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.
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
Porous Hip Implants
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)
Frequently
Asked Hip Replacement Questions
Hip
Replacement
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 implantcomponents 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.
Hip
replacement surgery includes : -
- Hip Replacement Symptoms
- Hip Replacement Precautions
- Hip Replacement Alternatives
- Hip Replacement Causes
- Hip Replacement Complications
For more information on Economical and Low cost Surgery
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