A hip replacement is a surgical procedure that includes the removal and replacement of portions of an injured hip joint either with an artificial joint or implant. It is aimed to relieve extremely severe hip pain and stiffness caused by hip arthritis and to improve function.
The implants used in this procedure are as follows:
- The Stem, which is made out of metal (either titanium or cobalt-chrome), is inserted into the thighbone.
- The Ball, which is usually made out of polished metal or ceramic, fits on top of the stem.
- The Socket is a combination of a plastic liner and a cobalt-chrome or titanium backing.
Hip implants generally last for around 13 to 15 years. After this time period, the patient undergoes another surgery which is known as Hip revision surgery.
Reasons for Hip Replacement Surgery
There are several conditions involved in hip degeneration, thereby making hip replacement surgery necessary.
- Osteonecrosis: In case of disrupted blood supply to the ball portion of the hip joint, resulting mainly from a dislocation or fracture, the ball might collapse and deform.
You might consider hip replacement if you have:
- Persistent pain in spite of medication
- Worsening pain in the hip while walking
- Inability to climb stairs
- Difficulty to rise from a seated position
Types of Hip Replacement Surgery
The three major types of hip replacement are:
- Total hip replacement
- Partial hip replacement
- Hip resurfacing
Total Hip Replacement: Most commonly performed hip surgery which involves worn-out or damaged areas of the hip being replaced with artificial implants. During the procedure, the doctor inserts a stem into the patient’s femur for stability. The head of the femur is replaced with a ball made up of metallic or ceramic alloy and the natural socket in the hip joint is replaced with a durable plastic cup.
Hemi Hip Replacement (Hip hemiarthroplasty): This procedure involves the removal and replacement of the patient’s femoral head only. It does not replace the socket. Surgeons typically perform this surgery in old age patients to repair certain types of hip fractures.
Hip Resurfacing: Hip resurfacing helps to relieve pain from cartilage loss. It involves resurfacing of the femoral head and socket. Most commonly performed in younger patients.
Diagnosis Before Hip Replacement Surgery
The diagnosis of patients requiring this procedure is mostly symptom-oriented which includes pain, loss of range of motion, and functional impairments in activities of daily life.
Apart from those certain special investigations like X-Ray, CT scans, and MRI is carried out to know the exact level of damage involved.
Hip Replacement Surgery Procedures
Hip replacement surgery can be performed in two ways namely traditional hip replacement and minimally invasive technique.
Traditional hip replacement
During Traditional hip replacement, the patient is given anesthesia at first. The doctor makes an incision along the side of the hip and dissects the muscles to expose the hip joint. After this, the ball portion of the joint is removed by cutting the femur with a saw. Then an artificial joint is attached to it using either cement or uncemented implants that allows the remaining bone to attach to the new joint.
The doctor then prepares the surface of the hipbone by removing any damaged cartilage and attaches the replacement socket part to the hipbone. The new ball part of the femur is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.
Minimally-invasive hip replacement
In the minimally-invasive approach, doctors make one to two incisions from 2 to 5 inches long. The same procedure is performed through these small cuts as with standard hip replacement surgery. The small incisions are mainly aimed to limit blood loss, ease pain after surgery, shorten hospital stays, reduce scar appearance, and accelerate healing.
Risk Associated with Hip Replacement Surgery
Generally, hip replacement surgery does have a very good prognosis. However, like all other surgeries, this also has some risks associated with it. These are as follows:
- Blood clots in the legs or lungs
- Injury to associated nerves
Recovery After Hip Replacement Surgery
Recovery after hip replacement surgery starts immediately and the patient is encouraged to get up and move around as soon as possible after surgery. Six to eight weeks of intense physiotherapy regime is required by the patient to improve muscle strength and range of motion.
While in the recovery stage, patients need to be sure about the following things:
- Don’t moist the surgical area. Keep it clean and dry. The doctor will give specific bathing instructions
- Take all medications as directed
- Keep all the follow-up appointments with your surgeon
- Attend physical therapy and complete home exercises
- Resume your normal diet unless otherwise instructed
- Do not drive until your doctor says it is safe to do so
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- What is total hip replacement (THR)?
Total hip replacement, also known as total hip arthroplasty, is a procedure in which a damaged or diseased hip joint is replaced with a prosthesis to relieve pain and improve function.
- Why is total hip replacement performed?
Total hip replacement is performed to alleviate chronic hip pain and improve mobility in individuals with conditions such as osteoarthritis, rheumatoid arthritis, avascular necrosis, hip fractures, or other hip joint degenerative disorders.
- How is total hip replacement surgery performed?
During the procedure, the surgeon removes the damaged hip joint components, including the femoral head and acetabulum, and replaces them with prosthetic components made of metal, plastic, or ceramic.
- Who is a candidate for total hip replacement?
Candidates for total hip replacement are typically individuals with significant hip joint pain, stiffness, and functional limitations that do not respond well to conservative treatments like medication, physical therapy, or lifestyle modifications.
- What are the different types of hip prostheses used in total hip replacement?
Hip prostheses used in total hip replacement can be categorized as cemented, uncemented, or hybrid (a combination of cemented and uncemented components). The choice of prosthesis depends on various factors, including the patient's age, bone quality, and surgeon's preference.
- How long does a total hip replacement last?
The longevity of a total hip replacement varies between individuals and depends on factors, including the patient's activity level, overall health, and the type of prosthesis used. On average, modern hip replacements can last 15-20 years or longer.
- What are some potential complications of total hip replacement surgery?
Complications of total hip replacement may include infection, blood clots, dislocation, implant loosening, nerve injury, or joint stiffness. The risk of complications is generally low but can vary based on individual circumstances.
- How long does it take to recover from total hip replacement surgery?
The recovery period for total hip replacement surgery varies, but most patients can resume light activities within a few weeks and achieve full recovery in about 3-6 months. However, individual recovery rates may differ.
- Can physical therapy help in the recovery process after total hip replacement?
Physical therapy is an integral part of the recovery process after total hip replacement. It helps improve strength, flexibility, and mobility, facilitating a successful return to normal activities.
- When can I resume driving after total hip replacement?
Most patients can resume driving 4-6 weeks after total hip replacement surgery. However, this varies depending on the individual's progress and the specific guidelines provided by the surgeon.
- Can total hip replacement be performed using minimally invasive techniques?
Yes, some surgeons perform total hip replacement using minimally invasive techniques that involve smaller incisions. Minimally invasive approaches may lead to shorter hospital stays and faster recovery for some patients.
- Can total hip replacement be performed on younger patients?
Total hip replacement can be performed on younger patients with hip joint conditions that significantly impact their quality of life. However, the decision to proceed with surgery in younger patients is carefully considered due to the potential for prosthetic wear and the need for future revisions.
- Can total hip replacement be performed on obese patients?
Total hip replacement can be performed on obese patients. However, weight management is essential for long-term success and durability of the prosthetic joint.
- What is the role of metal-on-metal hip prostheses in total hip replacement?
Metal-on-metal hip prostheses were used in the past, but concerns about metal ion release and tissue damage have led to a decline in their use. Modern prostheses often employ alternative bearing surfaces, such as ceramic or polyethylene.
- Can total hip replacement alleviate pain in the groin and lower back?
Yes, total hip replacement can often alleviate pain in the groin and lower back caused by hip joint conditions like osteoarthritis.
- Can total hip replacement be performed using robotic-assisted technology?
Yes, some surgeons utilize robotic-assisted technology to enhance precision and accuracy during total hip replacement surgery. This technology may offer benefits in some cases but is not universally employed.
- Can total hip replacement be performed on patients with avascular necrosis of the hip joint?
Total hip replacement can be a viable treatment option for patients with avascular necrosis of the hip joint, where the blood supply to the bone is compromised, leading to bone death and joint deterioration.
- Can total hip replacement be performed if there is a history of hip fractures?
Total hip replacement can be considered for patients with a history of hip fractures that result in joint damage or osteoarthritis. The decision depends on the specific circumstances and the extent of joint damage.
- Can total hip replacement be performed on patients with rheumatoid arthritis?
Total hip replacement can be an effective treatment for patients with rheumatoid arthritis when conservative treatments have not provided sufficient relief from pain and functional limitations.
- Can total hip replacement be performed on patients with hip dysplasia?
Total hip replacement can be considered for patients with hip dysplasia experiencing significant hip pain and functional impairments. However, surgical options, like hip osteotomy, may be considered in some cases.
- Can total hip replacement be performed on patients with hip joint infections?
In most cases, total hip replacement should be delayed or avoided in patients with active hip joint infections. Infection clearance and complete resolution are essential before considering joint replacement surgery.
- Can total hip replacement be performed on patients with inflammatory joint diseases like ankylosing spondylitis?
Total hip replacement can be considered for patients with inflammatory joint diseases like ankylosing spondylitis who experience hip joint deterioration and significant functional impairment.
- Can total hip replacement be performed on patients with hip joint tumours?
Total hip replacement may be performed for patients with non-cancerous hip joint tumours or benign conditions that compromise joint function and lead to pain or joint destruction.
- Can total hip replacement be performed if a previous hip surgery failed?
Revision total hip replacement, a more complex procedure, may be considered if a previous hip surgery failed or the initial prostheses have worn out or loosened over time.
- Can total hip replacement be performed on patients with a history of metal allergies?
Patients with a history of metal allergies may be at risk of adverse reactions to certain metal components used in prostheses. Alternative materials, such as ceramic or highly cross-linked polyethylene, may be considered for such patients.
FAQs reviewed by Dr. Ramneek Mahajan, Senior Director, Orthopaedics & Head of Joint Reconstruction (Hip & Knee) Unit.
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