Diagnostics

Hip Replacement Surgery

Hip Replacement Surgery

Hip replacement, or hip arthroplasty, is a surgical procedure to alleviate hip pain. The surgery involves replacing damaged portions of the hip joint with artificial implants. The hip joint comprises a ball located at the top of the femur (thigh bone) and a socket in the pelvis (hip bone). During hip replacement surgery, either one or both parts of the joint are replaced with prosthetic components.

Who performs hip replacement surgery?

Hip arthroplasty is performed by specialized orthopaedic surgeons who have undergone extensive training and gained substantial experience in treating various joint diseases, including hip joint disorders. Hip arthroplasty is conducted in a hospital setting, specifically in an operating room equipped with the necessary surgical instruments and equipment.

What are the types of hip replacement?

There are two main types of hip replacements:

  • Total Hip Replacement: In this procedure, the surgeon replaces the entire hip joint with a prosthetic joint. This involves replacing both the femoral head (top of the thighbone) and the acetabulum (socket in the pelvis). Total hip replacements are the most common type of hip replacement.
  • Partial Hip Replacement: Partial hip replacements are rare and typically reserved for specific cases, such as repairing certain types of hip fractures or removing tumours. In this procedure, only a portion of the hip joint is replaced.

When is hip replacement surgery recommended?

Hip replacement surgery is considered if hip pain persists despite pain medication and physical therapy, the pain worsens with walking (even with a cane or walker), interferes with sleep, affects the ability to walk up or down stairs, and makes it difficult to rise from a seated position.  Common indications include:

  • Arthritis that can affect hip joints include osteoarthritis, rheumatoid arthritis, or psoriatic arthritis
  • Hip fractures due to injury or trauma
  • Avascular necrosis or osteonecrosis occurs when the ball portion of the hip joint does not receive sufficient blood supply, which can happen due to factors like dislocation or fracture. In such cases, the bone may collapse and become deformed.
  • Childhood hip diseases can affect some infants and children, and while these issues may be effectively treated during childhood, they could lead to arthritis later in life. This is often due to abnormal hip growth and the impact on joint surfaces, which can result in
    long-term joint damage.

How is a hip replacement procedure done?

Preparing for surgery

  • Before hip replacement surgery, the doctor will conduct a thorough physical examination and perform various tests to assess the condition.
  • The patient should provide a comprehensive list of all medications and supplements.
  • Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest X-rays, may be required to aid in the surgical planning process.
  • While infections after hip replacement are not common, there is a risk of infection if bacteria enter the bloodstream. To minimize this risk, complete major dental procedures, including tooth extractions and periodontal work, must be completed before hip replacement surgery.
  • Informed consent is obtained from the patient or their relatives before performing surgery.


During surgery

During hip replacement surgery, the patient will receive either a spinal block to numb the lower half of the body or a general anaesthetic to induce a sleep-like state.

In the operating room, the patient will receive an IV line for medications in the hand or arm, and a urinary catheter might also be inserted.

The surgical procedure can be completed within two hours and involves the following steps:

  • An incision is made over the hip, passing through the layers of tissue.
  • Diseased and damaged bone and cartilage are removed, leaving healthy bone intact.
  • The replacement socket is implanted into the pelvic bone.
  • A metal stem is inserted into the top of the thigh bone, which is then topped with a replacement ball.


After surgery

After the surgery, the patient will be transferred to a recovery area, where they will spend a few hours until the anesthesia wears off. During this time, medical staff will closely monitor various aspects such as blood pressure, pulse, alertness, pain or comfort level, and medication requirements.

The patient will be encouraged to breathe deeply or cough to prevent fluid buildup in the lungs. The length of the stay in the recovery area will depend on the individual needs.

Recovery after hip replacement surgery varies for each individual. Generally, it takes several months to recover fully, and physical therapy is essential during this period.

Within 24 hours after surgery, the surgeon or physical therapist will provide specific stretches and exercises. They will monitor the strength and flexibility of the leg and hip and the ability to stand and sit.

The exercises will focus on strengthening and stretching the muscles around the hip joint. Over time, the patient will gradually resume activities such as climbing stairs, bending, and walking, regaining the range of motion and strength. It may take six to twelve weeks before the patient can use the hip with no restrictions.

For a safe recovery at home, don’t hesitate to seek tips from the surgeon or physical therapist on moving around the living space with caution after the surgery.  

During the recovery, remember to:

  1. Keep the surgical area clean and dry following the bathing instructions given by the doctor.
  2. Take all medications as prescribed.
  3. Attend all follow-up appointments with the surgeon.
  4. Stick to physical therapy sessions and exercise at home as advised.
  5. Resume a regular diet doctor instructs otherwise.
  6. Elevate the leg and use ice to control swelling.


Although complications from hip replacement surgery are rare, they can still occur. The most common complications include:

  • Infections
  • Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
  • Prosthesis-related problems, such as loosening or dislocation.
  • Bone fractures around the prosthesis.
  • Joint stiffness.


Promptly contact the surgeon if any of the following symptoms are experienced after a hip replacement:

  • Severe pain
  • Bleeding or any unusual drainage at the surgery site.
  • Swelling
  • Discoloration or redness around the surgery site.

References

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