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Hip replacement
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A hip replacement is a type of surgery to replace damaged parts of the hip with artificial joint (also called as prosthesis or an implant) made from metal and plastic components. The most common reason for a hip replacement is arthritis. A hip replacement surgery is generally used:
• when other treatments have failed to relief the pain
• to treat severe injuries such as broken hip or bone defects.
The operation can relieve hip pain, improve your mobility and the quality of life. You should consider a hip replacement surgery if you have these symptoms:
• persistent pain that interferes with your daily activities and sleep
• stiffness in your hip that is reducing your mobility and walking abilities
A hip replacement is also known as hip arthroplasty or a total hip replacement. Most patients who undergo total hip replacement surgery are between the age of 60 and 80 and are with degenerative osteoarthritis but adults of any age can be considered for this operation.
Who is it suitable for
✔ People with chronic hip mobility issues
✔ Individuals with chronic hip pain
✔ Elderly people suffering the effects of osteoarthritis
✔ People with a serious hip fracture
✔ Those who were diagnosed with rheumatoid arthritis
✔ Individuals experiencing severe hip pain, stiffness or inflammation
✔ People with bone-growth disorders
Treatment duration
Recovery
✔ A hip replacement surgery normally takes 2-4 hours
✔ Most patients need to stay in hospital overnight
✔ The complexity and duration of hip replacement vary from patient to patient, depending on their individual situation
✔ Most patients need to undergo rehabilitation to strengthen the new joint and improve flexibility
✔ Physiotherapy and occupational therapy is essential for better recovery
✔ After about 3 months you should be able to get back to most of your normal activities
✔ For some people, it takes 6 to 12 months to see the full benefits of the hip replacement procedure
Types of hip replacement surgery
The three major types of hip replacement are:
• total hip replacement
• partial hip replacement
• hip resurfacing
The most common type of hip replacement surgery is a total hip replacement, which involves replacement of the hip with artificial implants. The hip socket is replaced with a durable plastic cup, which can also include a titanium metal shell. Your femoral head will be removed and replaced with a ball made from ceramic or a metal. The new ball is fixed on a metal stem, which is then inserted into the top of your femur. At the end, all artificial joint surfaces are adjusted to have a better rotation angle.
Can I have both hips replaced at the same time?
In most cases patients can have both hips replaced at the same time if there is no history of cardiopulmonary disease. In some cases, however, it may be better to stage the surgeries. Always consult with your doctor before scheduling an opertation.
Before The Treatment
Hip replacement is a serious surgical intervention and preparation is similar to any other surgery. Before the surgery you will meet your doctor to discuss your surgery objectives and to perform an examination:
• Medical history - You should provide a complete medical history including your past and current medical conditions, chronic illnesses, previous surgeries, traumas and injuries. A doctor will ask about your hip pain, mobility as well as other symptoms, and how it affects your daily life.
• Medication review - Prepare to provide a list of medications that you might be taking including prescription drugs, supplements, over the counter medication and anything else that you are taking regularly.
• Examination - A surgeon will examine your before surgery to assess your hip mobility, alignment and strength.
• Diagnostics, tests and additional examination - It is likely that you will be asked to do an X-ray and/or MRI (magnetic resonance imaging) to determine the extent of the hip problem. Be prepared to undertake additional examination, diagnostics, a specialist consultation and blood tests if your surgeon requests before preceding with this treatment.
Before the surgery you will be advised by your surgeon how to prepare for this procedure, which may include dietary requirements and medication directions. It's recommended that you arrange for help during recovery and drive you home from a hospital.
What does it involve?
There are different types of hip replacement, but generally the following is involved:
• This procedure is generally performed under general or spinal anaesthesia.
• The hip replacement procedure will start with making incisions in the area of your hip.
• Anterior hip replacement surgery uses an incision at the front of the hip.
• Posterior hip replacement surgery uses a curved incision on the side and back of the hip.
• Joint is then removed and artificial prosthesis is placed. There are different types of prosthesis available on the market and you should agree the type of prosthesis with your doctor prior to surgery.
• Drain tubes may be placed through the incision to drain any excess fluid and blood.
• At the end, sutures are applied to close the incisions.
• Compression socking can be applied to reduce a risk of DVT.
Hip replacement procedure usually takes 2 to 4 hours but can takes longer. In most cases, patients have to stay in hospital overnight, and then will have to go through rehabilitation process until full recovery.
After the treatment
Straight after surgery you will be placed in a post-surgery care unit where a medical team will be monitoring your vital signs and help you manage pain and any other post-surgery symptoms. You are going to have a dressing and tube on your hip for drainage, which should be removed the day after surgery. Once the anesthesiologist is satisfied with your condition, you will be moved to an inpatient room for further recovery. Depending on the complexity of the operation and your situation you may need to stay in hospital for 3-5 days.
Rehabilitation is vital for a successful recovery and will normally commence as soon as you are in a stable condition. Usually, rehabilitation process begins within 24 hours after surgery. Most patients can resume walking with a cane, walker or crutches within day or two after surgery. As the days progress, you will increase the distance and frequency of walking. Your therapist will help you sit up, get in and out of bed, and practice walking and climbing stairs using a walker, cane or sometimes crutches.​ Your doctor will monitor your recovery and use a multifaceted approach to ensure comfort and mobility during the rehabilitation process.
It is recommended to continue rehabilitation process for at least 6 to 8 weeks. After 2 or 3 months most patients are able to resume everyday activities. However, it may take 6 to 12 months to see the full benefits of the hip replacement procedure.
Risks
Hip replacement surgery is considered safe and effective. However, very rarely, complications can include:
• infections
• blood clots (deep vein thrombosis, or DVT)
• hip dislocation, especially in the first few months after surgery
• one leg feels shorter than the other
• nerve and blood vessel injury
• swelling and stiffness
• continued pain
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