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The Hip
The hip joint is commonly known as a ball and socket joint and forms where the rounded head of the thigh bone joins the pelvis. The joint is surrounded and lined by cartilage, muscles and tendons. It relies on these tissues for support, stability and ease of movement.
• Symptoms of a hip problem may include:
• Pain at the hip
• Swelling
• Restricted movement of the leg
• A clicking, snapping, popping or grinding sound
• A feeling of looseness or instability
• Numbness or tingling in the hip
• Even knee pain may indicate a hip problem
Hip pain may stem from overuse and repetitive stress to the hip (as from regular running or biking long distances). Pain in this instance may indicate a stress fracture, muscle strain, tendonitis or bursitis (inflammation of the fluid sac cushioning the hip joint). Sudden and severe pain may indicate a more acute hip injury.
Runners and others who participate in aerobic activity may experience iliotibial band syndrome, indicated by snapping pain on the outside of the knee or hip, caused by an over development of the iliotibial band that runs down the outside of the thigh.
Various types of arthritis, including osteoarthritis, rheumatoid arthritis and lupus, may cause hip pain. Other causes include an infection, lack of blood flow or a pinched sciatic nerve.
• You should seek immediate care if you experience any of these serious symptoms:
• A sudden inability to bend, straighten or move the leg, or to stand or bear weight
• Severe pain
• A leg that looks twisted
• A leg that appears pale, cold, white or blue
• Numbness or severe swelling, or other sudden abnormalities to the shape of your leg or hip
To diagnose the exact nature of hip problems, your orthopedic surgeon may request an X-ray and/or an MRI. These diagnostic images help your physician pinpoint the nature of the problem and determine the right treatment for your condition.
To treat hip problems caused by repetitive or traumatic stress to the joint, conservative therapies such as rest may be successful. Weight loss, exercise and orthotic devices are other conservative therapies that may be prescribed depending on the underlying cause of the hip pain. These treatments also may be successful in the early stages of arthritis. However, as arthritis or other degenerative conditions cause hip problems to worsen, your physician may determine that the time is right for surgical alternatives.
If only one part of the hip joint is damaged or diseased, a partial hip replacement may be recommended. In most cases, the hollow cup-shaped socket in the pelvis, called the acetabulum, is left intact, while the head of the thighbone, or femur, is replaced with an artificial ball-shaped component similar to that used in total hip replacement surgery. Sometimes a device is used that fits over the head of the femur, eliminating the need to cut away the head of the femur. It is fixed to the femur with cement around the femoral head and has a short stem that passes into the femoral neck.
Partial hip replacement surgery is an inpatient procedure, and hospital stays and recovery times are similar to total hip replacement surgery as described below.
Your physician can help you determine if you are a candidate for partial hip replacement surgery due to your condition, your age, your weight and other factors.
In a total hip replacement surgery, the painful parts of the damaged hip are replaced with artificial hip parts called a prosthesis, a device that substitutes or supplements a joint. The prosthesis consists of steel components: a socket, ball and stem. The outer shell of the socket usually is made of metal and the inner shell consists of plastic, or the entire socket may be plastic. When the metal ball is joined with the socket, the new hip can allow for smooth, nearly frictionless movement.
If you and your surgeon decide that total hip replacement is right for you, a date will be scheduled for your surgery. Several steps may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician to have other conditions treated if necessary. Your physician may suggest that you lose weight and initiate an exercise program. If you smoke, be sure to inform your physician, as smoking can dangerously increase surgical risks and slow down the healing process.
Total hip replacement is performed through an incision over the side of the hip. The ball-end of the thighbone (femur) is cut and replaced with the new metal ball and stem component. It may be stabilized with or without cement. The damaged surface of the socket is smoothed in preparation for the insertion of the new socket. The ball and socket are then joined.
After surgery, you will begin a gentle rehabilitation program to help strengthen the muscles around your new hip and regain your range of motion. On the day of surgery, you may be asked to sit on the edge of the bed and dangle your feet. You also will learn how to protect your new hip while doing daily activities. You usually will begin walking with assistance within 24 hours. Your hospital stay typically lasts about two to four days.
Upon returning home, you will need to continue taking regular medications and continue exercising as directed by your surgeon or physical therapist. Walking, remaining active and practicing the required exercises are the quickest ways to full recovery.
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