What is Hip Replacement? Complications, Procedure and Surgery.

INTRODUCTION:

If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult.  Your hip may be stiff, and it may be hard to put on your shoes and socks.  You may even feel uncomfortable while resting.

If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.

First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since then, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement.

HIP JOINT:

The hip is one of the body's largest joints.  It is a ball-and-socket joint.  The socket is formed by the acetabulum, which is part of the large pelvis bone.  The ball is the femoral head, which is the upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

A thin tissue called synovial membrane surrounds the hip joint.  In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

HIP REPLACEMENT:

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

Hip Replacement Procedure:  The steps are:

  1. The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur.  The femoral stem may be either cemented or "press fit" into the bone. 
  2. A metal or ceramic ball is placed on the upper part of the stem.  This ball replaces the damaged femoral head that was removed.
  3. The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket.  Screws or cement are sometimes used to hold the socket in place.  Sometimes surgeons use an uncemented part for the socket and a cemented part for the femur. This combination is called a hybrid replacement.
  4. A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

Candidate for a Hip Replacement: 

There are no absolute age or weight restrictions for total hip replacements.

The reasons for surgery are based on a patient's pain and disability, not age.  Most patients who undergo total hip replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually.  Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Surgery Recommendation:   

There are several reasons why your doctor may recommend hip replacement surgery.  People who benefit from hip replacement surgery often have:

  1. Hip pain that limits everyday activities, such as walking or bending.
  2. Hip pain that continues while resting, either day or night.
  3. Stiffness in a hip that limits the ability to move or lift the leg.
  4. Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports.

Surgery Consideration:  For patients who have: 

  1. Osteoarthritis:  Arthritis, usually due to ageing.
  2. Rheumatoid arthritis:  Arthritis, due to chronic inflammation (autoimmune disease). 
  3. Post-traumatic arthritis:  Arthritis, following trauma.
  4. Avascular necrosis:  Destruction of femoral head due to lack of blood supply (due to dislocation, or fracture, or hip diseases).
  5. Childhood hip disease:  Hip problems in infants and children.

Types of Hip Replacement:

Traditional Total Hip Replacement:

In a traditional surgery, the surgeon makes a 10- to 12-inch incision through some of the muscles around the hip to expose the joint.  Then the surgeon removes the damaged bone and cartilage and replaces them with an artificial joint or prosthesis.

Minimally Invasive Surgery (mini-incision surgery):

In minimally invasive surgery, the surgeon makes one or two much smaller incisions between the muscles.  These incisions may be in the back, side, or front of the hip.  The recovery time for the mini-incision surgery is shorter than for traditional surgery.  Doctors tend to recommend minimally invasive surgery for younger patients and those who are of normal weight and healthier than those who are candidates for traditional hip replacement surgery.

COMPLICATIONS:

For hip replacement surgery, the complications may include:

  1. Infection [fever greater than 100 F (37.8 C); shaking chills; drainage from the surgical site; increasing redness, tenderness, swelling and pain in the hip].
  2. Blood clots in the leg vein, which may travel to the lungs, heart, and brain.
  3. Leg length inequality after a hip replacement may occur where one leg may feel longer or shorter than the other. A shoe-lift after surgery helps correct this.
  4. Dislocation occurs when the ball comes out of the socket.
  5. Loosening and implant wearing out, over the years where the hip prosthesis may wear out or loosen.
  6. Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur.
  7. Continued pain.

POSTOP CARE:

In the hospital, pain management, blood clot prevention, physical therapy, and pneumonia prevention are addressed.  At home, wound care, diet, and activity are advised. 

Tags: Hip , Hip Replacement , hip surgery , Hip Joint , Fracture

 

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