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Total Hip Replacement


What Is a Hip Replacement?

Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery are to improve mobility by relieving pain and improve function of the hip joint. Surgeons remove both, ball (femoral head) and socket (acetabulum) and are replaced by prosthetic parts made of metal, ceramic and hard plastic (polyethelene).

Hip-Replacement
Hip-Replacement

Who Should Have Hip Replacement Surgery?

The most common reason that people have hip replacement surgery is the wearing down of the hip joint that results from osteoarthritis. Other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), avascular necrosis (loss of bone caused by insufficient blood supply), injury, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

What Are Alternatives to Total Hip Replacement?

Before considering a total hip replacement, the doctor may try other methods of treatment, such as an exercise program and medication. An exercise program can strengthen the muscles in the hip joint and sometimes improve positioning of the hip and relieve pain. The doctor also may treat inflammation in the hip with nonsteroidal anti-inflammatory drugs, or NSAIDs. In a small number of cases, the doctor may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteroids reduce joint inflammation and are frequently used to treat rheumatic diseases such as rheumatoid arthritis. Sometimes Physical aid like cane or elbow crutch is advised to delay or avoid total hip replacement.

How is the total hip replacement surgery performed?

The hip joint is located where the upper end of the femur meets the acetabulum. The femur, or thigh bone, looks like a long stem with a ball on the end. The acetabulum is a socket or cup-like structure in the pelvis, or hip bone. This "ball and socket" arrangement allows a wide range of motion, including sitting, standing, walking, and other daily activities. During hip replacement, the surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural, gliding motion of the joint. Hip replacement surgery usually lasts 2 to 3 hours. Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a "cemented" procedure. In an uncemented procedure, the artificial parts are made of porous material that allows the patient's own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a "hybrid" replacement, which consists of a cemented femur part and an uncemented acetabular part.

Hip Replacement

Cemented Total Hip Replacement

Hip Replacement

Cementless Total Hip Replacement

What is a post-operative follow-up?

After surgery, medical staff will monitor different health parameters like blood pressure, pulse, consciousness, pain or comfort level and need for medications.

Following measures will be taken to prevent the risk of blood clots in your legs:

  • Early mobilization — you will be encouraged to sit up or walk with the help of crutches or walker on the same day or next day of surgery.  As early as 1 to 2 days after surgery, a patient may be able to sit on the edge of the bed, stand, and even walk with assistance.
  • Pressure application — to reduce the chance of blood clots in the legs, you will be provided air sleeves on your legs that help keep blood from pooling in the leg veins
  • Blood thinner medication — you may be needed blood thinner medication depending on your activeness and how soon you can walk, the surgeon will prescribe either oral or injected blood thinner for few weeks after surgery
  • Physical therapy — a physical therapist will guide you through some exercise that you should do in the hospital and also in the home to expedite recovery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, the overall health of the patient, and the success of rehabilitation.

Our clinic has some of the best doctors to perform the total him replacement surgery.

Self-care/ Precautions/ Dos and Donts after Total Hip replacement

Some general rules for any activity you do are:

  • DO NOT cross your legs or ankles when you are sitting, standing, or lying down.
  • DO NOT bend too far forward from your waist or pull your leg up past your waist. This bending is called hip flexion.
  • Avoid hip flexion greater than 90 degrees (a right angle).

 When you are getting dressed:

  • DO NOT dress standing up. Sit on a chair or the edge of your bed, if it is stable.
  • DO NOT bend over, raise your legs, or cross your legs while you are dressing.
  • Use helpful devices so that you do not bend too much. Use a reacher, a long-handled shoehorn, elastic shoe laces, and an aid to help you put on your socks.
  • When you are getting dressed, first put pants, socks or pantyhose on the leg that had surgery.
  • When you undress, remove clothes from your surgery side last.

When you are sitting:

  • Try not to sit in the same position for more than 30 to 40 minutes at a time.
  • Keep your feet about 6 inches (15 centimeters) apart. ...
  • DO NOT cross your legs.
  • Keep your feet and knees pointed straight ahead, not turned in or out.
  • Sit in a firm chair with a straight back and armrests
  • Always use Commode (western toilet) for toilet

When you are bathing or showering:

  • You may stand in the shower if you like. You can also use a special tub seat or a stable plastic chair for sitting in the shower.
  • Use a rubber mat on the tub or shower floor. Be sure to keep the bathroom floor dry and clean.
  • DO NOT bend, squat, or reach for anything while you are showering. Use a shower sponge with a long handle for washing. Have someone change the shower controls for you if they are hard to reach. Have someone wash the parts of your body that are hard for you to reach.
  • DO NOT sit down in the bottom of a regular bathtub. It will be too hard to get up safely.
  • Use an elevated toilet seat to keep your knees lower than your hips when you are using the toilet, if you need one.

When you are using stairs:

  • When you are going up, step first with your leg on the side that did not have surgery.
  • When you are going down, step first with your leg on the side that had surgery.

When you are lying in bed:

  • DO NOT sleep on the side of your new hip or on your stomach. If you are sleeping on your other side, place a pillow between your thighs.
  • A special abductor pillow or splint may be used to keep your hip in the proper alignment.

When you are getting into or riding in a car:

  • Get into the car from street level, not from a curb or doorstep.
  • Car seats should not be too low. Sit on a pillow if you need to. Before you get into a car, make sure you can slide easily on the seat material.
  • Break up long car rides. Stop, get out, and walk about every 2 hours.

DO NOT drive until your health care provider says it is OK.

When you are walking:

  • Use your crutches or walker until your doctor tells you it is OK to stop using them.
  • Put only the amount of weight your doctor or physical therapist told you was OK to put on your hip that had surgery.
  • Take small steps when you are turning. Try not to pivot.
  • Wear shoes with nonskid soles. Avoid wearing slippers as they can make you fall. Go slowly when you are walking on wet surfaces or uneven ground.

What Are Possible Complications of Hip Replacement Surgery?

The most common problem that may happen soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest. Less common complications of hip replacement surgery include infection, blood clots, and heterotopic bone formation (bone growth beyond the normal edges of bone).

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DR SHAILESH KESHAV MISHRA

Consultant Orthopedic, Joint Replacement and Arthroscopy Surgeon

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