“All you need to know about Hip Replacement Surgery”
— Get Well in India
Total Hip replacement surgery, also called as Hip Arthroplasty is a surgical procedure which removes the damaged or diseased parts of a hip joint and replaces them with an artificial one. The artificial joint is called a Prosthesis.
Total hip replacement surgery is done when all other treatment options like physiotherapy, medicines, steroid injections have failed to provide you with adequate relief and you are unable to perform your common everyday activities such as walking or getting in and out of a chair or you have developed stiffness in the hip area or you are feeling very uncomfortable while walking or even resting. In such a case you may consider having a hip replacement surgery.
The hip gets damaged by arthritis or a fracture, or any injury or any other condition. This condition occurs when cartilage on the end of the bone begins wearing away causing pain and stiffness. It happens over a period of time and when the cartilage wears away completely, the bones rub directly against each other and hip replacement is needed.
Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion and help you get back to your normal activities.
Dr. Kaushal Malhan
Knee Replacement Surgeon
Dr. Shreedhar Archik
Hip Replacement Surgeon
The hip joint is second largest weight-bearing joint in the body after Knee. During walking our body weight stresses on the hip and that stress can be five times the person’s weight. If your hip is healthy then it can support your weight and allow you to sit, walk, run without any pain.
The hip is a ‘ball-and-socket’ joint at the juncture of leg and pelvis. The hip comprises of three major components:
- Head of femur (or the Thigh bone)
- Acetabulum (a cup shaped socket in the pelvis)
- Ligaments (connecting ball to the socket)
The rounded head of the femur (or the thigh bone) forms the ball, which fits into the acetabulum (a cup-shaped socket in the pelvis) of the pelvis. This ball and socket design is what allows the poly-axial movement seen at the hip. The hip is made up of the pelvis and the femur. The pelvis is formed by three bones; the ischium, ilium and pubis.
The femur is the longest and strongest bone in the human body. The acetabulum is cup-shaped providing the articular surface for the head of femur to move within. The head of the femur is gripped by the acetabulum beyond its maximum diameter. The head of the femur and the inner part of the acetabulum are covered with a layer of hyaline cartilage.
The hip joint is a very sturdy joint because of the fit between the femoral head and acetabulum as well as strong ligaments and muscles at the joint. Other components of the hip assist in the mobility of the joint. Damage to any single component can negatively affect your motion and weight-bearing mechanism of the hip.
If you can imagine of the hip joint in layers, the deepest layer is the bone, followed by ligaments of the joint capsule and then the tendons and muscles are on the top. Nerves and vessels supply the muscles and bones of the hip. The hip joint capsule is a dense, fibrous structure which includes ligaments which help give stability of the hip.
The most common cause of chronic hip pain is Arthritis like Osteoarthritis, Rheumatoid arthritis, and Traumatic arthritis are the most common forms of this disease.
- Osteoarthritis: In this, the cartilage cushioning the bones of the hip wears away from friction in the joint due to many years of use causing acute hip pain and stiffness. Osteoarthritis may also be caused or accelerated by deformity since childhood.
- Rheumatoid arthritis: This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. The membrane produces excess synovial fluid thereby damaging the cartilage, leading to pain and stiffness. Rheumatoid arthritis falls in the most common type of a group of disorders called ‘Inflammatory arthritis’.
- Post-traumatic arthritis: This can result from a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
- Avascular necrosis: This is also called Osteonecrosis. This happens when there is a limited supply of blood to the femoral head due to any injury to the hip, such as a dislocation or a fracture. The lack of blood may cause the surface of the bone to collapse, and as a result arthritis.
- Childhood deformity: Some infants and children have hip problems where the hip may not grow normally affecting the joint surfaces.
If you have tried the non-operative treatments and you are still suffering from acute hip pain then watch for the signs mentioned below:
- Acute hip pain that limits everyday activities, such as walking or bending.
- Hip pain that continues while resting.
- Stiffness in a hip that limits the ability to move or lift the leg.
- Inadequate pain relief from anti-inflammatory drugs, physical therapy or walking supports.
- Groin pain which keeps you awake.
Your doctor will do some physical examinations to assess the mobility, alignment and strength of your hip area. He will also ask you to take an x-ray to find out the extent of damage in your hip. He may later ask you to go for magnetic resonance imaging (MRI) scan, to determine the condition of the bone and soft tissues of your hip.
Your orthopaedic surgeon will look at the results of the tests and will discuss with you the prospects of getting the hip replacement surgery done so as to relieve you from the constant pain and improve your mobility. He may suggest alternative treatments too such as medications or physiotherapy. And if nothing works out the best for you then he might recommend hip replacement surgery as the last resort.
Surgical Procedure Details
Before your surgery, an anesthetist will visit you to explain to you about the types of anesthesia. The most common types of anesthesia is general anesthesia (where you are put to sleep) and the other type is spinal, epidural, or regional nerve block anesthesia (where you are awake but your body is numb from the waist till ankle). The anesthesia team, with your inputs, will determine which type of anesthesia will be best for you.
During the operation, your orthopedic surgeon will make an incision (around 20 to 30 cm long) over your hip and thigh. They will then divide your hip muscles and separate (dislocate) your ball and socket joints.
Then they will remove the ball at the top end of your thigh bone (or femur) and put a replacement ball on a stem into your thigh bone. They will then hollow out your hip socket to make a shallow cup and put an artificial socket into it. Your orthopedic surgeon will then put your hip joint back together (i.e. they’ll put the ball into the socket).
Finally, they will close the incision made in your skin with stitches or clips and cover it with a dressing.
A hip replacement operation usually takes an hour or two.
The success of your surgery will depend on how well you follow your diet and exercise regime during the first few weeks following your surgery. Majority of people experience a dramatic reduction in pain and resume functional activities after Hip Arthroplasty.
Blood Clot Prevention: After your surgery, you will be at a greater risk of having blood clots in your legs. Below are the possible measures to prevent this complication:
- Walking: You need to walk with crutches or a walker post surgery, ideally on the same or the following day.
- Wear stockings: During the day of the surgery and after surgery, you may wear elastic compression stockings or inflatable air sleeves similar to a blood pressure cuff on your lower legs. The pressure exerted by the inflated sleeves helps keep blood from pooling in the leg veins and so blood clots aren’t formed.
- Blood-thinner: You might be prescribed with an injected or oral blood thinner after surgery. Depending on how early you walk, how active you are and considering other things, you may need blood thinners for several more weeks after surgery.
You may stay in the hospital for four to six days following your Hip Arthroplasty. You will be prescribed painkillers to reduce your pain and make you feel as comfortable as possible. Your doctor may use several methods to prevent blood clots and swelling.
Walking, hip movements and exercise, as recommended by your doctor and physiotherapist will play a major role in your recovery. You will probably begin physiotherapy the day after your surgery. Your pain will be controlled with medicine so that you can participate in the exercise. You will be discharged home or you might have to go to rehabilitation center. In either case, your physiotherapy won’t stop until you regain muscle strength and good range of motion.
You need to keep your surgical area clean and dry. You need to notify your doctor if you experience fever, pain, swelling, bleeding, tenderness, drainage from the incision site or you notice any other issue.
You need to take utmost care while walking or bending. You might not be allowed to drive and limit certain activities till you recover fully. A fall can damage the new joint, so take your own time to do things till you get a hang of it. You might need to use a walker or crutches, depending upon your condition.
Eat well-balanced meals and make sure to do your exercises everyday as it might take over a year for your muscles to become strong. Also remember to elevate both of your legs when sitting to minimize swelling.
- No pain: Your new joint should allow you to be more active. Providing painless standing, sitting, walking and bending. It should increase range of motion in your joint.
- No stiffness or impaired movements: This allows you to perform range of tasks including sport, swim and other activities.
- Restore quality of life: Your ability to move again, sit comfortable, bend without pain will enhance the quality of your life.
- Best Technology available: Best available technology has led to the development of long lasting materials used in the surgery which lasts for many years.
- Excellent chance of success: Hip replacement surgery has one of the highest success rates when compared to other forms of surgery. The mortality rates associated with this surgery are very low, and have decreased further in recent years.