By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

HIP REPLACEMENT USUALLY SUCCESSFUL, BUT INFECTION CAN BE A RISK

Question: In March 2008, I fell and fractured my left hip and received a total hip replacement. I’m 81 years old. I have two questions that you could help me with: 1. What is the average life of an artificial hip? 2. I understand artificial hips can become infected. How does this happen? What can I do to avoid infection? How is infection in hips treated?”

Answer: More than 230,000 people have hip replacement surgeries in the United States annually. It is most often performed on patients who have severe arthritis or those who have had hip fractures. It restores mobility in both cases. Most people who have a hip arthroplasty do very well. They are in the hospital for five to seven days, and usually begin physical therapy shortly after surgery. Physical therapy is continued after going home. Normal, pain free activity is the outcome in most people in just a couple of months.

Because the hip is such a major weight bearing bone, it is uncommon to see a hip replacement in a person under 60 years old. Physically active people in this age bracket who have hip problems are often candidates for another type of surgery called hip resurfacing.

At your age, your replacement hip is likely to be good for the rest of your life. That’s because the average “new hip” can last up to 20 years. During that time you should have full use of your limb. But excessive activity can cause the joint to wear out or dislocate ahead of schedule.

You ask about post-operative infections from hip arthroplasty. Up to 2 percent of all initial hip replacements do become infected. The figure is slightly higher for “revision operations” in which a previously installed replacement joint wears out and is then resurfaced or replaced. As the figures indicate, infections in the immediate post-operative period are not a common occurrence. Most patients are given antibiotics before and after surgery to prevent them.

A late post operative infection -- occurring anywhere from months to years later -- is possible, but relatively rare. The artificial hip, like any other foreign tissue, can cause inflammation and then become infected. Sometimes this process starts as a result of bacteria that were introduced at the time of the operation and then lay dormant for a long period of time. In other cases, bacteria travel from another part of the body that has become infected. That’s why it’s important for those with gum disease, pneumonia or urinary tract infections to have prompt treatment. It is also a good idea to consult your dentist about using antibiotics before routine dental work to prevent the spread of bacteria from your gums to your hip. Patients with diabetes or rheumatoid arthritis are twice as likely to get a late infection.

Finally, in an effort at full disclosure, I should mention that there are other possible complications from this type of surgery. These include blood clots in the legs, dislocation of the new joint, as well as fracture in the femur. Fortunately, these problems are also not very common.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.