Friday 17 January 2020

Dear Doctor: Will hip surgery end my active lifestyle?

"I have been referred to an orthopaedic team who say I will inevitably need at least one hip replacement. This has come as a big shock."

Dr Jennifer Grant

Dear Doctor, I’m a female in my mid-30s. Following ongoing hip pain and discomfort and subsequent X-rays, I was recently diagnosed with hip dysplasia, which went undetected as a baby.

I have been referred to an orthopaedic team by my GP, who says that I will inevitably need at least one hip replacement. This has come as a big shock, especially because I am an otherwise healthy, active person.

I weight train and dance on a regular basis. Will I have to give these activities up after the replacement... and will a repeat procedure be needed when I’m older?

The Doctor replies:  While being diagnosed with any disorder is not pleasant, there are some positive things I can point out to you. The orthopaedic team have suggested you will need at least one hip replacement, but this could be delayed for many years in your case. Also, you are engaged in regular cardiovascular (dancing) exercise and weight-resistance training. This means you are fit and I assume you are not overweight. By continuing these activities, you are optimising your chances of a successful surgical outcome and allowing a smoother recovery period.

I recommend you maintain a normal body mass index (BMI), your excellent flexibility and mobility through your dancing and your high muscle mass by weight-lifting. All of these factors will help to ensure your hip joint (natural or prosthetic) functions optimally for as long as possible.

Developmental dysplasia of the hip (DDH) describes a spectrum of conditions related to the growth and abnormal development of the hip joint during infancy and childhood, ultimately leading to hip pain and mechanical instability of the joint. DDH is much more common in females. Breech position in the womb during the third trimester of pregnancy is the single greatest risk factor for DDH. A family history of the condition also increases the risk.

By the end of the first trimester of pregnancy, the hip joint is fully formed. It is a ‘ball and socket’ joint. The ball is the femoral head (top of the femur or long thigh bone) that grows at a faster rate than the acetabulum (socket that the head of femur sits into). By the end of pregnancy, the femoral head or ball is less than 50pc covered by the acetabulum or socket. During the birthing process and the newborn period, many factors contribute to the development of the hip joint. 

Unfortunately, if DDH is not diagnosed, as appears to be the case here, or treatment was unsuccessful, then osteoarthritis can ensue with the need for hip replacement surgery.

The worst cases are generally picked up in infants, but some DDH is not diagnosed until adulthood. The best estimates are about 10pc (the range is 5-40pc in some studies) of all total hip replacements are due to DDH.

Total hip joint replacement surgery or total hip arthroplasty (THA) demonstrates excellent clinical and functional results that vary depending on the type of implant, the type of fixation, biomaterials, the patient’s age and preoperative function, among other factors. The risk of ‘revision’ surgery is less than 1pc per year in the first 20 years.

It is important to heed the advice of the physiotherapist and orthopaedic team about what activities should be limited or avoided altogether following THA surgery.

Over 90pc of patients are working successfully after THA and are without complications 15 years post procedure. Most people can resume their normal activities within a few weeks following surgery. High impact sports, (eg. running and contact sports) are not usually recommended. Instead, activities like brisk walking, cycling and swimming are advised to preserve the joint. Over 60pc of THA patients are still functioning at 25 years post-surgery

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