Advice Specific To Diseased Hips
Hip replacement is indicated in variety of hip disorders. However, replacing the diseased hip is risky in many conditions. There are certain careful advices to be followed by both the operating surgeon and the healthcare team.
Patients suffering from idiopathic form of osteoarthritis are usually heavy individuals with large hip joints and much sclerotic bone. Surgery in these patients carries certain risks. These patients have in general a well -preserved mobility in other joints. Following total hip replacement, these heavy patients tend to put excessive loads on their artificial hip joints at increases the risk of loosening. Also, there is an increased risk of deep vein thrombosis after total hip operation in idiopathic osteoarthritis of the hip. Young patients with osteoarthritis secondary to a hip fracture have increased failure rate of total hip replacements.
In rheumatoid arthritis, the bone is soft and the femoral bone has a large marrow cavity increasing the risk for fracture. Majority of patients also undergo cortisone treatment also after the total hip replacement. This inhibits the formation of new bone and may cause implant failure. In protrusion acetabuli the softened bottom of the hip socket protrudes into the pelvic space. The hips of these patients are extremely stiff. Operations of this condition may be difficult. There is a risk of a fracture of the thighbone during the operation of these patients. In these patients prosthetic infection may occur. The disease itself and the use of corticosteroids make these patients susceptible to general infection which then engages the artificial hip joint. There is also an increased risk of deep vein thrombosis. The patients are advised not to expose their artificial joints to excessive loads. Patients with rheumatoid arthritis have very thin skin so they tend to develop skin bruises that may become infected and serve as an entry for a bacterial infection.
Developmental hip dysplasias are faced with technical difficulty and high rates of failures. In congenital hip dysplasia, the weakened muscles around the hip may result in limp and uneven leg length. It can also lead to increased risk of hip dislocation. Patients are also at increased risk for sciatic nerve damage after difficult total hip operation.
Total hip replacement in congenital hip dislocation is very difficult. Special hip prostheses are used in this condition. The tension of soft tissues, including blood vessels and nerves, produced by this operation is considerable and may produce damage on nerves and vessels around the hip. Completely dislocated hips also compound all the risks faced by partially dysplastic hips as well.
In patients suffering from an infected hip joint, there may be pus and necrotic bone present with the healthy bone. There are chances that the original infection may flare up after total hip replacement. A long course of strong antibiotics is prescribed to prevent this. However, it may cause antibiotics-resistant bacterial infection and may produce side effects in the patients. There are increased chances of limp and joint dislocation.
Abnormal bone metabolism causing enlarged and deformed bones characterize Paget’s disease. Excessive bleeding complicates hip replacement in such cases.
Patients suffering from Gaucher’s disease face an increased risk of implant loosening.
Patients suffering from blood disorders such as hemophilia and sickle cell anemia have an increased risk of bleeding both intraoperatively as well as post operatively. Postoperative hematomas are also common in these patients. There are also chances of postoperative implant infection. Hip arthroplasty in chronic renal failure is generally successful except for the patients on dialysis who have an increased deep infection rate.
Hip arthroplasty in cases of tumor is associated with increased rate of complications like bleeding, implant failure and recurrence of tumor. Patients with a co morbid neurological disorder usually do not fare well and are generally associated with early implant failure. However, the final outcome depends on the type of neurological disorder.
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