Hip replacement surgery, also called total hip arthroplasty is a surgical procedure in which a damaged or worn out hip joint is replaced with an artificial joint (known as a prosthesis) made of metal and plastic components. This artificial joint (prosthesis) helps in reducing pain and improves functioning of the joint, making walking easier.
REASONS FOR HIP REPLACEMENT SURGERY
Hip joint replacement is required if one (or both) of the hip joints gets damaged causing persistent pain or problems with daily activities such as walking, driving and getting dressed. There are a number of conditions which can lead to chronic hip pain and disability, leading to replacement. Of all the conditions, this surgery is mostly a preference after a hip fracture or for severe pain due to arthritis.
Common reasons causing damage to hip joint are:
Osteoarthritis, known as wear-and-tear arthritis is a degenerative joint disease that is seen with aging, congenital abnormality of the hip joint, or prior trauma to the hip-joint. It occurs when cartilage present on
the end of bone begins wearing away, leading to pain and stiffness. When the cartilage wears off completely, the bones rub directly against each other causing decreased mobility and chronic pain
Rheumatoid arthritis is an autoimmune disease, in which the synovial membrane becomes inflamed. This membrane then produces excessive synovial fluid, damaging the articular cartilage.
Traumatic arthritis results from a serious hip injury or fracture. The articular cartilage becomes damaged and, over time, causes hip pain and stiffness.
Osteonecrosis. If there is inadequate blood supply to the ball portion of the hip joint, the bone may collapse and deform.
Hip fracture, broken hips, types of hip conditions that had appeared in childhood such as developmental dysplasia, congenital dislocation of hip and Perthes disease can also lead to degeneration many years after an injury and require the need for hip replacement surgery
CANDIDATE FOR HIP REPLACEMENT
Generally any person can be a suitable candidates for a hip replacement. Candidates for this surgery are not categorized by age, class or activity level. Most of the patients are between the ages of 60 and 80, but the surgery isn't confined to the elderly patients.
Hip replacement surgery is considered if a patient is experiencing hip pain that:
Persists, in spite of having pain medication.
Worsens with walking, even with a cane or walker
Interferes with sleep
Affects the ability to go up or down stairs
Makes it difficult to rise from a seated position
Not recommended for candidates:
A hip replacement is not recommended for people who are having serious health conditions. It is not
Severe Osteoporosis , because bones may be too brittle to properly support and adhere to the new joint prosthesis
Not able to follow the pre & post-surgical instructions. For example, person suffering from dementia or alcoholism are not recommended.
Any patient suffering with an existing infection or patients who are prone to infection are also not be eligible for this surgery. As these patients are at a high risk of post – operative complications.
HIP REPLACEMENT PROCEDURE
Before the surgery patient’s vital signs are checked to make sure blood pressure, heart rate, body temperature, and oxygenation levels are normal, so the surgery can be started. A mark is made on the hip undergoing surgery.
Surgeon then makes an incision into the hip, removes the damaged cartilage and bone and then implants the prosthetic joint. The new joint may require cement or other hardware such as screws to hold it in place. Surgical procedures differ depending on the patient’s needs and the surgeon’s approach, but generally the steps are as follows:
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Recovery can take several weeks or months, depending on the patient's health and age. . There are several factors contributing to the recovery after this surgery. Most of the hip implants are expected to last from 10 to 20 years, and these implants will naturally wear down with age.
This involves the early stages of recovery that is the ability to get out of the hospital bed and be discharged from the hospital. After the surgery, patient will be shifted to the recovery room for observation. Once the patient’s (vitals) blood pressure, pulse, and breathing are stable and the patient is alert, patient will be shifted to his hospital room. Hip replacement surgery usually requires a hospitalization of 4-5 days, but this will depend on patient’s progress.
Physical therapy: within the first six weeks is very important. This is important to help strengthen the hip joint. It is recommended to do small exercises such as contracting and releasing the muscles of your legs and buttocks, and ankle pumps. It is also very important to restrict the hip movement.
POST – HOSPITAL CARE
Once the patient is back home, it is very important to follow the doctor’s instructions during the first few weeks after surgery.
Caring for the incision:
The incision is closed with staples, which will be removed around 14 days after the surgery. It is important to keep the surgical area clean and dry. Specific bathing instructions will be provided to the patient.
Physical activity is an essential part of recovery.
Within three to six weeks, the patient should be able to resume most of their day to day activities.
Using stairs can be dangerous and should be avoided any help is not present.
Devices recommended for support include a cane, crutches, walker and handrails.
Six weeks after surgery, when full hip movement is regained, driving can be started.
During the first year of the surgery, routine follow-up visits are scheduled with orthopedic surgeon. After that annual visits will be required to assess the status and function of the implant.
Doctor should be informed, if the patient reports any of the following symptoms:
Redness, swelling, bleeding, or other drainage from the incision site
Increased pain around the incision site
Numbness and/or tingling in the affected leg
A limp, or problem while walking
Grinding or clunking from the hip
Hip replacement surgery, like any other surgical procedures, carries a risk of complications. A revision surgery may be suggested if any complication occurs. Complications from hip replacement surgery includes:
Unequal leg lengths
Loosening & implant wear
Stiffness in joint
Fracture & dislocation
Blood vessel injury
Are there alternatives to hip replacement surgery?
Hip replacement surgery is often the last resort for patients. Before going for the surgery the doctor may suggest methods including exercise, walking aids and medication.
How should a patient prepare for hip replacement?
Low impact cardio exercises are a good way to prepare for hip replacement surgery. It is good to consider using an exercise bike, doing water aerobics or swimming. All these exercises helpful in surgery preparation and they can also improve the symptoms of arthritis.
What is a dislocation of the hip?
Dislocation of the hip occurs when the femoral head (ball) comes out of the acetabulum (socket).
Why do hip replacements fail?
The most common reason for failure is loosening of the artificial ball where it is secured in the femur, or loosening of the socket. Wearing of the plastic spacer may also result in the need for revision.
What is a Revision Surgery?
Revision surgery is performed when a failed hip implant can only be repaired by another surgery. Failure can stem from normal wear and tear or from a faulty device. These second procedures are consider complex and significantly invasive.
Will a patient require a blood transfusion?
Blood transfusion may be required after the surgery.
How long and where will my scar be?
The scar will be approximately 6–8 inches long. It will be along the side of your hip.
When can a patient discontinue using a raised toilet seat after the surgery?
A patient can discontinue using a raised toilet seat between 6 and 10 weeks after the total hip replacement operation.
From when can the patient sleep on his operative site after a hip replacement?
Patient can sleep on your operative side whenever they feel comfortable. They may sleep on their non-operative side at 4 weeks with a pillow between their knees.
For how long a patient needs to have a bandage after the surgery?
Bandage is required for approximately 1 week after total hip replacement surgery. This should be changed daily to a new dry, sterile gauze. If required a patient may continue to wear a bandage to protect the incision from irritation.
When can the hip be immersed in water (e.g. bathing swimming pool, tub) after the surgery?
Hip can be immersed in water after 2 weeks, if there is no drainage from the incision site.
Can weights be used after the surgery?
Usually, weights should not be used for the first 2 months after total hip replacement surgery. Still everyone's strength varies & it should be consulted by the physical therapist before starting with weights.
Can a person set off the machines at the airport security after the surgery & is a doctor note required?
A patient set off the machines at airport security depending on the type of hip implant the patient has and the sensitivity of the security checkpoint equipment. At the follow-up visit the patient may ask to have a wallet card to carry while travelling.
What activities are permitted following the surgery?
A patient may return to most of the activities which can be tolerated by him after total hip replacement surgery. This including walking, gardening, and golf. Some of the best activities to help with motion and strengthening are swimming and a stationary bicycle.
What activities should be avoided after the surgery?
The activities that should be avoided are, impact activities, such as running and downhill skiing on expert slopes, and vigorous racquet sports, such as singles tennis or squash.
For how long this hip replacement will last?
It is expected that most hips last for more than 10–15 years. But still this varies from patient to patient.
Can a patient kneel after this surgery?
Yes, a patient can kneel 6 weeks after total hip replacement surgery. To kneel, touch down with the operative knee first. To arise from kneeling, use the non-operative leg first.