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WOMEN
AND TOTAL HIP REPLACEMENT
What about sex after total hip replacement?
Absolutely. This is, however, an issue that many patients
are shy to discuss. Available statistics demonstrate that 20 % of all patients expected an
improvement of their sexual life after the total hip replacement, but studies
showing how these expectations were fulfilled are still lacking.
Many women express concern about a dislocation or damage to
the new hip joint while having intercourse after the total hip operation.
After 8 to 12 weeks a new capsule has grown around the new
hip joint and the force has returned to the muscles around the total hip joint.
Therefore, after this period the risk of dislocation is low.
Moreover, in patients who were operated on with a posterior
or posterolateral access to the hip joint (the most often used operation access to the
hip), the risk of total hip dislocation diminishes with the patient lying supine, the hips
moderately bent and the knees apart. This is also the usual position for
intercourse.
For more information see www.aboutjoints.com
www.rothmaninstitute.com
Pregnancy and total hip replacement
"My doctor said to have my baby first and wait
with my hip surgery, the pregnancy might damage a total hip. And how
would I catch my daughter, which is so lively baby, with my old aching hips? And how
could I have the strength for all other chores with my old stiff hips? They also recommend
you to restrict your body weight during pregnancy, to protect your total hip.
But how can you do it when the belly is growing?..."
Between 2 to 3 % of all total hip replacements are done on
women in fertile age, about one half of these operations are carried out for inflammatory
arthritis of the hip joint.
Published studies demonstrate that even
women with bilateral total hip replacement may give birth to healthy babies.
The overall function and the X-ray picture of the total hip
prosthesis was not affected adversely by successful pregnancy and delivery in these
women patients.
| NOTE: While you are pregnant keep away
from X-ray examinations of your hips and pelvis, especially during the first three months!
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One published study showed that during pregnancy the mean
weight of the women patients increased with 13 kilograms. This weight increase has had no
effect on the total hip prosthesis. All these women have had cementless total hip
prostheses, their age ranged from 22 to 38 years.
During pregnancy and for further 3 months after delivery,
the range of movements in the operated hip increases considerably (this is the effect of
relaxing hormones produced during pregnancy). There is thus increased risk of dislocation
of the total hip, although no such complication was published as yet.
The delivery was through cesarean section in the half of
all pregnancies in women with total hip replacement. It is recommended that, if possibly,
the surgeon who implanted the total hip should be consulted before delivery. (McDowell,
2001)
Osteoporosis after menopause
Studies on women patients with total hip replacement
showed, that medication with hormone replacement therapy did not prevent development of
osteoarthritis in the hips of these patients (Erb, 2000)
It is conceivable that the osteoporosis (softening of bone)
that develops in women after menopause may increase the rates of total hip failures
in these women patients. As yet, there is no convincing proof for this assumption. Neither
are there studies investigating the effect of hormone replacement therapy on the rates of
failures of total hip replacements in women after menopause.
Diphosphonates are medicines used to
mitigate the development of osteoporosis in women after menopause. These
medicines are effective to stop the osteolysis (dissolving of bone) around joint
prostheses in animal experiments. According to some reports, the diphosphonates can even
treat the osteolysis: in some experiments new bone grew into the areas of destructed
bone. It is thus conceivable that these medicines might be used for treatment of
prosthetic loosening caused by osteolysis. (Millett 2002)
Many female patients with cementless total hips are
using Diphosphonates to prevent development of senile osteoporosis. There is a
concern that Diphosphonates, who work through slowing bone remodeling may hinder the
ingrowth of bone into the surface of cementless total hips. Animal experiments,
however, demonstrated that Diphosphonates do not inhibit bone ingrowth into apatite-coated
total joint implants (Mochida 2002).
Gender difference?
Studies demonstrate that women over 65 years of age
have already before the total joint surgery more pain and less function in their hip
joints than men (Holtzman 2002).
One year after the total hip surgery this difference
between women and men persists (Table)
| ACTIVITY |
% women needing assistance |
% men needing assistance |
| walking |
30 % |
21 % |
| housework |
29 % |
23 % |
| shopping |
27 % |
19 % |
References:
Holtzman et al: Med Care 2002; 40: 461-70
McDowell: J Bone Joint Surg-Am, 2001; 83-A: 1490-5.)
Erb A, et al.: Ann Rheum Dis 2000;59: 105-9)
Millett PJ et al: J Bone Joint Surg-Am; 2002; 84-A: 236-
49)
Mochida Y et al: J Bone Joint Surg-Am; 2002; 84-A: 226- 35)
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