Avascular Necrosis, Core Decompression, and Total Hip Replacement
Hip Replacement X-Ray
Diagnosis: Avascular Necrosis of the Hip
At age 42, a family member, "Joe," was diagnosed with avascular necrosis in both hips. After an unsuccessful attempt at core decompression, he had a total bilateral hip replacement. It was a year-long journey, but today his hips are as good as new, and he is pain-free.
Joe first became aware of the problem last August when he thought he had pulled a muscle riding on a jet ski. After three weeks, the pain had not diminished, and his other hip started to hurt. At that point, he met with his doctor who referred him to an orthopedic specialist. An x-ray showed minor arthritis, but the more detailed MRI confirmed the diagnosis of avascular necrosis.
Avascular Necrosis of the Femoral Head
What is Avascular Necrosis?
Avascular necrosis (AVN) of the hip occurs when the blood supply is cut off from the femoral head, resulting in deterioration of the bone. If the condition is not treated, the femoral head will eventually collapse. AVN is very painful and can be treated with core decompression or hip replacement.
AVN can be caused by a bone or joint injury, but also by an unexpected degenerative condition. You are more susceptible to AVN if you:
- are a male over the age of 30
- are overweight
- have a family history
- drink alcohol excessively
- have had chemotherapy
- have taken large doses of steroids
For Joe's treatment, the doctor recommended core decompression for both hips. This surgical procedure involved drilling a small hole into the femoral head, scraping out the damaged tissue, and replacing it with a synthetic bone graft. The goal was for the drilling to relieve the pressure in the bone and to trigger a revitalization of blood vessels. Joe was advised that the surgery had a 65-70% success rate, which though not a sure thing, sounded like the best plan.
The week before Christmas, he had the surgery on one hip, and then a week later had the other side done. Each procedure was out-patient surgery and recovery time was short. He went home with crutches and the incision pain was minimal. The small incisions were closed with staples that were removed two weeks later. Joe was pain free for almost two months, but then his condition continued to deteriorate. The core depression did not work.
Hip Replacement Incision ScarsClick thumbnail to view full-size
Bilateral Hip Replacement
Joe's condition rapidly deteriorated and both femoral heads began to collapse. He could still walk, but was in a great deal of pain as he hobbled around. He continued to take pain medication until he was advised to have a double hip replacement. There needed to be separate surgeries for each hip, at least 6-8 weeks apart. The time in between gives the patient the chance to rehabilitate the new hip.
Joe's most damaged hip was replaced in June. The surgery, which only lasted about 45 minutes, went very well with no complications. Recovery time was about two hours. He stayed in the hospital two nights and was released with a walker. After one week, the incision pain was almost gone. Walking was still difficult, though, since the other hip was in bad shape.
Two months later, he had the second hip replacement. The surgery lasted a little longer, about 1 1/2 hours, because it took longer to match the exact size replacement that would make his legs the same length. Recovery room time was two hours again, and he stayed another two nights in the hospital.
Medical Equipment and Supplies for Hip Replacement Recovery
If you have a hip replacement, these are some types of medical equipment that may be used during your recovery:
- wheelchair if both hips are replaced at once
- portable raised toilet with side handles
- pressurized leg wraps
- anti-embolism stocking (prevents blood clots)
- electronic thermal pack system (keeps incision area cool to reduce swelling)
- handheld rope machine to help you put on your socks
- plastic urinal to use at night
Hip Replacement Recovery
After each hip replacement surgery, recovery was very quick. The day after surgery, a physical therapist had Joe walking around the hospital corridors with a walker. Once home, he had an in-home physical therapist that gave him specific exercises to perform. After about ten days, he was able to travel to his physical therapy appointments. There, the therapists usually massaged his incision area to loosen knots and then worked on exercises to increase his mobility.
For two weeks after each surgery, Joe took pain medication and a blood thinner to prevent blood clots. He had difficulty getting comfortable at night in a sleeping position, because his bed was too firm and the sofa was not much better. Finally, he found that sleeping on an air mattress worked best.
After ten days, he had a follow-up appointment with his doctor which included x-rays. There were not any staples to remove this time, because surgical glue had been used for the 8 inch incision. The next follow-up appointment was at six weeks.
Putting on a Sock After Hip Replacement Surgery
Medical Equipment PhotosClick thumbnail to view full-size
Medical Equipment for Hip Replacement Recovery
At home, Joe used a walker for about a week. Stairs were a challenge, as was sitting on a commode. The hospital sent him home with a raised portable toilet that could stand alone or be stationed right above a regular commode. After one week, Joe, was able to manage the regular toilet.
Another piece of equipment that was very beneficial was the pressurized leg wrap and ice pack system (VascuTherm). This machine was used in the hospital, and then it was sent home with Joe for about three weeks. While he was in the hospital bed, the machine was connected to leg wraps that inflated and deflated around the calves. This process kept the blood circulating and prevented blood clots. Once home, the machine was hooked up to a localized thermal pack that cooled and helped a lot with swelling of the incision site.
After the first hip replacement, Joe had difficulty putting on socks. He mentioned that to a nurse on the second hospital stay and she sent him home with a neat rope gadget that allowed him to put socks on himself. The sock is attached to a flat plastic piece and then ropes allow you to lower the sock down to foot level. Pull the ropes up and the sock slides on. See photo above.
Life After Hip Replacement
Joe now has no pain and is able to walk normally. He does not have 100% mobility in his hips, meaning that he cannot bend and squat as easily as before. He was advised that these new hips should last about 30 years, which is a big improvement to what was being used a few years ago. The ceramic femoral head and high-quality plastic lining contribute to the predicted long life.