Arthritis of the hip. Everyday life with an endoprosthesis
Guidelines: Living with an artificial hip joint.
An artificial hip joint means not only the end of a long torture for most of our patients, but almost also a significant improvement in quality of life. Previously often many physical and everyday activities weren't longer possible or only to a limited extent, patients with a hip endoprosthesis (THR) can even drive a car an - in most cases - do sports again.
But what should you consider with an artificial joint? What precautions need to be considered? In our guide we have compiled the most important tips and rules of conduct for you. In the "FAQ" section, our expert for hip replacement, Prof. Pavel Dufek, gives answers to many frequently asked questions.
This it what you should consider with hip replacement.
Everyday life & sports with an endoprothesis.
Pay attention to certain rules when driving.
You are not allowed to drive until the doctor has allowed you to put your full weight on your hip. This is usually the case after three months. As soon as you have his OK, you should keep to the following rules:
The car seat should be adjusted as high as possible and the backrest be flatter than usual. Push the seat right back before you get in. Sit down slowly diagonally/crosswise to the seat. For the driver seat first of all lift your right leg straight into the car and at the same time turn your body round. Then reposition your left leg and pull the car seat forwards again depending on your body size. When getting out proceed in reverse order: Lift the left leg out using your hands, turn your body around, position your right leg and get up slowly. If you want to get in on the passenger side of the car, the same recommendation applies but only in reverse order.
Start sporting activities at the earliest three to six months after the operation.
At least three to six months after implantation of the artificial joint you should not play any sport because first of all a new joint capsule has to form. There is too great a danger from the start that your new joint will spring out of its socket. Sporting activity carried out too early also presents a danger of calcification around the joint. Also the bone must grown into the titanium surface of the artificial joint shaft so that the prosthesis is firmly anchored.
Do sports in moderation.
Now you have has a break from sport this will apply: You will no doubt become active again. Carefully selected sport in moderation in no way shortens the lifetime of an artificial hip, but actually strengthens the corset muscle. The muscles ensure that the joint head is retained in the hip socket (acetabulum) and will not spring out.
Regular sport stimulates bone metabolism so that your artificial joint is anchored better in the bone and the durability of the prosthesis is prolonged. It is important that you improve your joint coordination and mobility by sport. In this way you reduce your risk of falling – a major danger for those who have artificial joints.
Is cycling to be recommended in particular?
Cycling is the best sport for an artificial hip according to many experts: Because when cycling on the flat only half your body weight is put on the operated joint. When walking on the other hand 1.8 times your body weight is put on the joint and when standing on one leg even 3.2 times body weight. The minimum weight bearing and optimum strength of the muscle corset around the hip makes cycling first choice even with a racing bike. However experts also advise against cross-country journeys because of the high risk of falling and being shaken.
What types of sport are still suitable for you?
Besides cycling we also recommend swimming to our patients as a suitable type of sport. Breast stroke should be avoided however because the frog-like movements of the legs put too much pressure on the prosthesis. Experienced doctors recommend Nordic Walking because by using sticks the entire skeletal system is relieved of strain by 30%.
You shouldn't learn golf from scratch.
We recommend after a period of physical rest to to take up types of sport preferably which patients have played before having hip disease. Learning a complex and technically challenging type of sport from scratch often leads to abnormal positions and unnecessary stresses on the new joint. This is also true for playing golf, which at the beginner's stage means too much stress on new hip joints and even more so for new knee joints.
What types of sport are out of the question for you?
Even for experts some types of sport are out of the question after joint replacement operations. So for instance all types of team sports especially direct contact sports. The risk of injury is too great because your artificial hip could come out of the diaphysis if bumped or if you fall. Therefore you should no longer ice skate either with new joints. Also inadvisable are types of sport which require a lot of strength such as weight lifting, boxing, bowls, surfing or climbing.
Accept pain and see it as an efficient police force.
If you feel pain, you should at least give up sport temporarily. Because pain is the efficient police force of our bodies.
We urgently advise: Have faith in your ability to be mobile. Whoever remains inactive has a much greater risk of stumbling and falling. Every time you stumble you put stress on the operated joint with 8.7 times your body weight. When falling the prosthesis can even break.
Frequently asked questions about hip replacement.
Can I do sports with an artificial hip?
Prof. Dufek: We aim to improve the quality of life of our patients so that they can deal with everyday life independently and without pain. Therefore being able to play sport is not actually our top priority. But with surface replacement prostheses many patients can play sport again. According to the guidelines of the German Association of Sports Physicians, certain types of sports should only be commenced 6 months after surgery.
Recommended after 6 months:
- light jogging
- Swimming (when doing the breaststroke: avoid regular leg kicking)
- possibly light tennis with good technique
Generally unsuitable sports are:
- Alpine skiing (if then at the earliest after 1 year)
- Cross-country skiing (because of the danger of falling)
- all competitive contact sports
- Strength training of the hip musculature alone
What does an artificial hip joint consist of?
Prof. Dufek: A complete artificial hip replacements consists
1. of a acetabulum/socket. This acetabulum/socket is anchored in the pelvis. It is made for instance from a metal shell and is lined on the inside with plastic or ceramic.
2. of a femoral head. This head or ball moves about in the socket. To keep its position when exposed to stresses, the prosthesis head sits on a long stem which is anchored in the thigh bone. The stem is made from metal and the head either from metal or porcelain.
If the complete joint is replaced your doctor will speak about a total endoprosthesis (TEP), a total joint replacement within the body. Sometimes only the femoral head or only the acetabulum/socket is replaced. This is called a partial prosthesis.
What anchorage system is the right one for me?
Prof. Dufek: There are two options for anchorage in the hip bone:
- The use of so-called bone cement, a plastic similar to acrylic glass, with which the prostheses is "cast" in the bone.
- So-called cementless anchorage. The good fit thus achieved firmly clamps the prosthesis in the bone in the first instance. Then the bone grows into the surface of the prosthesis achieving long-term stability.
Both anchorage methods (the cemented and cementless method) have advantages and disadvantages. Cemented anchorage can loosen the prosthesis after some years because of the ageing processes in the cement. Also abrasion particles from the plastic acetabulum/socket can play a part in the loosening process. A requirement for cementless anchorage is a bone substance which is tolerated well by the bone bed. It is often the choice for younger patients. The surgeon makes the decision during surgery when he can directly evaluate the quality of the bone.
When should someone have a hip joint operation?
Prof. Dufek: The decision for an operation is not an easy one. However if there is severe pain and considerable restriction in mobility and daily life is severely impaired, it is often advisable to have an operation. In particular chronic pain when resting and at night is an indication of a disease that should be treated.
A joint replacement can make work and every day life considerably easier. Should you give an operation consideration, your doctor will examine all the general risks and risks particular to you. He should advise you in depth on this topic.
If you already have hip arthritis how can a joint replacement be avoided?
Prof. Dufek: An operation which reconstructs the surfaces of your joints, i.e. repairs them, can postpone an artificial joint replacement or even the use of a prosthesis. Axial corrections in the joint or cartilage plasties also delay the use of prostheses. A good supplement is treatment with hyaluronic acid. This is injected directly into the affected joint. The product acts as a lubricant and therefore reduces not only friction but also inflammation. A positive side effect is the reduction of pain.
What risks are there with a joint replacement operation?
Prof. Dufek: An artificial joint is a foreign body. This however is usually well tolerated. Often there is low blood supply around the prosthesis. If you have poor immunity or you belong to a risk group, then there is an increased risk of infection.
The following count as belonging to a risk group
- Patients who are older than 75 or 80 years of age
- patients who have previously had an operation
- People suffering from rheumatism
- Patients with arterial circulation disorders.
During a medical consultation the various risks are discussed with you and it is established whether you are at greater risk. Other risks could be thrombosis, intolerance to medication or damage to the surrounding structures (vessels, nerves, bones, or muscles).
How long does a joint replacement operation last and how long will I have to stay in hospital?
Prof. Dufek: How long an operation lasts depends absolutely on the type and scope of the operation. It will usually last around 1 hour. Your stay on the ward in hospital will be between a week and 10 days. Better implants and gentler operation techniques also ensure a shorter duration of stay during follow-up treatment - known as rehabilitation. In earlier times this was 6 weeks but today only 3 weeks are necessary. Most patients can therefore manage their everyday activities on their own after about 5 weeks.
How great is the friction between the articulating components of the prosthesis?
Prof. Dufek: Femoral head and acetabulum, the articulating prostheses components linked to one another, are usually made of metal, ceramic or polyethylene. These materials ensure low friction even with extremely small amounts of abrasion. Nevertheless after many years this abrasion is of relevance because it can accumulate between the bone and the prosthesis parts encouraging disintegration of bone and eventually loosening of the prosthesis. A solution to this in the case of hip replacements is to use ceramic on ceramic bearing surfaces. These total prostheses are resistant to wear and are a biologically well-tolerated combination, which unfortunately industry offers at a high cost.
Does the artificial joint feel like a type of foreign body after the operation?
Prof. Dufek: Every artificial joint is initially a foreign body, but anatomical reconstruction is more and more successful. The feeling of something different very quickly goes away. The real advantages of a pain-free joint that works properly is what matters most.
If cartilage tissue is damaged the femoral head and acetabulum (hip socket) rub against each other. Arthritis develops.
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