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Hip Replacement Surgery

What is hip replacement surgery?

Hip replacement surgery is removal of damaged bone and cartilage and replacing them with prosthetic structures, which are usually made up of metal and plastic.

 

How do you know if you need to undergo hip replacement surgery?

Consider visiting your doctor if you have severe hip pain and stiffness, which limits your daily activities such as walking, sitting, squatting. Hip pain is even present at rest and is not relieved after taking pain medications.

In addition, elderly patients with rheumatoid arthritis (autoimmune disease causing severe joint pain), osteoarthritis (degenerative disease of joints) or traumatic arthritis (damage due to fall or injury) with intolerable pain should consider visiting an orthopedician.

 

Orthopedic evaluation

Your doctor/ orthopedician will perform through evaluation of your signs and symptoms before proceeding with any kind of treatment.

  • Medical history- your doctor will ask questions regarding onset of symptoms. He/she will question if you have any other existing comorbidities such as diabetes mellitus, hypertension, thyroid disorder etc.
  • Physical examination- next your doctor will perform a thorough physical examination and look for any kind of swelling, skin discoloration, tenderness or injury around the hip joint.
  • Diagnostic tests- your doctor may advise you to undergo X-ray or MRI (magnetic resonance imaging) of the hip joint to determine extent of damage to the joint and surrounding soft tissue structures. Additionally blood and urine tests may also be performed.

 

Medical decision making

After reviewing the results of your diagnostic tests (X-ray/ MRI, etc), your doctor will have a detailed discussion with you regarding the various treatment options available. Initially pain medications and steroids may be prescribed, but in case of severe damage to the joint surgery (hip replacement surgery) is recommended. Most of the patients are candidates for surgery irrespective of their age. Hip replacement surgeries have been successfully performed in both young and elderly patients. Your doctor will brief you about the procedure and its outcome. Never hesitate in asking any kind of questions to your doctor.

 

Types of hip replacement surgery

There are mainly 3 different types of hip replacement surgery. They are-

  • Total hip replacement
  • Partial hip replacement
  • Hip resurfacing

In order to understand these, let’s have a brief look at the anatomy of the hip joint. Hip joint is a ball and socket joint in which the ball shaped head to the femur fits into socket of the pelvic (acetabulum of pelvis). The joint is enclosed in a capsule and is further supported by various muscles, ligaments and tendons.

 

In case of total hip replacement surgery, (most common type) head of the femur is replaced with a ball, which is either made up of ceramic or metal alloy, while the acetabulum is replaced with a plastic cup.

Partial hip replacement also called hemiarthroplasty. In this type, only the head of the femur is replaced with a metal ball. This procedure is mainly performed in case of fractured hips in elderly patients.

Hip resurfacing involves trimming the femoral head and placing a hollow metal cap over it. The damaged cartilage and bone is also removed from the joint. This procedure is mainly performed in young and physically active individuals.

 

Preparation required prior to surgery

  • The orthopedic surgeon will do a preoperative evaluation a few weeks before the surgery is planned.
  • Review of medications will be performed and in case a patient is taking any blood thinning medicine such as aspirin, it will be discontinued.
  • Weight loss is recommended for obese patients.
  • Exercises to strengthen muscles around the hip joint should be performed preoperatively.
  • Blood tests, urinalysis, chest x ray, electrocardiogram (ECG), etc should be performed as advised by the doctor.
  • In case the reports suggest any kind of infection, severe diabetes mellitus, high blood pressure, severe heart or lung disease or any other active metabolic disorder, then surgery is deferred until the condition is resolved.

 

Can both hips be replaced at the same time?

Bilateral hip replacement surgery can be performed in healthy individuals who are less than 75 years of age and have no history of any cardiopulmonary disease. However, it may be better to stage the surgeries in certain individuals.

 

How is hip replacement surgery performed?

The surgery usually takes 1 to 2 hours. Your surgeon will start with giving anaesthesia. You may be given general, local or spinal anesthesia depending on your health status. A 8 to 10 inch cut is made along the side of the hip to expose the joint. The ball portion of the joint is cut and replaced with a prosthetic ball. Next, the socket part of the joint is prepared by removing the damaged cartilage and is replaced by a cup shaped prosthesis. The ball is pushed into the socket and the artificial joint is glued with the help of a special cement. A drain is placed which will drain out fluid and prevent postoperative swelling around the joint.

 

Recently some surgeons have been performing hip replacement surgery using minimally invasive techniques. Few of the advantages of a minimally invasive hip replacement surgery over standard hip replacement surgery are-

  • Smaller incisions (2 to 5 inches)
  • Reduced scar appearance
  • Less pain
  • Less chance of blood loss
  • Faster recovery

 

Most patients stay in the hospital for a day or two after surgery. However, for a few patients surgery can be performed as an outpatient procedure and these patients can return home on the same day.

 

What happens immediately after surgery?

After the surgery has been successfully performed, the patient is transferred to the hospital room. On waking up vitals (blood pressure, body temperature, pulse rate and respiratory rate) are taken. Wound is inspected and fresh dressing is applied. Drain is usually removed the next day. Pain medications are often prescribed for a short period. The next day the physiotherapist will make you sit in bed. He/she will also assist you in taking a few steps with the help of a walker, crutches or cane. Hospital stay may vary from 2 days to a week.

 

Next few days in hospital

You will be under close observation of your surgeon and physiotherapist for the next few days. Pain levels will be closely monitored and accordingly doses will be altered. The nursing staff will do daily wound inspection. Your physiotherapist will encourage you to perform specific strengthening and range of motion exercises for the hip joint. Walking around for short distances is also encouraged.

 

What happens after discharge from hospital? (First 3 months)

Once back home you can resume your normal diet. You should drink plenty of fluids. Certain lifestyle modifications will ease your everyday activities such as, raised toilet seat, handrails in bathroom, hand held jet/shower spray, shower seat and high chair for sitting. It is also important to declutter your house and remove any unnecessary piece of furniture, wires in the walkway, loose rugs and door mats to avoid risk of falls. Always keep the floor of the bathroom dry and keep shampoos and soaps away on a stand. Limit staircase use to only once a day. You can also resume driving after consulting your surgeon.

Continue physiotherapy after discharge from hospital for at least 6 to 8 weeks. You will experience pain and stiffness post-surgery but this should not stop you from exercising. Exercises should be performed under supervision and you can contact a physiotherapist for home visits.

 

Recovery beyond 3 to 6 months

Gradually you will regain strength and performing daily activities will be much easier. However, you still need to continue physiotherapy and can take regular appointments for the same. Regular walk is essential in maintaining hip joint mobility. Certain activities should always be avoided, such as

  • Sitting on the floor
  • Sitting crossed leg on bed
  • Twisting the operated leg
  • Floor bending
  • Squatting
  • Lifting heavy weights
  • High impact activities such as, jumping, jogging or even running
  • Contact sports such as, football, basketball
  • Prolonged sitting in a car while traveling

 

The prosthetic joint is designed for everyday activities and performing any of the above-mentioned activities could lead to joint dislocation, which may require another surgery. Although you will be fully functional 6 months after surgery, regaining complete muscle strength around the hip joint may take up to 2 years. A cemented joint prosthesis has the longest recovery time.

 

How long will the new joint last?

The artificial joint will last somewhere between 10 to 20 years depending on the type of artificial joint material used and usage. In case the joint is dislocated or damaged, repeat surgery has to be performed (hip revision surgery) but this one is rather more complicated than the original surgery.

 

What are the chances of complications?

It is quite uncommon to have complications after hip replacement surgery. However, less than 2% of patients may encounter certain complications. Some of the possible complications are-

  • Infection
  • Blood clots
  • Difference in leg length
  • Joint dislocation
  • Wear and tear of implant
  • Nerve compression around hip joint

 

Warning signs

Any unusual signs or symptoms that you notice post-surgery are termed as warning signs. These should not be ignored and you should inform your doctor right away. Major warning signs include-

  • High fever above 100°F or 37.8°C
  • Unusual swelling over hip joint, thigh or leg.
  • Extreme pain with both rest and activity.
  • Unequal leg length
  • Tingling or numbness in thigh or leg region
  • Radiating pain in thigh or leg region
  • Sudden shortness of breath (dyspnea)
  • Tenderness in calf muscles
  • Chest pain
  • Oozing of wound
  • Rupture of wound

 

Ignoring these warning signs increases the risk of complications.

 

Tips to speedy recovery

  • Surgical wounds should be kept dry for at least 3 weeks.
  • Keep your weight under check.
  • Use a firm mattress and avoid sitting on soft couches.
  • Use inflatable leg coverings/pressure stockings to reduce swelling.
  • Taking iron supplements will promote tissue healing.
  • Regular light exercises to maintain strength and mobility.
  • Regular walking for 20 to 30 minutes, at least 3 or 4 times a week.

 

 

 

 

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