Total Hip Replacement Surgery
What are the various causes of hip pain?
There are many different causes of pain in the hip joint which may
include osteoarthritis, fractures/ dislocations, tendonitis
(inflammation of the tendon surrounding the hip), rheumatoid arthritis,
osteonecrosis (restricted blood flow to the bone), injury or radiating
lumbar pain can also cause pain in the hip joint.
What is the cure?
There can be various methods for treating the pain. Mild cases can
be treated through rehabilitation, but the severe cases may require
surgery.
Why is total hip replacement surgery performed?
When other therapies fail to provide relief from the pain of a damaged
hip, hip replacement may be the answer. Hip replacement - called total
hip arthroplasty - can relieve pain and give you back the range of
motion you need to go about your daily tasks.
What is the average age of people going for Total Hip Replacement?
THR used to be an option primarily for adults age 60 and above. But
improved technology has made b and longer-lasting artificial joints
that are feasible for more active people, including younger people.
However, active people face the possibility of another surgery to
replace worn out artificial hip joints after 15 or 20 years.
Do I need a total hip replacement surgery?
If the other therapies, such as pain medications have failed, hip
replacement is usually the answer. If you experience severe pain, loss
of motion or deformity of your hip joint, you require hip replacement
surgery.
Hip replacement is also used in people with hip injuries, rheumatoid
arthritis and other medical conditions, such as a bone tumor or bone
loss due to insufficient blood supply (avascular necrosis).
Total Hip Replacement surgery is generally delayed by the doctors in
favor of less invasive procedures. But, if you have difficulty walking
or performing everyday activities such as getting dressed, you do
require hip replacement surgery.
What is total 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 is the total hip replacement surgery done?
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.
The surgery usually takes two to four hours, which varies with each
patient, depending upon the severity. 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.
A bandage is applied and a special drain is usually inserted into the
wound to drain the fluid that naturally develops at the surgical site.
You would then be taken to the recovery room, where you would be
closely monitored.
When you regain consciousness, you would be taken to the hospital room,
where a nurse would be with you. You would also be given pain killers
and the knee might remain swollen for a few days.
When can I return to normal activities after surgery?
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.
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 surgeon philosophy and the
patient's condition.
What is the life of a replaced hip?
The longevity of the prosthetic varies with every patient depending
upon physical condition, activity level, weight as well as the accuracy
of implant placement during surgery.
Though total hip replacement has become a common and predictable
surgery, with very high success rates, it should be kept in mind that
there is no guarantee that a prosthetic joint will last the rest of
patient's life.
As with any mechanical joint, the hip joint 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 knee 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.
What precautions do I need to take after total hip joint
replacement surgery?
Though this is not an exhaustive list of the precautions, these are the
general guidelines to be followed after the surgery. The surgeon and
the physical therapist will guide you in details about the do's and
don'ts after the surgery.
- Avoid heavy lifting and excessive stair climbing
- Maintain appropriate weight
- Avoid "impact loading" sports such as jogging, downhill skiing and high impact aerobics, twisting or impact stresses.
- Consult your surgeon before beginning any new sport or activity
- Avoid excessive bending when weight bearing, like climbing steep stairs
- Do not lift or push heavy objects
- Do not kneel
- Avoid low seating surfaces and chairs. .
How is hip rehabilitation done?
A total knee replacement rehabilitation program is begun after the surgery.
To help regain strength, balance and range of movement in your
knee, a specifically designed rehabilitation programme is started when
you are back in the hospital room. The physical therapist will help you
perform appropriate exercises. 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
You can expect to stay in the hospital for about five to six days after
your surgery. You may or may not be transferred to a rehabilitation
facility for a few more days, as determined by your surgeon. Your
bandages and sutures will usually be removed before you leave the
hospital. At home, you will need to continue your exercises. Standard
total hip replacement surgery is generally covered by most insurance
plans. You will need to check with your particular healthcare plan for
details.
Where is the incision for total hip arthroplasty?
The incision is located over the outer aspect of the hip. There is a
bone that you can feel on the very outermost aspect of your hip. The
incision is usually centered over this bone and is approximately four
to six inches in length, running from along the length of the leg and
right at the top of the bone on the outer part of the hip, running a
bit posteriorly towards the buttock.
Do I need to take antibiotics after dental and other procedures after the joint replacement?
Your total joint replacement is an immuno compromised area in your
body. Your immune system and white blood cells have a difficult time
clearing bacteria from joint replacements. Therefore, it is best to
avoid and reduce the risk of any possible infection. To do this, it is
commonly recommended that for dental procedures, particularly those
involving a dental abscess, and for other procedures that are at risk
for putting bacteria into the blood stream, that a patient be given
antibiotics around the time of these procedures. The greatest risk for
infection to occur after these procedures is within the first two
years. After that time, there is a risk of infection with these
procedures but it is significantly reduced.
Are there chances of my body rejecting the artificial parts?
The materials used for total hip replacement arthroplasty include
titanium, cobalt chrome, and polyethylene. To date, there is little
evidence suggesting any allergic reaction to these materials. Top
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