Articular Hip Surface Replacement at the Apollo Hospitals Health City Hyderabad
Articular Surface Replacement of Hip Joint : -
Cobalt-chrome cast parts. Parts are precision machined to fit each other with small space for body fluid to lubricate. The backside of the cup has a roughened surface to allow bone to grow into implant. Nearly all major implant makers either have in production or are developing metal-on-metal hip resurfacing components
Advantages of Hip Resurfacing
Femoral head is Preserved : -
Femoral canal is preserved and no associated femoral bone loss with future revision. Also, the risk of microfracture of femur with uncemented stem implantation is eliminated.
Larger size of implant "ball" reduces the risk of dislocation significantly.
Stress is transferred in a natural way along the femoral canal and through the head and neck of the femur. With the standard THR, some patients experience thigh pain as the bone has to respond and reform to less natural stress loading.
Use of metal rather than plastic reduces osteolysis and associated early loosening risk.
Use of metal has low wear rate with expected long implant lifetime.
Activity : - Some patients experience back discomfort after surgery. This is caused by the general soreness of the hip area and partly by the prolonged lack of movement required before, during, and after surgery. Periodic change of position helps to relieve discomfort and prevents skin breakdown.
The dislocation rate is very low. There will be some precautions, mostly to prevent dislocation, which is more likely to occur the first six to eight weeks after surgery.
These precautions include : -
Using 2-3 pillows between your legs and not crossing your legs
Not bending forward 90 degrees
Using a high-rise toilet seat
Initial Rehabilitation : - The first day after surgery you will be assisted to a reclining chair, and physical therapy may begin. You will gradually begin to take steps, walk, and learn to climb stairs with the aid of a walker or crutches. This initial rehabilitation generally takes 4-6 days. During this time, discomfort may be experienced while walking and exercising. Pain medication will be ordered by the doctor as needed. Most patients are relieved of their painful pre-surgical hip condition.
Therapy and Rehabilitation Program
Following surgery, you will work with a physical therapist to become independent in walking, going up and down stairs, getting in and out of bed, and doing exercises to improve the range of motion and strength of your hip. You will be instructed by your physical therapist in a specific home exercise program to meet your needs.
Quadriceps Setting : -Tighten the muscles on the top of your thigh. At the same time push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds. Progress to 20 repetitions, 3 times a day.
Gluteal Setting : -Lie either on your back with your legs straight and in contact with the bed. Tighten your buttocks in a pinching manner and hold the isometric contraction for 5 seconds, relax 5 seconds. Progress to 20 repetitions, 3 times a day.
Isometric Hip Abduction : -Keeping your legs straight, together, and in contact with the bed, place a loop or belt around your thighs and attempt to spread your legs. Hold the contraction for 5 seconds, relax for 5 seconds. Progress to 20 repetitions, 3 times a day.
Do's and Don'ts
Your new hip is designed to eliminate pain and increase function. There are certain movements that place undue tress on your new hip. For your safety, these should be avoided. This is especially true during the first few months after your surgery.
DO NOT move your operated hip toward your chest (flexion) any more than a right angle. This is 90 degrees.
DO NOT sit on chairs without arms.
DO grasp chair arms to help you rise safely to standing position. Place extra pillow(s) or cushion(s) in your chair so that you do not bend your hip more than 90 degrees.
DO Keep your involved leg in front while getting up.
DO use high chair at home.
DO use a chair with arms. Place your operated leg in front and your uninvolved leg well under.
DO NOT sit low on toilet or chair initially.
DO get up from toilet as directed by your therapist. Use the elevated toilet seat if we have given you one.
DO use a long-handled reacher to pull up sheets or blankets or do as directed by therapist.
DO NOT bend way over.
DO NOT turn your knee cap inward when sitting, standing, or lying down.
DO NOT try to put on your own shoes or stockings in the usual way. By doing this improperly you could bend or cross your operated leg too far.
DO NOT cross your operated leg across the midline of your body (in toward your other leg).
DO NOT lie without pillow between legs.
DO keep a pillow between your legs when you roll onto your "good" side. This is to keep your operated leg from crossing the midline.
Activity : -
Continue to walk with crutches or a walker as directed by the doctor or physical therapist.
Your physician will determine how much weight you can place on your operated leg.
Walking is one of the better forms of physical therapy and for muscle strengthening.
However, walking does not replace the exercise program which you are taught in the hospital.
The success of the operation depends to a great extent on how well you do the exercises and strengthen weakened muscles.
If excess muscle aching occurs, you should cut back on your exercises.
Place a smooth surface (card table, plywood sheet, etc.) under your legs. Begin with your legs together, and then spread them apart as far as you can. Hold them apart for 5 seconds. Return to the starting position. Progress to 20 repetitions 3 times a day.
Sitting : - Avoid sitting more than 60 minutes at a time. DO NOT cross your legs. In fact, keep your knees 12 to 18 inches apart. Always sit in a chair with arms. The arms provide leverage to push yourself up to the standing position. A high kitchen or bar-type stool works well for kitchen activities.
Avoid low chairs and overstuffed furniture because they require too much bending (flexion) in your hip in order to get up. Do not bend forward while sitting in a chair, causing more than a 90 degree bend in your hip. Use the toilet seat riser for the next eight weeks to avoid excessive bending of the hips.
Bending : - For the first eight weeks, you should not bend over to pick up things from the floor. You may want to acquire a pair of slip-on shoes and a long-handled shoe horn to avoid excessive bending.
Other Considerations : - It is recommended that you do not drive until six weeks following surgery. When getting into a car, back up to the seat of the car, sit and slide across the seat toward the middle of the car with your knees about 12 inches apart. A plastic bag on the seat will help you safely slide in/ out of the car.
For the next 4-6 weeks avoid sexual intercourse. Sexual activity can usually be resumed after your two-month follow-up appointment. You can usually return to work within three to six months, or as instructed by your doctor.
Continue to wear elastic stockings until your return appointment. Don't shower until after staples are removed. Showers may be taken two days after your staples are removed. Do not sit in a bathtub until your physician okays that activity.
Your incision : - Keep the incision clean and dry. Also, upon returning home, be alert for certain warning signs. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor. Generally, the staples are removed in three weeks.
Remember : - Your physician, physical therapist, and nurses are striving to make a painless, functional hip possible for you. The real success of your hip replacement, however, depends partly on you-especially how conscientiously you exercise and how diligently you apply the principles of home care and self-limitation.
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