Hip Replacement Surgery

The goal of most hip replacements is to alleviate hip pain due to arthritis. During surgery, the orthopedic surgeon resurfaces the bones that form the ball-and-socket of the hip joint. When complete, the prosthetic ball fits into the prosthetic hip socket to create a new hip joint.

Contents

• Know your hip joint.
• What are the conditions that require hip replacement?
• Doctor examination before hip surgery.
• What are the treatment modalities available for my hip disease?
• When should I go for a hip replacement?
• Is my age appropriate for hip replacement?
• What should I expect after hip replacement?
• Know the hip replacement surgery

Know your hip joint (Anatomy)

• Your hip is a ball and socket joint. This means that it’s made up of 2 parts that allow for movement and rotation. 
• Your hip is made up of the femoral head, which is the top end of your femur (thigh bone), and a socket in your pelvis called the acetabulum. 
• The femoral head is a round surface that looks like a ball. It fits into the acetabulum and allows smooth movement of the hip. 
• The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily
• A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

What are the conditions that require hip replacement? 

• Osteoarthritis. 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.
• Rheumatoid arthritis. 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.
• Osteonecrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called osteonecrosis (also sometimes referred to as “avascular necrosis”). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause osteonecrosis.
• Childhood hip disease. Some infants and children have hip problems. Even though the 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

Doctor Examination before hip surgery

• Medical history. 
  • Your orthopaedic surgeon will gather information about your general health and ask questions about the extent of your hip pain and how it affects your ability to perform everyday activities.
• Physical examination. 
  • This will assess hip mobility, strength, and alignment.
• X-rays. 
  • These images help to determine the extent of damage or deformity in your hip.
• Other tests. 
  • Occasionally other tests, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your hip.

What are the treatment modalities available for my hip disease?

Non-surgical treatment options for hip pain:

• Anti-inflammatory medicines
• Glucosamine and chondroitin sulfate
• Pain medicines
• Limiting activities that are painful
• Assistive devices for walking such as a cane
• Physical therapy

What are the surgical treatment options? (Types of hip replacement)

• There are 2 types of hip replacements, a partial hip replacement and a total hip replacement.
  • In a partial hip replacement, the femoral head is removed and replaced with a metal stem that is inserted into your femur. A ball is placed on the top part of the stem. A device called a “bipolar cup” snaps on the ball of your new hip and rotates in your own hip socket.
  • In a total hip replacement, in addition to your femoral head, your acetabulum is also replaced with a metal socket. The metal socket is attached to your bone by cement, screws, or your bone itself.

When should I go for hip replacement? 

• 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
• When all the conservative treatments including lifestyle remedies, anti-inflammatory medication, physical therapy, waling supports and injections failed after trying for minimum 6 months
• Physically and mentally ready
• Someone for care is available for a minimum of 6 weeks
• Financial arrangements done
• Free/leave from work for atleast 6 weeks
• Found a good hospital with physiotherapist near your accommodation; there will be follow up visits for suture removal, rehabilitation and complications (if any)

Is my age appropriate for hip replacement?

• 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

What should I expect after hip replacement? 

• An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
• With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
• Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
• With appropriate activity modification, hip replacements can last for many years.

Know the hip replacement surgery

Preparation before surgery

• It is important to do the recommended exercise leading up to your planned surgery as this will strengthen your muscles and help in the recovery period.
• Stop smoking and decrease your alcohol intake
• Try to eat a healthy diet in the time leading up to your operation. Proper nutrition can help enhance your recovery.
• Try to prepare a recovery room preferably at ground floor with the following
  • pillows for elevating the lower leg
  • a bedside commode or urinal if the bathroom isn’t accessible
  • a bed that isn’t too high or low off the ground
  • ice packs for the knee
  • a telephone, or cellphone and a charger, to call for help
  • easily accessible, identifiable, and neatly arranged medications
  • a walker or crutches
  • writing materials to take notes or list questions for the healthcare team
  • comfortable sleepwear
  • comfortable shoes that are safe for walking around the house in
• Get all the prescribed tests and investigation before the day of surgery

What will happen in the operation theatre?

• Your anesthesiologist will give you anesthesia through your IV line (you will fall asleep) or spine (you will be semi awake). 
• Your surgeon will make an incision (surgical cut) that will run about 5 inches (12.7 centimeters) above your hip to about 6 inches (15.24 centimeters) below your hip.
• They will remove the diseased portion of your bone and replace it with your prosthesis.
• It will be fitted and fixed in place.
• During your surgery, plastic drainage tubes may be placed in the area of the replacement implant and will exit near your incision. These tubes will drain fluid from the surgical area to help reduce swelling. The drainage tubes may be stitched in place so they will not fall out. They are connected to a container that collects the drainage.
• Once your surgery is finished, your incision will be closed with staples or sutures (stitches). You may also have Steri-StripsTM (thin pieces of tape) or Dermabond® (surgical glue) over your incisions. Your incisions may be covered with a bandage.

After surgery

• After your hip replacement surgery, you must follow special hip precautions like:
  • Don’t bend at the waist or hip more than 90 degrees.
  • Don’t cross your legs while standing, sitting, or lying down.
  • Don’t rotate your operated leg (leg you had surgery on) inward. Don’t lie, sit, or stand with “pigeon-toes.”
• Physiotherapist will advise some rehabilitation exercises which are important for good recovery.
• You should be able to:
  • walk with a cane or no device in 2–3 weeks
  • drive after 4–6 weeks, depending on what the doctor recommends
  • return to a sedentary job in 4–6 weeks
  • return to a job that involves physical effort in 3 months
  • travel after 4–6 weeks, when the risk of a blood clot has reduced
  • shower after 5–7 days
  • have a bath after 4–6 weeks, when it is safe to soak the wound
• Have a balanced diet to enhance recovery.