Hip joint replacement at a younger age

Most hip joint replacements are done in people who are older. As a result, the behavioral guidelines indicated for the first weeks after the operation are often based on older people. Yet there are also many younger people who need a new hip, usually caused by an accident. It may be that after an accident the young person is initially helped back on his feet with his own hip, because people prefer to postpone hip joint replacement for as long as possible. The young person, who is often left with a deformity of the joint due to the accident, will over time experience increasing problems with this joint and therefore find it increasingly difficult to walk.

Developments

A number of orthopedic surgeons are therefore of the opinion that one should wait as long as possible before placing a hip prosthesis because a prosthesis can only be replaced a small number of times.
Fortunately, development in this area does not stand still, and technology has now progressed to such an extent that a hip prosthesis can last up to 20 and sometimes even 25 years, depending on use. A hip prosthesis can also be placed up to 3 times, although this becomes increasingly difficult as a prosthesis is placed more often and as the patient gets older. The older the patient, the more brittle the bones become. This means that the risk of complications also increases. Due to new developments, most orthopedic surgeons now indicate that a hip joint can be replaced more quickly than before.

Frog in cooking pot

When such a hip joint becomes increasingly worse over the years, the patient increasingly pushes his or her limits. Every time he compromises on mobility and pushes his pain threshold. This can go quite far, until the situation becomes truly untenable and work is no longer possible. It is comparable to the frog in the cooking pot: if it is thrown into boiling water, it immediately jumps out, but if it is heated with the water, it simply stays in place. You also often see this in people with a bad hip. If they had so much immobility and pain from one day to the next, they would immediately have something done about it. But someone who has been doing it for a long time will continue with it for a very long time.
Yet the question remains whether you will live to be 80, you are alive now and often have to support a family and work. It is therefore advisable to sound the alarm in time and consult with the orthopedist whether it is wise to replace the hip.

Choice of hospital

When the time has come that a hip prosthesis should indeed be fitted, various hospitals can be chosen. Each hospital has its own technique for placing a hip prosthesis (for example with or without cement) and there is also a choice of different types of hip joints.
On the one hand, the consideration is to go to one of the larger hospitals, such as the UMCG or the Radboud hospital in Nijmegen. Nijmegen specializes in orthopedics and conducts a lot of research. After a number of years, a prosthesis can become somewhat loose and in Nijmegen they have developed a method for this: repairing the bone bed using bone chips. The department has gained international fame for this. Other techniques for hip joint replacement are also being developed there. The latest techniques are developed more often at university hospitals. However, there are usually a number of surgeons in training, and there is a chance that the operation will be performed by such a doctor in training. Not everyone finds this desirable, although a doctor in training often has years of experience before specializing and is very well supervised in everything he or she does. At regional hospitals, such as the Bethesda in Hoogeveen or the Wilhelmina hospital in Assen, the chance is smaller. These hospitals perform so many joint replacement operations every year that they also have extensive experience in these types of operations. It is advisable to rely on your feelings; some people feel at home at a hospital in their area, others want to go to a hospital that is at the forefront of the latest developments . A conversation with an orthopedist can also be the deciding factor; you must have confidence in the doctor who will perform the operation. But whatever choice is made, in every hospital there is great attention to the health and well-being of the patients and operations are carried out accurately according to the guidelines.

Start-up process

If it is decided to undergo surgery to replace the hip joint, it will generally take a number of weeks after this decision before the operation is performed. Some things are arranged in advance, such as blood collection and a conversation with the pharmacist and anesthetist. The prospective patients receive all kinds of information about the dos and don’ts before and after the operation. For example, you must not have any wounds on your legs or pubic area before the operation. After hip surgery, certain movements should not be performed at first because there is a chance that the hip will dislocate.

A new hip

After the operation, the patient receives an infusion of morphine, which he can arrange himself. Of course there is protection against excessive use.
The next day you have to get out of bed immediately, and as soon as the IV has been removed, crutches are provided. The physiotherapist appears at the bedside and focuses primarily on skills to promote self-reliance, so that the patient can manage at home. This includes advice on how to walk with crutches and, for example, learning to climb stairs. After an average of 5 days, the patient can go home and rehabilitation begins with their own physiotherapist. He will work on walking patterns, strengthening and control of the muscles, etc. 6 weeks after the operation there is a check-up with the surgeon, during which photos are also taken, and another check-up after 12 weeks. The next appointment will only be after 10 months.

Home again

During the first few days, the patient may experience severe bruising in the leg, which may turn completely purple. The fluid also sinks, so it is advisable to keep the leg elevated when in a rest position. In between, it is advisable to often walk short distances or do exercises.
The patient must be very careful during the first 6 weeks after the operation to ensure that the hip does not dislocate. The muscles suffered a lot from the operation, and recovery takes 6 weeks. The muscle layer that runs over the hip keeps the hip in place and therefore in the socket. The leg should not be moved inwards, bent beyond 90 degrees or twisted. You must walk with two crutches for 6 weeks, due to poor balance, but also as a warning to the outside world. Afterwards, in principle (in consultation with the physiotherapist) you switch to 1 crutch. After another 6 weeks it can in principle be put away. These are of course standard guidelines, and many of the guidelines are also aimed at the average patient, who is generally older for hip joint replacement. It may therefore be that someone who is younger recuperates much faster than average. That completely depends on the condition before the operation.

Final trajectory

Someone who is already elderly will be more likely to be satisfied with what he can do after hip joint replacement than someone who is, for example, forty. An elderly person is often happy when he can do his daily things again and take a short walk, for example. Someone who is younger has many more wishes and will therefore normally enter a much longer rehabilitation process. In that case, it is therefore wise to continue rehabilitation under the supervision of a specialized physiotherapist, for example in a gym. Customized exercises can be done there that suit the current situation. All in all, the final steps are the heaviest and it can take up to a year before the patient reaches his final potential.