CONTENTS:
Preoperative anxiety
Fear for
Pain during and after surgery
Urine & bowel problems
Length of recovery
Fear for
AIDS
postoperative infection
blood clots
risk of heart failure&
death
nerve damage
second operation
faulty prosthesis
unequal leg length
dislocation of the new hip
PREOPERATIVE
ANXIETY
You have had no previous experience with total
hip replacement operation and it is only natural that you are anxious. Feeling of anxiety
and depression before the total hip operation is usual for all patients. (Curiously
enough, patients with previous experience, people with the other hip already
operated on, are anxious too).
The preoperative anxiety disappears during the week after
the operation when you have realized that the surgery has succeeded and all is well. Your
preoperative anxiety will be replaced be feelings of relaxation and relief.
Be prepared, however, that a bout of unmotivated anxiety
may return during the first three postoperative months. You may be disappointed with the
slow progress of your rehabilitation, you may feel that the new joint is still stiff and
sometimes still painful. Relax, it takes several months before your new total hip shows
its best.
The useful way to cope with the preoperative anxiety is to
acquire more information. Make a list of questions about your concerns and then go and ask
your doctor, your surgeon and anesthesiologist, the fellow patients about the things that
bother you.
FEAR FOR
Pain during and immediately after
surgery
Patients are surprised how little pain they experienced
after the total hip surgery. This is due to the modern forms of anesthesia which can
keep you fully conscious and yet pain-free one or two days after the operation.
If you are scared about having pain during operation, speak
with your anesthesiologist who will convince you that this doesn’t happen.
Pain after return home
You will probably notice that much of the old
"arthritic pain" in your hip disappeared the next day after your
total hip operation.
You must, however, realize that it usually takes at
least three months before the "surgical pain" (pain from the
tissues severed during surgery) disappears. Expect also some pain during the training of
your new joint at home.
Problems with bowel and urine
during hospital stay
Here the skilled personnel will help you. You will not stay
in bed more than perhaps one day, and when you will be mowing, these problems will
disappear.
CONCERNS FOR THE
LENGTH OF RECOVERY
The length of recovery after a total hip replacement varies
according to the patient and the type of total hip prosthesis. For uncomplicated primary
total hip operations you may return home one week after the operation ( and often even
earlier), and you may be able to drive your car already after eight to twelve weeks. Be
prepared, however, that you will need some form of training of your hip for at least six
months.
Remember that the operation takes only about ninety
minutes, but the rehabilitation of your new hip will take several months of arduous work.
FEAR
FOR POSTOPERATIVE COMPLICATION
Fear for risk of getting AIDS from
blood transfusion.
This risk is minimal and can be eliminated entirely if you
can donate and spare your own blood before your operation.
Fear for postoperative wound
infection
It is very rare nowadays, it occurs in less than 0,5% of
all primary operations. When it occurs it is a serious complication, but almost always
treatable.
Fear for blood clots after
surgery.
Small blood clots in the veins of the lower extremity after
total hip replacements occur in 40 to 50% of all patients, but in most cases this
complication is not even discovered.
All patients nowadays will get preventive
treatment against deep vein thrombosis, which diminishes the formation of blood clots.
Only in about 3% of all patients operated on with a total
hip the blood clots (the deep vein thrombosis) causes pain and swelling in the leg,
usually when the patient has already returned home. Treatment of an established blood is
effective and many patients does not even need to return to the hospital.
Fear for nerve damage
Damage to the nerves that cross the hip joint occurs
in about 1 % of all total hip replacement operations. At risk are patients operated on for
hip dysplasia and patients with revision operations of previously failed total
hips. About 60 % of all patients with this complication recover completely.
Fear for risk of heart failure and
risk of dying
Total joint replacement is a major surgery and as such it
caries with it some risks to the life of the patient. The mortality caused by the surgical
trauma of the total joint replacement operation is very low. At risk are patients >75
years old, patients with heart condition, and patients whose total hip prostheses must be
cemented.
The statistics show that the risk to die during and
early after the surgery, although already small, is steadily diminishing during the
last years. The risk was 1death on 2 000 operations in the past, now it is three times
lower still (1: 6 000) (Parvizi 1999)
If you have a total hip already operated on, be glad!
All statistics demonstrate that after total hip operation you have big chances of living
longer then people in the general population.
FEAR THAT
THE NEW TOTAL HIP WILL FAIL
Fear for the need to have the
surgery redone.
Some people worry that the body will "reject" the
hip joint prosthesis, or that the new joint "wears out" and a second
operation will be necessary.
The fact is that just like the joints you were born
with, your new artificial hip joint wears out over time. How much, depends among other
things on your age and activity.
In spite of improving quality of total hip
prostheses, there is a certain risk that your artificial hip joint will become loose
in the future and a second operation will be necessary. The risk of the second operation
increases with years since the total hip surgery.
Fear to get a faulty total
hip prosthesis
Every new artificial joint gets a unique
identification number at manufacture, that is included in the operation protocol.
When the manufacturer of the artificial hip joints discovers a fault in the
fabrication of artificial joints, he contacts the surgeons who have been using these
implants.
Patients who get implants with some fabrication
fault may be thus identified by their surgeons and followed closely. There
are barriers that should prevent fabrication faults, but on rare occasions such
accidents can still happen.
Fear to have Unequal leg length
About 7 % of all patients experience the sensation of
unequal leg length after the total hip operation. In many cases, this feeling of the leg
length discrepancy is due to
-
muscle contractures around the operated hip,
-
changes in the spine present already before the operation
This "apparent leg-length inequality" usually
disappears after rehabilitation and stretching of muscles and joint capsule
during one year after the surgery.
Then there is a true, anatomical leg length discrepancy
that need to be treated by shoe lift.
If you have had an unequal leg length already before your
total hip hip surgery, remember that the objectives of your actual
total hip surgery are in order of priority:
-
relief of pain
-
stability of the new hip
-
mobility of the new hip
-
equalizing the leg length
Be thus realistic in your expectations to have the leg
length discrepancy corrected fully by the total hip operation.
Fear that the new hip joint will
dislocate
You will be taught the 90 degrees rule - don't bend
your thigh more than 90 degrees. After that, some patients live in constant fear that
their new hip joint will come out during sleep etc. In reality, the risk of such
dislocation after the first total hip replacement operation is low -usually about 1 % to 4
%. In many reports it also appeared that at risk are old patients, patients with
several previous operations in their total hips, and patients with brain damage.
Statistics also demonstrate that liquor intake, accident, or other forceful external
events often preceded total hip dislocation.
For more information about postoperative complications
visit also the following chapters:
General
complications
Total hip infection
Loosening
Other
total hip complications
Before you take any action, please read the Disclaimer
References:
Parvizi J et al: Clin Orthop 1999; 369:39-48)
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