Hip replacement surgery, also called total hip arthroplasty, involves removing a diseased hip joint and replacing it with an artificial joint, called a prosthesis. Hip prostheses consist of a ball component, made of metal or ceramic, and a socket, which has an insert or liner made of plastic, ceramic or metal. The implants used in hip replacement are biocompatible - meaning they're designed to be accepted by your body - and they're made to resist corrosion, degradation and wear.
Hip replacement is typically used for people with hip joint damage from arthritis or an injury. Followed by rehabilitation, hip replacement can relieve pain and restore range of motion and function of your hip joint.
Your Hip Surgery
The hip is a ball and socket joint. The ball portion of the joint is called the femoral head, and is part of the upper leg bone (femur). The socket portion is called the acetabulum, and is part of the pelvic bone. The femoral head (ball) fits into the acetabulum (socket) and moves within its natural fluid, called synovial fluid, which helps to lubricate the joint during motion
In a healthy hip joint, the surfaces of these bones where the ball and socket rub together are very smooth and covered with a tough protective tissue called cartilage. Arthritis causes damage to the bone surfaces and cartilage. These damaged surfaces eventually become painful as they wear.
There are many ways to treat the pain caused by arthritis. One way is total hip replacement surgery. The decision to have total hip replacement surgery should be made very carefully after consulting your doctor and learning as much as you can about the hip joint, arthritis, and the surgery.
In total hip replacement surgery, the ball and socket that have been damaged by arthritis are removed and replaced with artificial parts made of metal and a durable plastic material. We call these artificial parts "implants," or "prostheses."
Two Types of Hip Fixation
There are two main types of fixation philosophies-cemented and porous. Both can be effective in the replacement of hip joints.` The physician (and the patient) will choose the best solution that is specific to the patient's needs.
Cemented Hip Implants
The cemented hip implant is designed to be implanted using bone cement (a grout that helps position the implant within the bone). Bone cement is injected into the prepared femoral canal. The surgeon then positions the implant within the canal and the grout helps to hold it in the desired position.
Porous Hip Implants
The porous hip implant is designed to be inserted into he prepared femoral canal without the use of bone cement. Initially, the femoral canal is prepared so that the implant fits tightly within it. The porous surfaces on the hip implant are designed to engage the bone within the canal and permit bone to grow into the porous surface. Eventually, this bone ingrowth can provide additional fixation to hold the implant in the desired position.
What to Bring to the Hospital ?
Below is a list of things you may want to bring with you to the hospital in preparation for your surgery. Talk with your physician, as he/she may have additional information about preparing for your hospital stay.
Your personal belongings should be left in the car until after surgery. Tell your family that your room will be assigned when you are in surgery or in recovery, at which point they can bring your personal items to your room.
Personal grooming items that you may want to pack include a toothbrush, toothpaste, hairbrush, eyeglasses/contacts, comb, deodorant, shaving cream/electric razor, shampoo, lotion, undergarments, and a robe.
Bring slippers or flat rubber-soled shoes for walking in the hallways.
Bring loose-fitting clothing for your trip home.
Bring any medications you are currently taking. You should also write down your medication information to be given to the hospital staff. Be sure to include the name, strength, and how often you take the medications. Please communicate any allergies you might have to your doctors and the nursing staff.
If you use a breathing exerciser (IBE), be sure to bring it with you from home, as you will probably need this right after surgery.
Leave jewelry, credit cards, car and house keys, checkbooks, and items of personal value at home. Bring only enough pocket money for items such as newspapers, magazines, etc.
During Surgery
The patient is first taken into the operating room and given anesthesia. After the anesthesia has taken effect, the skin around the upper thigh is thoroughly scrubbed with an antiseptic liquid. An incision of appropriate size is then made over the hip joint.
Replacing the Socket Portion of the Joint
One type of implant that replaces the socket consists of a metal shell that is lined with a strong plastic liner.
Removing the Surface of the Socket
The leg is maneuvered until the femoral head is dislocated from the socket.
A special reamer is then used to remove the damaged cartilage and bone surface from the acetabulum, and to shape the socket so it will match the shape of the implant that will be inserted.
Inserting the Implant
The shell portion of the socket implant may be attached either by using a special kind of epoxy cement for bones, or by pressing the implant into the socket so that it fits very tightly and is held in place by friction. Some implants may have special surfaces with pores that allow bone to grow into them to help hold the implant in place. Depending on the condition of the patient's bone, the surgeon may also decide to use screws to help hold the implant in place.
When the shell portion of the socket implant is in place, the plastic liner is locked into place inside the shell.
Replacing the Ball Portion of the Joint
The implant that replaces the ball consists of a long metal stem that fits down into the femur. The metal ball is mounted on top of this stem.
Removing the Ball
A special power saw is used to remove the damaged femoral head.
Clearing and Shaping the Canal
The upper leg bone has relatively soft, porous bone tissue around the center. This part of the bone is called cancellous bone. It surrounds the canal, which mainly contains blood vessels and fatty tissue.
Special instruments are used to clear some of the cancellous bone from the canal, and then to mold the inside walls of the canal to fit the shape of the implant stem.
Inserting the Implant
The stem implant may be held in place by either using the special cement for bones, or by making it fit very tightly in the canal. If cement is used, it is injected into the canal first, and then the implant is inserted into the canal. If cement is not used, the implant is simply inserted into the canal. Like the socket implant, the stem implant may have a special surface with pores that allow bone to grow into them.
On some implants, the stem and ball are one piece. On others, they may be two separate pieces. If the ball is a separate piece, it is usually secured to the top of the stem after the stem has been inserted.
Closing the Wound
When all the implants are in place, the surgeon places the new ball that is now part of the upper leg bone into the new socket that is secure within the pelvic bone. If necessary, the surgeon may adjust the ligaments that surround the hip to achieve the best possible hip function.
When the ligaments are properly adjusted, the surgeon sews the layers of tissue back into their proper position. A plastic tube may be inserted into the wound to allow liquids to drain from the site during the first few hours after surgery. After the tube is inserted, the edges of the skin are sewn together, and a sterile bandage is applied to the hip. Finally, the patient is taken to the recovery room.
The Following are the Types of Hip Surgeries performed at We Care India partner Hospitals (Give Link to all)
This page provides a brief introduction to hip replacement. It can help you make a list of questions to ask your doctor, but it is not meant to provide complete information. Check with your surgeon's office about more comprehensive resources and patient education materials.
What causes hip pain?
Osteoarthritis
Fractures/dislocations
Rheumatoid arthritis
Aseptic bone necrosis / Avascular necrosis
Is there a cure?
Since hip pain results from damage to the joint, there is no "cure." However there are a variety of treatment options available, ranging from rehabilitation to total hip replacement surgery.
What is a hip replacement?
In a total hip replacement surgery, the painful parts of the damaged hip are replaced with artificial hip parts called a prosthesis, a device that substitutes or supplements a joint. The prosthesis consists of steel components: a socket, ball, and stem. The outer shell of the socket is usually made of metal and the inner shell consists of plastic, or the entire socket may be plastic. When the metal ball is joined with the socket, the new hip can allow for smooth, nearly frictionless movement.
How do I know if I need a hip replacement?
If you have difficulty walking or performing everyday activities such as getting dressed, it may be time to consider hip replacement surgery.
Doctors generally try to delay total hip replacement for as long as possible in favor of less invasive treatments. However in patients with advanced joint disease, hip replacement offers the chance for relief from pain and a return to normal activities.
How do I prepare for hip replacement surgery?
If you and your surgeon decide that total hip replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will help to ensure that other health problems you may have, such as diabetes or high blood pressure, will be identified and treated before surgery.
You doctor may suggest that you lose weight and initiate an exercise program. If you smoke, be sure to speak with your doctor about it, as smoking can dangerously increase surgical risks and slow down the healing process.
You should also finish any dental work that may be underway to prevent germs in your mouth from entering the bloodstream and infecting the joint. It is likely that you will need blood during hip surgery, and your surgeon may place an order with the blood bank in case a transfusion is needed. If you prefer, or if your surgeon feels it is needed, you may want to donate your own blood ahead of time to reduce the risk of your body reacting to the blood transfusion. Read the Surgery Calendar for more information on how to prepare for surgery.
What happens during hip replacement surgery?
On the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia.
The surgery usually takes two to four hours, although this is dependent upon the severity of the arthritis in your hip. In the operating room, a urinary catheter will be inserted and left in place for one or two days. Compression stockings and pneumatic sleeves will be put on both legs. The procedure is performed through an incision over the side of the hip. The ball-end of the thighbone (femur) is cut and replaced with the new metal ball and stem component.
It may be stabilized with or without cement. The damaged surface of the socket is smoothed in preparation for the insertion of the new socket. The ball and socket are then joined. When the surgeon is satisfied with the fit and function, the incision will be cleaned and covered with dressings. You will also find small drainage tubes coming out of the hip to drain fluid from the wound.
You will be sent to the recovery room and as the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. You will also be given pain medication and will find a foam wedge or pillows placed between your legs to help hold your joint in place. When you are fully conscious, you will be taken back to your hospital room.
How long does the surgery take? What is the recovery time?
In the weeks immediately following surgery, you may need walking aids such as a cane or crutches. Within a few months, however, you should be able to return to normal activities.
For more information, please read, Your Hip Surgery and After Hip Surgery.
How is the implant affixed in the body?
Bone Cement : -
A special type of bone acrylic cement may be used to secure some or all of the implant components to the bone. If used, the bone cement takes about 15 minute to set.
Press-Fit : -
In other cases, the implants may be "press-fit" into the bone. Press-fit components may have a special porous coating that allows tissue to grow up to it for fixation.
Combination : -
In some cases, your surgeon may choose a combination of cement and press-fit attachment, depending upon the implant components and condition of the pelvic and thigh bone.
The decision as to whether to use a cemented or press-fit component depends upon many factors, including the manufacturer's intended use of the product, surgeon philosophy and the patient's condition.
What can I expect after surgery?
When you are back in your hospital room you will begin a gentle rehabilitation program to help strengthen the muscles around your new hip and regain your range of motion. On the day of surgery you may be asked to sit on the edge of the bed and dangle your feet. You will also learn how to protect your new hip while doing daily activities.
As soon as possible, usually within the next 24 hours, your physical therapist will help you start walking a few steps at a time. As you heal you will progress from walker to crutches and then a cane. Before you are dismissed from the hospital, an occupational therapist will also show you how to perform daily tasks at home with your new hip. For example, he or she will instruct you on how to go to the bathroom, how to dress yourself, how to sit or stand, how to pick up objects and many others.
After about two to four days, or when your surgeon determines that you have recovered sufficiently, you will be discharged. You may be transferred to a rehabilitation facility for a few more days, as determined by your surgeon. Upon returning to your home, you will need to continue taking your regular medications and continue exercising as directed by your surgeon or physical therapist. Walking, remaining active and practicing the required exercise are the quickest ways to full recovery. Read the Surgery Calendar to learn more on what to expect after surgery.
How long will a joint replacement last?
Longevity of the prosthetic hip varies from patient to patient. It depends on many factors, such as a patient's physical condition, activity level, and weight, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient's life.
Today, total hip replacement has become a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic hip can do and how much activity it can withstand. As with any mechanical joint, the ball and socket components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement.
As with car tires or brake pads, the rate of wear depends partly on how the hip joint is used. Activities that place a lot of stress on the joint implants, as may be the case with heavier and more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components. Your doctor will be in the best position to discuss these issues with you, taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.
Talk with your doctor about the following points, and how they might affect the longevity and success of your hip replacement : -
Avoiding repetitive heavy lifting
Avoiding excessive stair climbing
Maintaining appropriate weight
Staying healthy and active
Avoiding "impact loading" sports such as jogging, downhill skiing and high impact aerobics
Consulting your surgeon before beginning any new sport or activity
Thinking before you move
Avoiding any physical activities involving quick stop-start motion, twisting or impact stresses
Avoiding excessive bending when weight bearing, like climbing steep stairs
Not lifting or pushing heavy objects
Not kneeling
Avoiding low seating surfaces and chairs.
Are there any complications?
Some common complications specific to hip replacement surgery include loosening or dislocation of the implant and a slight difference in leg length.
Your healthcare team will discuss these possible complications with you and the precautions taken against them.
How old is the average patient?
In the U.S., the average joint replacement patient is around 65-70 years old, however patients of all ages have received hip implants.
What activities can I do or not do after receiving a hip implant?
Typically, patients are advised to avoid high impact sports such as jogging, basketball, racquetball, gymnastics, etc.
Safer activities may include walking, golf, swimming, and bicycling.
Your doctor will advise you on safe activities for your particular condition.
Will an implant set off a metal detector?
Patients have reported mixed experiences at airports: some detectors go off and some don't.
You may be provided with a special card to keep in your wallet explaining that you have a hip implant.
What about sex?
Doctors generally allow patients to resume sexual activities as soon as they feel able. In the months following surgery, patients are generally advised to take it easy and modify their positioning to keep pressure off of the joint while it's healing. As always, it is best to consult with your doctor about what's safe for your particular condition.
Will a hip implant last a lifetime?
The longevity of a prosthetic hip (how long it will last) varies from patient to patient. It depends on many factors, such as a patient's physical condition and activity level, body weight and the surgical technique. A prosthetic joint is not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient's life. All prosthetic hips may need to be revised (replaced) at some point.
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