TOTAL HIP REPLACEMENT SURGERY

The demand for hip replacement surgery has increased rapidly in the last ten years. According to the Journal of Biomedical Materials Research, globally and every year, more than a quarter of a million patients with severely deteriorated hip joint are benefitted with satisfactory outcomes after a hip replacement surgery. The reason is progress in surgical management and improved pre and post-operative care.

Hip joint can be damaged by fracture, sudden fall, arthritis or other conditions, which causes severe pain and difficulty in performing normal daily activities such as walking, standing, or getting in and out of a chair. The hip joint can feel so still and painful that even sleeping and resting may become difficult. When the damage is such that conservative treatment methods fail to give further relief, hip replacement becomes the last and best alternative to improve the quality of life in such patients.

The hip jointis a synovial type of joint known as ball-and-socket joint. It is one of the largest joints in the body that bears the whole body weight, including the exertion of the hip and leg muscles, allowing you to do the activities like walking, running, and jumping. It is also one of the most flexible joints that enables the greatest range of motion just like your shoulder joint, when compared to the other joints of the body.

Total hip replacement was first performed effectively by Charnley in the 1960's. Hip replacement or total hip arthroplasty is a surgical procedure to replace the damaged hip bone and cartilage with an artificial joint or prosthesis.

Typical steps involved in a total hip replacement are:

  • The surgeon will first remove the damaged femoral head and replace it with a metal stem. The metal stem should be placed into the empty center of the femur by cementation or fitted under pressure into the bone.
  • Then, the upper part of the stem is replaced with a ceramic or metallic ball, which will work as the femoral head for the patient.
  • Now, the damaged cartilage surface of the socket is replaced with the metallic socket. The surgeon may sometimes use the screws or cement to keep the socket in alignment, if required.
  • A spacer, made up of metal, plastic, or ceramic is placed between the socket and the new ball, which provides a smooth gliding surface.
  • hip joint structure

    Indications for Hip Replacement

    Hip replacement is suggested when there is:

  • Damage to the joint surfaces leading to pain.
  • Immobility due to pain.
  • Deformities.
  • Osteoarthritis of the hip joint.
  • Rheumatoid-arthritis of the hip.
  • Traumatic arthritis.
  • Congenital dislocation of hip.
  • Avascular necrosis.
  • Bone or joint tumors.
  • hip joint bones damaged by osteoarthritis

    Hip Replacement Surgery Contra-Indications

    Conditions when hip replacement surgery is not usually suggested:

  • Infection in or around the hip
  • Severe diseases of muscles, nerves
  • Uncontrolled diabetes mellitus
  • Heart diseases
  • Lung diseases
  • Neurological conditions
  • Vascular disease and other
  • Systemic diseases
  • Candidature of Hip replacement surgery:

    Though there is no age or weight related limitation of hip replacement surgery, research has shown that obesity generally causes a higher risk of post-surgery complications. With respect to age, since artificial joints usually last about 15-20 years, if surgery is performed at a younger age, revision surgeries may be required in the later age. Usually, the recommendation for hip replacement is given after weighing potential benefits such as lowering the patient's pain and disability against various risks. Most of the patients who undergo the procedure are between the ages of 50-80 years. Before heading to the surgery, the surgeon evaluates the eligibility of the patients for the procedure. He or she will suggest you some diagnostic tests listed below to assess your eligibility for the hip replacement surgery. Obtaining additional medical opinions from other surgeons may help a patient become certain about the need to undergo a surgery.

    osteoarthritis deformed hip joint

    Eligibility Assessment for Hip Replacement Surgery

    Your orthopedic surgeon will advise you to go for the following tests before the procedure:

  • Complete blood examination.
  • Renal function tests.
  • Liver function test (LFT).
  • Complete urine analysis.
  • Assessment of cardiac and respiratory function .
  • Assessment of mineral density of bones for osteoporosis.
  • X-rays of both the limbs from hip to the ankle joint taken in two planes.
  • CT scan or MRI of the hip may also be required.
  • diagnosis of hip joint deformity through x-ray

    Alternatives To Hip Replacement Surgery

    Non-surgical treatments:

    Conservative methods are recommended for the patients with hip problems due to osteoarthritis or other conditions.

  • Weightlose or maintenance of a healthy weight
  • Physical therapy
  • Using of assistive device (such as a cane or walker)
  • Pain-relieving medications
  • Glucocorticoid injection into the painful joint.
  • Surgical treatments

    Few surgical alternatives to total hip replacement exist such as hip osteotomy and Birmingham hip resurfacing.

    Complications after Hip Replacement:

    About 1 in 9 of all total hip replacements requires revision within 10 years, of which, 70 percent revisions are mostly done due to the wear-related complications. Some of the common post-operative complications are.

  • Postoperative pain
  • Urinary tract infection or retention of urine: urinary catheterization for the operation is routine and can lead to these.
  • Thromboembolism.
  • Chest infections.
  • Post operative implant fractures.
  • Dislocation of the hip.
  • Wound infection or dehiscence.
  • Infection of the prosthesis.
  • Particle disease: a foreign-body reaction to implant debris causes focal osteolysis.
  • Implants used in hip replacement:

    The implants used during the hip replacement surgery, are:

  • Prosthetic head.
  • Femur bone (upper part).
  • A hemispherical shaped cup to replace the acetabulum (cup shape).
  • The pelvis socket in which the femoral head fits.
  • structure of an artificial hip joint

    However, some patients may require hip resurfacing, where the head and neck of the femur are not removed. Instead, the surgeon resurfaces or sculpts the femoral head to attach with a metal cap for a short term. Hip resurfacing is one of the most successful and popular procedure performed in the male patients under the age of 55.

    Exercises after Hip Replacement:

    Regular exercises are recommended to improve the normal hip motion and strength and for the gradual return to the everyday activities. The orthopedic surgeon and a physiotherapist recommend some exercises for 30 minutes, 3 times a day, during your early recovery period.

    Some of the exercises are:

    Ankle pumps:

  • Push your foot up and down.
  • Repeat exercise for several times as often as every 10 minutes.
  • This exercise can be started after the surgery and should be continued until you are fully recovered.
  • ankle pump exercise

    Ankle rotation:

  • Move your ankle joint inward toward your other foot and then outward away.
  • Repeat 5 times in each direction, 4 times a day.
  • ankle rotation exercise

    Bed supported knee bends:

  • Move your heel toward your hip, bending your knee and keeping your heel on the bed. Do not let your heel touch the bed.
  • Repeat 10 times, 4 times a day.
  • supported bending of knee

    Buttock contractions:

  • Contract buttock muscles and count till 5, and then relax.
  • Repeat 10 times, 3 or 4 times a day.
  • buttock contraction exercise

    Abduction exercises:

  • Move your leg out to the side as far as you can and then back.
  • Repeat 10 times, 4 times a day
  • hip abduction exercise

    Quadriceps set:

  • Tighten your quadriceps muscles, try to straighten your knee. Hold it for 10 sec.
  • Repeat this exercise 10 times in a 10 minute period.
  • Continue until your thigh feels fatigued.
  • quadricpes exercise

    Straight leg raises:

  • Tighten your quad muscles with your knee fully straightened on the bed.
  • Keeping the quad muscles tightened, lift your leg several inches off the bed.
  • Hold it for 5 seconds, then slowly lower.
  • Repeat until your thigh feels fatigued.
  • straight leg exercise

    Stand knee raises:

  • Lift your operated limb by flexing the knee joint.
  • Do not lift your knee higher than your waist.
  • Hold for 3 counts and then put your leg down.
  • Repeat it for 10 times, thrice daily.
  • standing knee exercise

    Standing hip abduction:

  • Hip, knee, and foot should point straight forward.
  • Your body and knee should be straight, lift your leg to the side.
  • Lower your leg so your foot is back on the floor.
  • Repeat it for 10 times; 4 times a day.
  • standing hip abduction

    Standing hip extensions:

  • Lift your operated leg backward slowly.
  • Try to keep your back straight, hold it and count till 3, and then return your foot to the floor.
  • Repeat it for 10 times; 4 times daily.
  • standing hip extension

    Precautions after hip replacement

    First of all, it is very important to avoid over-working and putting full weight on the joint during the recovery period. In addition, you should follow some precautions to prevent the unwanted complications, such as:

  • Do not cross your legs or turn them inward.
  • When you lie on side, put a pillow between the legs.
  • Avoid flexing your hip, when you want to reach to some objects.
  • You should use assisted tools for reaching objects.
  • Always sit only on the elevated chairs.
  • Always move carefully to prevent a fall.