Clinician-to-Clinician Update Clinician-to-Clinician Update

Total Hip Arthroplasty Returns Patient to Activities

December 2016

Contributed by Patrick K. Horst, MD

Patients in need of total hip arthroplasty often present with severe pain and reduced activity levels, which contribute to their overall distress. For these patients, surgical interventions when combined with an integrated treatment program can result in marked improvements in mobility and reduction in pain. In this case, patient education and rapid rehabilitation contributed to a successful outcome.

Patient

An elderly male patient with severe right hip and groin pain was referred to the University of Minnesota Health orthopaedic providers. The patient had been very active, but pain had confined him to a wheelchair and restricted his activities. Anti-inflammatory medications, acetaminophen, and the use of a cane had proven unsuccessful in managing his pain and helping him maintain his activity level.

Management

X-rays of the patient’s pelvis and right hip showed a loss of joint space in the right hip as well as new bone formation, and cysts in the hip socket and femoral head. The X-ray confirmed a diagnosis of right hip osteoarthritis, and total hip arthroplasty was recommended to the patient. Blood tests and screening confirmed that the patient was fit to undergo a surgical procedure.

The orthopaedic surgeon discussed with the patient the various surgical approaches available for hip replacement. The discussion included counseling about the risk of complications. As the patient was elderly but otherwise healthy, his total risk of complications was well below 10%. The patient was told to expect good recovery over the course of a few weeks.

Adult-Spec-Dec-2016-Case-Study-Image-1
— Figure 1. X-ray and computer modeling to determine implant size.

The patient opted to undergo the procedure. The surgeon, anesthesiologist, and nursing staff met with the patient on the day of surgery and reviewed the plan with him and his wife. The patient was brought to the operating room and underwent induction of anesthesia. In the procedure, the worn femoral head was removed, and the hip socket was cleaned out. The new socket and femoral implants were placed. An intraoperative X-ray confirmed proper position and seating of the components (Figure 1). The wound was washed, and the hip joint and skin were closed with absorbable suture. The patient was brought to the recovery room in good condition.

The same day after the surgical procedure, physical therapists assisted the patient in walking briefly. The day after surgery the patient began walking with the aid of a walker. He was discharged from the hospital to his home 2 days postsurgery. After a few weeks of physical therapy, he transitioned to a cane and was able to resume his volunteer work and regular walks. Although his hip was sore for the first week after surgery, he reported that the pain in his hip and groin had improved immediately.

At 6 weeks postprocedure, X-rays showed that the implant was in good anatomical position (Figure 2). The patient’s pain and distress were relieved, and he was fully active again. Yearly screening was recommended to track his progress.

Adult-Spec-Dec-2016-Case-Study-Image-Case-Study-Image-2-Cropped
— X-ray after arthroplasty with implant in place.

Discussion

Patient expectations correlate significantly with patient satisfaction with outcomes of joint arthroplasty1, 2 and patient education serves as an important factor in improved outcomes. In this case, consultations combined with surgical intervention and rapid rehabilitation achieved a dramatic decrease in pain and improvement in mobility.

References

  1. Ibrahim MS, Khan MA, Nizam I. Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review. BMC Medicine. 2013;11(37).
  2. Mahomed NN, Liang MH, Cook EF, et al. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29(6):1273-1279.
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