Managing Avascular Necrosis: Exercise, Hip Replacement Success, and Pain Relief

Issues related to ischemic necrosis of the hip joint and postoperative outcomes of secondary or tertiary hip arthroplasty?

1.
Due to previously being ill and taking a large amount of corticosteroids, I am now suffering from avascular necrosis (stage II to III, with slight collapse of the bone).
I have undergone decompression surgery, and the pain has improved somewhat, but it still persists, especially in humid conditions and during winter.
Since my hip joint hurts, I haven't exercised in a long time.
I'm afraid that not exercising will lead to weight gain, increasing the pressure on my hip joint, as well as muscle loss in my glutes and legs, making it harder for me to climb stairs and increasing the risk of hip joint impingement.
I would like to ask the doctor what exercises I can do besides dietary control.
Is swimming or cycling advisable?
2.
I would like to ask the doctor, since I am still young, how many years it might be before I need to undergo hip replacement surgery.
The ideal lifespan of a single replacement is about 20 years, and with each subsequent replacement, the lifespan decreases.
Therefore, I might need to go through at least three replacements.
What is the success rate for undergoing three replacements? Will I be completely unable to walk when I am older?
3.
I would like to know if, six months after hip replacement surgery, I can engage in normal activities as I did before the injury.
Will there still be limitations in the range of motion similar to the first three months post-surgery? Also, will my hip joint still hurt during winter or in cold weather after the surgery, or will the pain be completely gone after the replacement, only to return when a second replacement is needed?
4.
Is the risk of infection high after hip replacement surgery? I would like to know what percentage of patients in Taiwan experience infections after hip replacement surgery, and what measures can be taken to prevent infections? Thank you for your answers, doctor.

Miao, 20~29 year old female. Ask Date: 2020/05/22

Dr. Shi Guozheng reply Orthopedics

1.
You can choose low-impact exercises, such as swimming.

2.
Current technology allows for the use of better materials, which may last around 30 years; however, the survival rate for subsequent replacements decreases to about 85%.

3.
Typically, patients will almost return to normal function three months post-surgery, with activity restrictions lasting about three to six months.
After recovery, patients usually do not experience pain again, unless there is a loosening of the implant in the future.

4.
The infection rate is approximately 0.1%.
It is important to keep the wound clean, and any infections in other organs or skin should be treated immediately.
If dental work is necessary, antibiotics should be taken beforehand as a preventive measure.

Reply Date: 2020/05/22

More Info

Managing avascular necrosis (AVN) can be a complex process, especially when it involves the hip joint. Your concerns about exercise, the potential need for hip replacement surgery, and the associated risks are valid and require careful consideration. Let’s address your questions one by one.

1. Exercise Options: Given your condition and the pain you experience, particularly in damp and cold weather, it’s crucial to engage in low-impact exercises that minimize stress on your hip joint while promoting muscle strength and flexibility. Swimming is an excellent option as it provides resistance without putting weight on your joints. Water aerobics can also be beneficial. Cycling, particularly on a stationary bike, is another low-impact exercise that can help maintain cardiovascular fitness and strengthen the muscles around your hip without excessive strain. Additionally, gentle stretching and strengthening exercises focusing on the hip and surrounding muscles can be beneficial. Always consult with your healthcare provider or a physical therapist before starting any new exercise regimen to ensure it’s safe and appropriate for your specific condition.

2. Hip Replacement Surgery: It’s understandable to be concerned about the longevity of hip replacements, especially if you anticipate needing multiple surgeries throughout your life. Generally, the success rate for hip replacements is high, with many patients experiencing significant pain relief and improved function. The lifespan of a hip implant can vary based on factors such as your activity level, weight, and overall health. While it’s true that each subsequent replacement may have a shorter lifespan than the previous one, many patients can still maintain a good quality of life. It’s essential to follow your surgeon's advice regarding activity levels post-surgery to maximize the longevity of your implant. Regular follow-ups with your orthopedic surgeon can help monitor the condition of your hip and address any concerns early on.

3. Post-Surgery Activity Levels: After a hip replacement, many patients can return to normal activities, but this can vary based on individual circumstances and the extent of the surgery. Typically, after six months, many patients experience significant improvements in mobility and can engage in a wider range of activities. However, some may still have limitations in range of motion compared to a healthy hip. Pain can persist in some cases, particularly in colder weather, but many patients report a significant reduction in pain levels compared to their pre-surgery condition. It’s essential to manage expectations and understand that while many patients experience relief, some may still have occasional discomfort, especially during weather changes.

4. Infection Risks: The risk of infection following hip replacement surgery is a concern, but it is relatively low. In general, the infection rate for hip replacements is estimated to be around 1-2%. Factors that can increase the risk include obesity, diabetes, and smoking. To minimize the risk of infection, it’s crucial to follow your surgeon’s pre-operative and post-operative instructions carefully. This may include taking antibiotics before dental procedures or other surgeries, maintaining good hygiene, and attending all follow-up appointments. If you notice any signs of infection, such as increased redness, swelling, or fever, it’s essential to contact your healthcare provider immediately.

In summary, managing avascular necrosis involves a multifaceted approach that includes appropriate exercise, understanding the implications of potential surgeries, and being vigilant about post-operative care to minimize risks. Always maintain open communication with your healthcare team to tailor a management plan that suits your individual needs and lifestyle.

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