Total Hip Replacement Surgery
If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting. If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
Hip replacement was first performed in 1960. Since than it has undergone lots of changes and modifications in both surgical technique and technology, thus improving its survival and functionality. Today, hip replacement surgery is one of the most successful operations in all of medicine.
The following information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.
Common Causes of Hip Pain
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis." Post-traumatic arthritis.
This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
Avascular necrosis is destruction of head of femur (ball of hip joint) due to lack of blood supply. An injury to the hip, such as a dislocation or fracture, may also limit the blood supply to the femoral head. However, this can result without any specific cause (idiopathic) in 40% of the patients, alcohol consumption, steroid use, and deceases like rheumatoid arthritis, sickle cell anaemia etc are other main causes. The lack of blood eventually causes the surface of the bone to collapse, resulting in arthritis over a period of months to years. Some diseases can also cause avascular necrosis.
Childhood hip disease
Some infants and children have hip problems like Perthe's disease, Slipped upper femoral epiphysis and Congenital hip displasia. Even though these problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components. The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the thigh bone (femur). The femoral stem may be either cemented or "press fit" into the bone. A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed. The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
Are you the right candidate for hip replacement surgery?
The decision to have hip replacement surgery should be a cooperative one made by you, your family,nand your orthopaedic surgeon. There are no absolute age or weight restrictions for total hip replacements. Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
When Surgery Is Recommended.
There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports.
- Hip pain that limits everyday activities, such as walking or bending.
- Hip pain that continues while resting, either day or night.
- Stiffness in a hip that limits the ability to move or lift the leg.
You will most likely be admitted to the hospital on the day of your surger
After admission, you will be evaluated by a member of the anesthesia team. The most commonly spinal anesthesia is preferred for hip replacement surgery (you are awake but your body is numb from the waist down). Epidural catheter is added to spinal if long surgery time is expected in revision cases. The anesthesia team, with your input, will determine which type of anesthesia will be best for you. General Anaesthesia is rarely indicated for hip replacement in patients who have spine deformity due to which regional anaesthesia is not possible.
Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic or metal, which may have an outer metal shell). The prosthetic components may be "press fit" into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on a number of factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.
The surgical procedure takes one to two hours in general. Your surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip. After surgery, you will be moved to the recovery room where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room. You can walk full weight bearing on operated limb from first post-operative day.
Possible Complications of Surgery
- Infection - there is 1-2 % risk of infection in primary hip replacement through out the globe
- Blood Clots - Deep vein thrombosis
- Leg-length Inequality - very rare and usually negligible
- Dislocation - after hip replacement is a known complications. If patient follows post-operative instructions sincerely, chances of dislocation can be greatly minimised.
- Loosening and Implant Wear - this is time related process, however, with newer bearing implant wear has been greatly reduced.