If the hip has been damaged by arthritis, fracture or other conditions, common activities such as walking or sitting in a chair can be painful.
If medications, changes in the patient's daily activities, and the use of walking stands do not adequately help improve their symptoms, they may consider hip replacement surgery as an option. It is a safe and effective procedure that can relieve pain and increase movement.
Held for the first time in 1960, hip replacement surgery is one of the most successful operations. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Health Research and Quality, more than 300,000 total hip replacements are performed each year in the United States.
How Hip Replacement Surgery Is Performed
In a total hip replacement (also called arthroplasty or total hip prosthesis), damaged bone and cartilage are removed and replaced with prosthetic components.
The damaged femoral head is removed and replaced by a metal rod placed in the center of the femoral shaft. The femoral stem can be cemented or snap-fit into the bone. A metal or ceramic ball is placed on the top of the stem to replace the damaged femoral head that was removed. The surface of the damaged cartilage of the acetabulum is removed and replaced by a metal cup. Sometimes screws or cement are used to hold the cup in place. A plastic, ceramic or metal spacer is inserted between the new ball and the coty to allow a smooth gliding surface.
Candidates to undergo hip replacement surgery
There are no absolute age or weight restrictions for total hip replacements. Recommendations for surgery are based on the patient's pain and disability. Most patients who undergo this intervention are between 50 and 80 years old, but orthopedic surgeons evaluate patients individually.
Total hip replacements have been successfully performed at all ages, from the young adolescent with juvenile arthritis to the elderly patient with degenerative arthritis.
When surgery is recommended for hip replacement
There are several reasons why a Traumatology specialist can recommend hip replacement surgery. People who benefit from it often have:
- Hip pain that limits everyday activities such as walking or flexing.
- Pain in the hip that continues while resting, either day or night.
- Stiffness in the hip that limits the ability to move or lift the leg.
- Inadequate relief of pain from anti-inflammatory drugs, physical therapy or walking aids.
The orthopedic surgeon will review the results of the patient evaluation and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options such as medications, physical therapy, or other types of surgery may also be considered.
Realistic Expectations of Hip Replacement Surgery
An important factor in deciding whether to perform a hip replacement surgery is to understand what the procedure can and can not do. Most people who undergo this surgery experience a dramatic reduction in hip pain and a significant improvement in their ability to perform common activities of daily living.
With normal use and activity, the material between the head and the hip of each hip replacement implant begins to wear out. Excessive activity or overweight can accelerate this normal wear and tear and make the replacement loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping or other high-impact sports.
Suggested activities include unlimited walks, swimming, golf, driving, hiking, biking, dancing and other low impact sports. With proper modification of activity, hip replacements can last for many years.
Procedure of the intervention
The surgical procedure lasts between 1 and 2 hours. The orthopedic surgeon will remove damaged cartilage and bone and then place new metal, plastic or ceramic implants to restore alignment and function of your hip.
After surgery, the patient will be transferred to the recovery room where he will remain for several hours while supervising his recovery from anesthesia. After waking up you will be taken to your hospital room.
The success of the surgery will depend, to a large extent, on how well the patient follows the instructions of his orthopedic surgeon regarding home care during the first few weeks after surgery.
Wound Care After Hip Replacement
The patient may have sutures or staples that run along his wound or a suture under his skin. Sutures or staples will be removed approximately 2 weeks after surgery. This should prevent the wound from getting wet until it has been completely sealed and dried. You can continue to bandage the wound to avoid irritation of clothing or support stockings.
Diet and exercise to follow after a hip replacement
Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. The patient should be sure to drink plenty of fluids.
Exercise is an important component, particularly during the first few weeks after surgery. The patient should be able to resume most of the normal light activities of daily living within 3 to 6 weeks after surgery.
The program of activities should include:
- Walk to slowly increase your mobility, initially at home.
- Restarting other normal household activities, such as sitting, standing and climbing stairs.
- Specific exercises several times a day to restore movement and strengthen the hip. It is likely that the exercises can be performed without help, but the experience of a physiotherapist can come well the first few weeks after the surgery.
Possible Complications of Hip Replacement Surgery
The complication rate after surgery is low. Serious complications, such as infection, occur in less than 2% of patients. Major medical complications, such as heart attack, occur less frequently. However, chronic diseases can increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit complete recovery.
The infection can occur superficially in the wound or around the prosthesis. Minor wound infections are usually treated with antibiotics. Severe infections may require further surgery and prosthesis removal. Any infection in the body can spread to your joint replacement.
Blood clots may also form in the veins of the legs or pelvis, and they are one of the most common complications. These clots can pose a risk if they spread to the lungs. The orthopedic surgeon will outline a prevention program that may include antiplatelet medications or low molecular weight heparin, inflatable leg stockings, ankle pump exercises, and early mobilization.
- Inequality of leg length
Sometimes one leg may feel longer or shorter than the other. Some patients may feel more comfortable with a shoe lift after surgery.
- Dislocation of prosthesis components
This happens when the ball comes out of the cup. The risk of dislocation is greater in the first months after surgery while tissues are healing. Closed reduction can solve the problem without further surgery. In situations where the hip continues to dislocate, additional surgery may be necessary.
- Implant wear
Over time, the prosthesis may wear out or become loose. This occurs more often because of everyday activity. It may also be due to a biological thinning of the bone called osteolysis. If the loosening is painful, a second surgery may be necessary.
- Other complications
Injury to the nerves and blood vessels, bleeding, fracture and stiffness. In a small number of patients, there may be persistent pain after surgery.