Hip Replacement

Hip replacement surgery is a joint surgery and is one of the most successful surgeries in the orthopaedic field. It was first performed in 19601 and since then the advent of technology, modern medical practices have contributed in making the hip replacement surgery advanced ever since. As per the reports of Agency for Healthcare research and quality, around 300,000 people – alone in United States – opt for this surgery, every year.

Ninety to ninety-five percent of patients can expect to have their total hip replacement functioning at 10 years, and in 85% they will still be functioning at 20 years. Although 85% of patients undergoing total hip replacement have a diagnosis of osteoarthritis, inflammatory arthritis, both seropositive and seronegative, is an important indication for total hip replacement and can offer tremendous improvements in quality of life even in the very young.

CAUSES:-

Patients suffering from arthritis usually undergo this treatment procedure to get relief from pain. According to American academy of orthopaedic surgeons, usually the people who opt for hip replacement surgery are in the age group of 50-80. The reason other than arthritis for hip replacement is when tumour grows in the hip.

Osteoarthritis : It is basically an age-related wear and tear of tissues – mostly occurs in people more than 50 years of age or in people who have ancestral lineage of arthritis. The cartilage tissues between the two joints act as cushion – which, when wears out – causes rubbing of the two joints, resulting into pain and stiffness in the hip region.

Sometimes, the extent of osteoarthritis is also dependent on the formation of hip bones during infancy and pre-adolescent growth period.

Rheumatoid Arthritis : Synovial membrane – which generates synovial fluid and has lubricating action – thickens and becomes inflamed. This inflammation is due to the auto-immune functionality of the membrane. This causes the chronic pain and stiffness in the joints, due to the damage of the cartilage. Rheumatoid arthritis is also known as “Inflammatory Arthritis”.

Post-traumatic Arthritis : It develops in a person after he has faced some sort of damage or injury in the joint. First, it starts off as stiffness and pain in the joint and can later turn into arthritic issues.

Avascular Necrosis : Also commonly called as Osteonecrosis, occurs when there is a fracture in the joint which stops the blood flow to femoral head – leading to the collapse of surface of the bone – and thereby resulting into Arthritis.

DIAGNOSIS:-

Before hopping on to the hip replacement surgery – the doctor or surgeon needs to evaluate the medical conditions of the patients beforehand, to avoid any mishap and check if the surgery is an utmost necessity or not.

Medical History – The task of the surgeon is to first, assess your general health and then check, how much the hip pain affects daily chores and if any impending medical conditions might adversely affect the surgery.

Physical Examination – The purpose of physical examination is to assess the strength, mobility and alignment of the hips.

X-Rays – This is done to assess the exact condition of the hip bones and joints. These images precisely represent the extent of deformity of hips.

Other Tests – In some cases, when the surgeon is still not certain of the treatment, he asks for an MRI to analyse the soft tissues on your hip and the bone condition.

Other things that are necessarily kept in mind, before proceeding to the surgical procedure are – the test of skin irritations and infections, storage of your blood for usage after the surgery, dental evaluation for any infections and urological evaluations for older patients before the surgery.

PROCEDURE:-

Total hip replacement surgery – like any other surgeries require attention and care after the surgery is done, in order to achieve the best possible results out of it. After proper diagnosis of the patient – he is advised to get in the best possible health conditions and then the surgeons embark upon the surgical procedures.

The surgical procedure involves various steps –

• 1. The patient is advised not to have anything, 12 hours before the surgery and is provided with dripping IV solutions, to ease out the intake of medications and fluids after the surgery.
• 2. Then, anaesthetic team observes the patient – for which kind of anaesthesia would best suit him. Usually, general anaesthesia which is either spinal, epidural or regional nerve block. In some cases, if the patient is not suited for general anaesthesia then local anaesthetics are given to the patients.
• 3. The next step is the surgical operation – that is, incision of the joint, then removal of the wear out cartilages and bones and at last replacement of the parts with the prosthesis implant.

   

• o The incision is made through tissue layers on the back of the hip
• o Damaged part is removed by leaving the bones at their place.
• o Implants are press fit in the pelvic bone, to replace the socket.
• o The implant is aligned perfectly in the bone and then cemented.

 

• 4. After the surgical operation, the patient is advised to take care of the wounds by partaking actively in the rehabilitation program.

RISKS & COMPLICATIONS:-

Every medical treatment option has some downside to it – depending on the conditions, minor mistakes and some unavoidable unforeseen previous medical conditions. However, in hip replacement surgery, the chances of complication are considerably less. Serious issues such as joint infection occurs in less than 2 percent of the cases, and major complications such as heart failures due to DVT is almost negligible.

Infection – infections can happen during the surgical procedure or during wound caring as, they are spread into the joint by the bacteria. If the infection is recognized later, then the surgery is to be redone and anti-infectants could be used. These are very uncommon in Hip replacement surgery, though.

Blood Clots – Blood clotting occurring in deep veins during total hip replacement surgery can prove to be fatal, if the veins burst it might lead to pulmonary embolism. This is treatable with anti-clotting medicine if noticed in time being.

Leg length Discrepancy – Primereasons due to which the limb discrepancy is observed is linked to prosthetic malalignment, radiographic loosening, and comorbidities. But, some of the discrepancies observed could not be attributed to any of these observed reasons. This discrepancy is observed in order to count for the stability of the Hip joint.

Implant loosening – It is very common kind of complications observed after hip replacement surgery. The prosthesis, if not sealed perfectly would lead to the wearing out and loosening of the implants in due time. Redoing of the surgery is the treatment option for this.

CONCLUSION:-

Hip replacements usually have higher success rates. In fact, the AAOS has called hip replacement as “one of the most successful operations in all of medicinal practises.” Most people who have underwent the procedure report significant amount of improvement in doing daily chores.

The most common risk is dislocation of the new joint. This usually occurs in patients who do not prescribe to the standard rehabilitation program devised by surgeon and PT, before resuming normal activities. It may also occur in patients who do not follow instructions with utmost care for looking after the hip after surgery. However, with new prosthesis, hip dislocation can be greatly reduced. Infections and blood clots are also potential complications, but proper procedures can help prevent these from occurring.

Hip joints last many years, but high-impact activity or obesity may reduce their lifespan. Some people need to get a second hip replacement if the first one begins to deteriorate. With newer designs and materials, however, they may even last several decades.

Hip Replacement Surgery FAQ