About Hip Replacement
Regular hip pain limits the day-to-day activities of the patients. One may not be able to walk or bend properly due to degenerating hip joint. One of the main reasons is osteoarthritis in elderly people. In this article you will read about the different types of hip replacement surgeries, causes of hip pain, when you should consider undergoing hip replacement surgery, how to prepare yourself for the surgery, risks, hip replacement in India success rates etc.
Read about the hip replacement surgery cost in India.
Anatomy of Hip:
Hip is one of the body’s largest weight bearing joints. It is ball and socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is femoral head, which is upper end of femur (thighbone).
Articular cartilage covers the bone surface of ball and socket. Synovial membrane (thin tissue) surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid which lubricates the cartilage and eliminates the friction during hip movement. Bands of the tissue (ligaments) connect the ball to the socket and provide stability to the joint.
What is Hip Replacement?
It is a surgical procedure in which the hip joint is replaced by a prosthetic implant.
The procedure involves:
- Making an incision along the side of the hip.
- Cutting the upper end of the thighbone.
- Replacing it with the implant components.
- Stabilizing it with or without the cement.
- Smoothening of the hip joint which receives the ball component so as to fit the new metal socket properly.
- Joining of the new ball and socket joint.
Common Causes of Hip Pain:
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This is age related wear and tear type of arthritis. It is more common in people above the age of 50 years. Also, it happens in people with a family history of arthritis. In this condition the cartilage cushioning wears away. The bone then rubs with each other causing hip pain and stiffness.
Rheumatoid arthritis (inflammatory arthritis):
This is an autoimmune disease in which the synovial membrane (specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath) becomes inflamed and thickened. Therefore, damages the cartilage leading to pain and stiffness.
This can follow a serious hip injury or fracture damaging the cartilage hence lading to hip pain and stiffness overtime.
Avascular necrosis (osteonecrosis):
Injury or dislocation to the hip joint may limit the blood supply to the femoral head. The lack of blood may cause the surface of the bone to collapse therefore leads to arthritis. Some diseases may also cause osteonecrosis.
Childhood hip disease:
Some infants and children have hip problems. Even after the successful treatment during childhood, it may still cause arthritis later in life. This happens because the hip may not grow normally. It affects the joint surface as well.
When is Surgery Recommended?
There is no absolute age or weight restriction for hip surgery. Most patients who undergo surgery are of 50-80 years of age.
There are several reasons why your doctor will recommend hip joint replacement:
- Hip pain that limits everyday activities like walking or bending.
- Pain persists even after taking pain relieving medicines.
- Hip pain continues while resting.
- Stiffness in the hip that limits the ability to move or lift the leg.
- Inadequate pain relief from medicines, walking supports and physical therapy.
Diagnosis of Hip/ Joint Replacement:
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The complete history and physical examination allows the physician to determine any correlation between symptoms of pain with past history. Also, the physician will inquire about experiencing episodes of trauma or instability. They will also examine the ligaments and hip alignment. The doctor may also order one or more specialized tests.
Aspiration: It involves removal of small amount of fluid from the affected hip joint. To rule out systemic arthritis and infection in the hip.
Arthrogram: It is a special type of X-Ray in which a contrast dye is injected into the hip to outline the cavity surrounding the joint.
Magnetic Resonance Imaging (MRI): It uses large magnet, radio waves and a computer to generate the images.
Computed Tomography Scan (CT Scan): It is a special type of X-Ray which uses computers to generate 3D images. It checks the severity of avascular necrosis and generate more accurate image of the joint.
Bone Densitometry Test: This test measures the density and strength of the bones. This test is for patients at the risk of osteoporosis or other disorders that affects the bone density.
Who Should Not Have Replacement Surgery?
- People who can not follow the pre and post surgical instructions. Eg- people suffering form dementia or alcoholism.
- Any patient suffering with an existing infection. Or patient who are prone to infections are not eligible for surgery.
- Also, Nicotine users.
Deciding To Have Hip Surgery
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Talk with your doctor: Your orthopaedic doctor will review the results of your evaluation and discuss whether hip surgery is the best option for you. They may also discuss other treatment options like – medications, physical therapy or other type of surgery.
In addition, they may also discuss potential risks and complications of this surgery. Risks including those related to the surgery and those that can occur after the surgery. You can also ask any questions you have.
Have realistic expectations: The most important factor in deciding whether to have a hip joint surgery is to understand what the procedure can and can not do. Also, most people who undergo hip joint replacement surgery experience reduction in pain and significant improvement in their ability to perform common activities.
Most surgeons advise against high-impact activities like unlimited walking, swimming, running etc.
Types of Replacement Surgeries:
An orthopaedic surgeon will advise you about which joint replacement is right for you depending on the case history.
Total Hip Replacement Surgery:
(Image Credit-Hip Replacement in India)
This is a common procedure to alleviate pain and debilitation which the hip related problem causes. Immediate benefits of this operation are great. After 4 months in uncomplicated cases, the patient is pain free. Also, has full mobility of the hip and can walk with minimal or no limp.
Partial Hip Replacement Surgery:
In partial replacement, the hip socket is left intact. Artificial component replaces the head of the femur bone. Doctor recommends this surgery in case where only the femur head is broken or destroyed.
Hip Resurfacing Surgery:
Hip resurfacing is a surgical procedure which is an intervention alternative to total replacement surgery. It is a technique to reline rather than replace the worn hip joint. It creates a bigger hip ball than is generally used in hip replacement. This may reduce the risk of dislocation. It is mainly for younger patients who are
- Not morbidly obese
- Clinically qualified for hip replacement
- Have non-inflammatory degenerative joint disease.
- Do not have an infection
- Not allergic to metals used in the implants
Minimally Invasive Hip Replacement Surgery (MIS):
It is a new technique. Instead of making long incision, the doctor makes 2 inch (5 cm) or 3.5 inch incision. The doctor uses smaller implants. The surgeon removes damaged bone and inserts parts of the new prosthesis. MIS takes only an hour and a half. Causes less bleeding and patient can leave the hospital the following day.
Double Hip Replacement Surgery:
It is a successful treatment for hip arthritis and osteoarthritis. The surgery involves the removal of two damaged and worn parts of the hip joint-hip socket and the ball. Then the surgeon replaces them with smooth, artificial implants. This makes the hip strong, stable and flexible again.
Revision Hip Replacement Surgery:
It is a procedure to replace the worn out implants. This operation varies from minor adjustments to massive operations replacing significant amounts of bone. Pain is the primary reason for revision. However, the surgery may involve simple linear exchange to changing one or more of the components.
Types of Prosthesis in Replacement Surgery:
(Image Credit-Total Hip Replacement)
Regardless of which type of surgery you undergo-traditional or minimally invasive, the parts used to replace the joint are the same. It comes in two different varieties: Cemented and Uncemented.
- Cemented parts are fastened to existing, healthy bone with a special glue or cement. Hip replacements using these parts are “cemented” procedure. Therefore, cemented replacement is more frequently used for older and less active people with weak bones.
- Uncemented parts rely on process called biologic fixation which holds them in place. In this process the parts are made with porous material. Therefore, allows your bone to grow into pores and hold the new parts in place. It is more frequently used in younger and more active people.
The primary disadvantage of uncemented prosthesis is that it takes more time to recover. Because it takes a long time to recover for the natural bone to grow and attach to the prosthesis. It requires the patient to limit their activities for up to 3 months to protect the hip joint. The patient experiences thigh pain in months following the surgery, while the bone is growing into the prosthesis.
Sometimes the doctor will use a cemented femur part and an uncemented acetabular part. This combination is hybrid replacement.
How do I prepare for Hip Surgery?
You will meet the orthopaedic surgeon for an examination. The surgeon will ask about:
- Your medical history and current medications.
- Do a brief physical examination to make sure you are healthy enough to undergo surgery.
- Examine your hip. They will see the range of motion in your joint and strength of surrounding muscles.
- Other blood test, X-rays and possibly and MRI.
When you check in for your surgery, you will have to remove your clothes and put on hospital gown. You will be either on general anaesthetic or a spinal block. This will numb lower half of the body.
During the Procedure:
To perform the joint replacement, your surgeon:
- Makes an incision on the side or front of your hip, through the layer of tissue.
- Removes diseased and damaged bone and cartilage, leaving healthy bone intact.
- Implants the prosthetic socket into your pelvic bone to replace the damaged socket.
- Replaces the round top of your femur with the prosthetic ball, which is attached to a stem that fits into your thighbone.
After the Procedure:
After the surgery, the hospital staff will move you to the recovery area for few hours while your anaesthesia wears off. They will then check your blood pressure, pulse, alertness, pain or comfort level and your need for medications.
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Blood clot prevention:
After your surgery, there will be increase in blood clots in your legs. Possible measures include:
- The hospital staff will encourage you to sit up and try walking with crutches or walker soon after your surgery.
- Both during and after surgery, you may wear elastic compression stockings or inflatable air sleeves on your lower leg. The pressure exerted by the sleeve helps keep the blood from pooling in leg veins. Hence, reduces the chances of blood clot.
- Your surgeon may inject or prescribe oral blood thinners after surgery. However, you may need blood thinners for several more weeks after surgery.
The physical therapist may help you with some exercise which you can do in the hospital and at home to recover fast. Also, this activity and exercise will be a part of your everyday routine to regain the use of your joint and muscles. They will also help you learn how to walk using supports, crutches and walker. This therapy will help you to increase the weight you put on your leg. This will continue until you are able to walk without support.
Home Recovery And Follow up care:
Before you leave the hospital, you and your caregivers will get some instructions.
- Arrange to have a friend or relative to prepare meals for you.
- Place everyday items at waist level, so as to avoid bending.
- Make some modifications to your home.
After about 6-8 weeks after surgery, you will have your follow -up appointment with your surgeon to make sure your hip is healing properly. Most people resume their normal activities by this time. Further recovery with improving strength will often occur for 6-12 months.
How long does the Surgery take?
The average time of hip joint replacement surgery is 1-2 hours. It also depends on how complicated your case is. Although, your physical state and weight, severity of joint, type of replacement you are receiving are the main factors which determine the surgery time.
Will I need Blood During or After Surgery?
Rarely the patient needs blood. You may donate your own blood to use during your surgery if needed. This is autologous blood donation. If you choose to do that, start donating several weeks before the surgery. Therefore, ensuring you have more time to donate blood and enough blood collection.
What are the Risks Associated with Hip Joint Replacing?
Overall infection associated with joint replacement is uncommon. However, most infections are treated with antibiotics. In case of major infection near the joint replacement area, the surgeon will remove and replace the prosthesis.
Certain positions can cause the ball of your hip to dislocate. The surgeon will recommend not moving more than 90 degrees and don’t let your legs to cross in the midline of your body. If the hip dislocates, your doctor may fit you with the brace to keep the hip in correct position. Although, if it keeps on dislocating, it may require surgery to stabilize it.
Difference in leg length:
Your surgeon will take steps to avoid this problem. But occasionally a new hip makes one leg look longer or shorter than the other. One of the reasons for this is weakness in the muscles surrounding the hip. In this case, progressively strengthening and stretching the muscles may help.
Clots can form in your leg veins after surgery. However, the doctor may prescribe blood thinner medications to reduce the risk of blood clot.
During surgery, healthy portions of your hip may fracture. Sometimes the fractures are so small and heal on their own. However, in certain cases the fractures are big and needs correction.
This complication is rare with new implants. Although if your new joint do not solidly fix to your bone it may loosen over time. As a result it causes pain in hip. Also, it requires surgery to fix.
Metal on metal complication:
Most artificial hip joints have polished metal or ceramic ball that fits into the cup liner that is hard plastic. Sometimes the cup liner is metal. Metal on metal prosthesis are more likely to release ions into the bloodstream, which therefore causes inflammation and bone erosion. Therefore, metal to metal prosthesis is less common.
Success Rates of Hip Replacement in India:
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Success rates of hip replacement surgery largely depend upon effective implementation of doctors/ surgeons instructions. Many patients are however capable of performing the exercise which the doctor advises. However, in majority of cases the patients do not experience any complications.
How long will my new Hip last and when can a second replacement be done?
Most replaced hips last for more than 10-15 years. It depends on patient to patient. If the patient is active and young, it may last less as compared to the patient who is less active. It requires Revision hip replacement.
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