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Sports & Joint Surgery
Living Actively Following Hip Replacement
Each year, hip replacement surgery relieves
pain and improves mobility for virtually all of the 120,000
patients who undergo the procedure. Although most patients
are
in their 60s and 70s, hip replacement is appropriate for any
adult with severe hip pain and limited ability to walk —
from those in their 80s to athletes as young as Bo Jackson,
the baseball and football player who received an implant at
age 29. Entertainer Liza Minnelli had a hip replacement lat
age 49. While implant recipients must "retire" from
certain activities, many more activities can be resumed or
started for the first time and there's widespread agreement
about which
ones are safe. Even under the best circumstances, however,
hip implants may slowly wear out or loosen, and eventually need
to be replaced because of the possibility of failure (a sudden,
painful event that can cause serious injury). For this reason,
implant recipients should be followed regularly. Many patients
don't receive such monitoring for two reasons: First, data from
long-term follow-up studies have only recently become available;
second, insurance coverage is often limited to a few months
following surgery. To address this shortcoming, the National
Institutes of Health (NIH) recently issued a consensus statement
stressing the importance of lifetime care for all hip replacement
patients.
What Activities Are Safe?
Hip replacement nearly always provides dramatic pain relief
and major improvements in walking speed, stride and the ability
to climb stairs. But with a growing number of people receiving
implant before age 60, and the increased emphasis on the benefits
of exercise throughout life, improved function has become an
important goal.
Today, only a few high-risk activities are
forbidden, and implant recipients can participate in many low-
and non-impact activities. Most surgeons urge their patients
to remain active because of the healthful benefits of exercise.
According to a study in the Mayo Clinic Proceedings,
more than three-quarters of the surgeons who performed 1,015
15 hip replacements at the Mayo Clinic in 1993 recommended sailing,
swimming, scuba diving, cycling, golfing, and bowling for their
patients.
Other activities the surgeons sometimes recommend
include speed walking, tennis volleyball, ice skating, hiking,
backpacking, cross-country skiing, and ballet. More than three-quarters
of the surgeons said they advised against running, football,
baseball, basketball, hockey, soccer, handball, racquetball,
water skiing, and karate.
The specific activities recommended for an
individual patient depend on general health, fitness, motivation
and familiarity with the activity. Exercise must be undertaken
sensibly because the implant doesn't contain nerve fibers and
can't produce injury-warning sensations (i.e. pain) the way
a normal hip can. As a result, some recipients may be inclined
to work out too hard for too long, which can accelerate wear
and premature failure of the implant. Physical therapy and exercise
can help condition patents for the activities they wish to pursue,
and special footwear can provide extra cushioning and support.
Ms. Minnelli has been able to include some dance routines in
her performances, while Mr. Jackson has permanently retired
from playing baseball and football.
Choosing the Best Procedure
The type of implant you receive depends mostly on the quality
and density of your bone. All implants contain a ball attached
to a stem, which is inserted into the thighbone, and a socket
that must be fixed to the pelvis at the other end. This can
be accomplished with or without cement in the latter approach,
the ends of the implant are coated with a porous material and
tightly fitted into place; the porous material encourages new
bone growth, which fuses with the device and provides additional
reinforcement.
Often, however, the stem of the implant is
cemented to the thighbone, and the socket is secured without
cement (a "hybrid" hip). Sometimes screws or other
hardware are used as additional anchors. If your bones are
strong
enough, a prosthesis without cement is usually preferred.
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