Case Studies

Case studies in orthopedic care: Joint Replacement – HIP

Patient history

Recreational water-skiing is punishing enough on the body. But step up to competition level, and the stresses and strains affecting ligaments, bones and joints multiply many-fold – as do the resultant musculoskeletal problems. This championship skier from Florida certainly understood that to be true: After a lengthy career cutting in and out of slalom courses and exposing his body to extreme g-forces in the process, he began experiencing chronic pain in the groin and thighs. The pain was severe enough to make this highly skilled athlete wonder whether his days as a competition skier were fast approaching an end. At that point, friends urged him to travel to Nevada where he could be seen by surgeons at Tahoe Fracture & Orthopedic Medical Clinic.

Case description

Upon physical examination and X-ray studies, the patient was found to have very advanced osteoarthritis of his hip.

Treatment plan

The best option for this particular patient was hip replacement surgery, admittedly a controversial choice owing to his relatively young age. Following frank discussion about the benefits and risks of this surgery, the patient eagerly consented to undergo it. Surgery was performed by taking a posterior-lateral approach from a 4½-inch incision. (The minuscule amount of body fat present on this impeccably fit patient made it feasible to employ so small a cut, rather than utilize the 7- to 9-inch incision more typical of hip replacement surgeries.) The replacement hip itself consisted of a conventional cup and ball-tipped stem implant fabricated from the latest generation of polyethylene and ceramic materials. Using cementless fixation technique, the implant was pressed into the worn-out socket and into the femur’s marrow cavity. Skin closure was accomplished with staples to reduce the amount of absorbable suture in the wound.

Outcome

The patient spent the next two days in the hospital; physical therapy (later emphasizing resistance training) was initiated 24 hours postoperatively. Surgery did not adversely affect leg length; thus, by the sixth postoperative week, the patient was ambulating normally – gone was the limp that had been his constant companion for the previous three years. During those first six weeks, the patient was asked to refrain from performing certain activities of daily living (such as bending over) in order to prevent dislocation of the artificial hip. After six weeks, it was necessary for him to avoid only extremes of motion. Also, the patient was counseled to defer participation in sports for 12 weeks postoperatively, at which time he would be able to return to the water and concentrate on making a comeback to competition-level skiing. (He ultimately went on to win a world championship title.)

Discussion

Hip replacement patients who have never previously skied are advised against taking up the sport because the spills and mishaps bound to occur while trying to master the basics represent an unacceptable increase in the risk of fracture. They only should engage in skiing if they were accomplished at it prior to surgery, as was the patient here. Many studies have demonstrated average joint-survival rates of over 20 years for hip replacement implants. However, the longevity rate of 20 years is the reason that hip replacement is considered controversial for adults under the age of 50. For them, their relative youth may mean a need for new implants or revision surgery at least one time at some point down the road in order to remain productive prior to reaching advanced age. Nonetheless, hip replacement is often a good choice for adults regardless of age because the long-term results are normally very good, better in fact than for any other joint replacement surgery.

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