What is it?
Total hip replacement is a surgical procedure for replacing the hip joint. This joint is composed of two parts--the hip socket (acetabulum, a cup-shaped bone in the pelvis) and the "ball" or head of the thigh bone (femur).
During the surgical procedure, these two parts of the hip joint are removed and replaced with smooth artificial surfaces. The artificial socket is made up of a metal shell inside of which is a high-density plastic or ceramic liner, while the artificial ball with its stem is made of a metal or ceramic.
These artificial pieces are implanted into healthy portions of the pelvis and thigh bones and affixed with a bone cement (methyl methacrylate) ie Cemented THR
An alternative hip prosthesis has been developed that does not require cement. This hip has the potential to allow bone to grow into it. This is called as Cementless THR.
In some cases, only one of the two components (socket or stem) may be fixed with cement and the other is cementless. This would be called a "Hybrid" THR.
When do we consider total hip replacements?
Total hip replacements are usually performed for severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or aseptic necrosis (a condition in which the bone of the hip ball dies). Most patients who have artificial hips are over 55 years of age, but the operation is
occasionally performed on younger persons. Circumstances vary, but generally patients are considered for total hip replacements if:
- pain is severe enough to restrict not only work and recreation, but also the ordinary activities of daily living
- pain is not relieved by arthritis (anti-inflammatory) medicine, the use of a cane, and restricting activities
- significant stiffness of the hip
- Xrays show advanced arthritis, or other problems
What can be expected of a total hip replacement?
A total hip replacement will provide complete or nearly complete pain relief in 90 to 95 percent of patients. It will allow patients to carry out many normal activities of daily living. | PATIENT EXPECTATIONS | SURGEON EXPECTATIONS |
| 100% pain relief | 90-100% pain relief |
| 100% normal walking pattern | Trace of limp to 100% normal walking pattern |
| Able to run and jump | Should avoid running or jumping |
| Able to bend fully forwards | Bend to 100-110° at the hip |
| Able to sit in deep or low lounges and chairs | Never sit in deep lounges or chairs |
| Able to turn the leg fully "any which way" | Avoid internal rotation of the hip permanently |
| The hip will "last forever" | The hip will last for about 15-20 years |
| The hip will never dislocate | Occasional hips will dislocate |
| The hip will never get infected | Occasional hips will get infected |
| Leg lengths will be equal | Leg lengths will be equal +/- 1cm |
surgery?
Results are generally very good, most people are relieved of nearly all of their hip pain. Approximately 90% of total joints will last 20 yrs, depending on patient use and activity levels. This may vary from person to person.
How long do artificial hips last?
About 90 % of total hip replacements are successful up to 20 years. The major long-term problem is loosening. This occurs because either the cement crumbles (as old mortar in a brick building) or the bone melts away (resorbs) from the cement.
Preparing for Surgery
Preparing for a total hip replacement begins a few weeks ahead of the actual surgery date. Maintaining good physical health before your operation is important. Activities which will increase upper body strength will improve your ability to use a walker or crutches after the operation.
Pre–op Medical Check-up :
During your pre-op visit, lab tests will be advised to insure that you are in good general health. Chest x-rays and an ECG are obtained if you have not had one taken for six months or if otherwise indicated. If at any time you become ill, such as with a cold or flu, you need to call your doctor. Remember, we want you to be in your best possible health !
The doctor will also make sure that a urinary tract infection is not present. Urinary tract infections are common, especially in older women, and often go undetected. Teeth need to be in good condition. An infected tooth or gum may also be a possible source of infection for the new knee. The orthopaedic surgeon may ask you to see a medical doctor.
You may be instructed to stop taking your anti-inflammatory medications (Ibuprofen, aspirin, etc ) one week before surgery. Bring a written list of past surgeries and of the medications and dosages that you normally take at home.
A physician will also review your medical history and the medications that you take. He will listen to your heart and lungs, and do a general physical exam. He will check for any type of infection. If infection is found, surgery is generally delayed until the infection is cleared.
Will I need blood?
Most patients don’t require a blood transfusion after a total hip replacement. If needed it, there is always blood available in the blood bank.
What are the risks of total hip replacement?
Total hip replacement is a major operation. The effect of most complications is that you must stay in the hospital longer.
The most common complications are not directly related to the hip and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in a leg, or blood clots in a lung.
1. Infection
Infection can occur following any type of surgery. In order to minimize the potential for infection to occur at the time of surgery, antibiotics are given before & after surgery. Infection following total hip replacement is of special concern because of the prosthetic components. The prosthetic components have no blood supply and this makes them susceptible to infection. If the prosthetic components become infected, additional surgery is almost always required in order to treat the infection.
2. Persistent Pain
While more than 90% of patients have complete or nearly complete relief of pain following total hip replacement, there are some patients with some persistent pain. In many cases, the pain resolves with time. In other cases, a specific cause for the pain can be identified and treated.
3. Blood Vessels and Nerves
There are several major blood vessels and nerves around the hip. Rarely, a major blood vessel or nerve is injured during total hip replacement surgery.
4. Blood Clots
Blood clots can form in the large veins of the legs and pelvis following major surgery, such as total hip replacement. It is possible for such a clot to break loose from the vein and travel to the heart. The clot can pass through the heart and into the lungs. This is called a pulmonary embolus. In order to prevent this from happening, blood thinners are prescribed post-operatively
5. Dislocation
Just like your real hip, and artificial hip can dislocate (where the ball comes out of the socket).
There is a greater risk just after surgery, before the tissues have healed around the new joint, but there is always a risk.
Your doctor will instruct you very carefully how to avoid activities and positions which may have a tendency to cause a hip dislocation.
6. Other Medical Complications
In a few patients, due to the advanced age & co-existing medical problems, there may be some medical complications like Hematemesis ( GI Bleed, etc), breathlessness, etc. This may necessitate a stay in the ICU for monitoring & so on.
Myths & Facts about Total Hip Replacement
Too Old ?
Hip replacement is safe and successful at any age. With modern & regional anaesthesia, infection fighters, and the skill of experienced joint surgery specialists, you don’t “have to live with the pain.”
Too Young ?
Today’s bearing surfaces (Ceramics) make artificial joints last longer than ever before. When performed properly, hip replacement can be expected to last 15-20 years. When the first hip replacement wears out, another new one can be put in. It’s much like re-treading a tire or recapping a tooth.
Too Overweight ?
For people with hip arthritis, it’s almost impossible to lose weight when even simple walking is too painful. In fact, it’s much easier to exercise and lose weight when hips are pain-free after hip replacement.
Too Long To Recover ?
Patients are usually allowed to walk within 24 hrs after surgery. Discharge from the hospital is around the 3-4th day. Healing and recovery after hip replacement is generally complete in 4-6 weeks.
Limitations of Total Hip Replacement Technology
In many ways, a total hip replacement is similar to a set of automobile tires. How long the knee replacement lasts is related to the type and amount of use, and not simply how long it has been implanted.
Although it is anticipated that a total hip replacement will last for many years, some fail sooner than expected. The main causes of failure are loosening, wear, osteolysis and component breakage. Fortunately, these occurrences are rare. Unfortunately, they can occur and generally necessitate additional surgery.
Fracture of the bone around a total hip replacement can also occur and surgery may be necessary to stabilize the fracture.
Loosening, wear and osteolysis generally occur slowly over time. The patient may not initially experience any pain or other symptom indicating a problem. For this reason, it is generally recommended that all total knee replacements be evaluated with x-rays on a yearly basis. This way, problems can be detected and treated early and, therefore, more easily.
Read More:Revision Hip Replacement / Arthroplasty | Dr. Rahul Damle
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