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Hip, hip hooray!

If you've suffered from the pain and physical impairment of a diseased hip but have been reluctant to consider total hip replacement for whatever reason, a report in the June 28 Journal of the American Medical Association deserves your attention. A large panel of experts in all fields relating to the subject, convened by the National Institutes of Health, concluded:

"Successful replacement of deteriorated, arthritic, and severely injured hips has contributed to enhanced mobility and comfortable, independent living for many people who would otherwise be substantially disabled. New technology involving prosthetic devices for replacement of the hip, along with advances in surgical techniques, has diminished the risks associated with the operation and improved the immediate and long-term outcome of hip replacement surgery."

More than 120,000 artificial hip joints are being implanted each year in the United States, leading to a consensus among these experts that total hip replacement (THR) "is an option for nearly all patients with diseases of the hip that cause chronic discomfort and significant functional impairment." They found THR to be "a highly successful treatment for pain and disability, with most patients having an excellent prognosis for long-term improvement in symptoms and physical function. Thanks to antibiotics, anticoagulants, and early mobilization following surgery, the infections and deep vein thromboses that complicated earlier efforts at THR have been significantly reduced.

Although THR is most commonly used for hips damaged by osteoarthritis, many other types of hip disease have been successfully treated with the operation. Among them are rheumatoid arthritis, avascular necrosis, traumatic arthritis, certain hip fractures, benign and malignant bone tumors, Paget's disease involving the hip, ankylosing spondylitis, and juvenile rheumatoid arthritis.

Previously used mostly in patients between 60 and 75, THR is increasingly being offered to both older and younger patients. The results have shown that advanced age alone is no contraindication to the procedure. Only active local or systemic infection or other conditions that might seriously increase the risk of complications or death appear to be valid reasons for not doing THR. Even obesity, which has caused some concern in the past because of a higher mechanical failure rate in very heavy patients, is no longer seen as a significant problem.

Clearly, THR should not be considered until an extended course of nonsurgical management has been tried. This would include the use of medication for pain, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, walking aids, and avoiding activities that produce pain or discomfort. When these have failed to give relief, THR is a viable alternative for almost everyone. The results are immediate, recovery from surgery is usually rapid, and the long-term outlook is bright.
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Title Annotation:benefits of hip replacement surgery
Author:Brown, Edwin W.
Publication:Medical Update
Date:Aug 1, 1995
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