoid low, soft chairs
       and couches.

(2)   Avoid low, soft beds.

(3)  Avoid low toilet seats.
       Elevated toilet seats
       are easy to install
       and can be found in
       any medical supply
       store. It is also a
       good idea to install
       a handle to help
       you sit down and
       stand up.



10. Drivers

Stepping into and out of a car puts enormous pressure on your hips and should be done carefully if you have an artificial hip joint. To reduce strain:

(1)  Always place your feet
       side by side and support
       yourself with your arms
       before getting into or out
       of the car.

(2)  In two-door cars, always
       sit in the front seat, and 
       not in the back seat.

Following these guidelines can help you avoid dangerous twisting motions that could loosen your new joint.



11. Caution with Metal

Most artificial hip joints contain metal components. If this is true in your case, inform the staff about your prosthesis in the following situations:

1. Before a magnetic
    resonance imaging
    (MRI) scan.
2. Before electronic security
    checks at airports.
3. When undergoing certain
     forms of electrotherapy
4. or before any kind of 
    surgical procedure 
    (since you might need

You may ask for a card from your  surgeon stating that you have a hip prosthesis.



12. Recommended Sports

With an artificial joint you can still play sports. We provided some basic rules in the last issue of ARTHRITIS INFO. Also keep in mind that it is best to avoid sports with high impact. Playing golf is allowed, as long as your surgeon approves it. Recommended sports include: bicycling, hiking and swimming. Be sure to remain alert and defensive when bicycling and  hiking, in order to avoid falls that could damage your new hip.



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