When you have developed arthritis in your hip, the surfaces of the ball-and-socket joint between your thigh bone and pelvis bone are no longer smooth. The bones' surfaces become rough, and the cartilage lining is worn away. As a result, your hip becomes painful and stiff. Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint and relieving pain.
Synonym
Hip Replacement, Total Hip Arthroplasty
About the Procedure
During the surgery, an incision of about 10 inches long is made along the side of your hip and thigh. The surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then, the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The stem is fixed into your thigh bone and the new socket into the space in your pelvis. The skin is then closed with stitches or clips. There are many different types of artificial hips. Your surgeon will decide for the type to be used for you. Total Hip Replacement surgery usually lasts 2 to 3 hours. Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a 'cemented' procedure. In an un-cemented procedure, the artificial parts are made of porous material that allows the patient's own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a 'hybrid' hip replacement, which consists of a cemented femur part and an un-cemented acetabular part. In recent years, some surgeons have begun performing what is called a minimally invasive, or mini-incision, hip replacement, which requires smaller incisions and a shorter recovery time than traditional hip replacement.
Length
The Total Hip Replacement procedure usually takes about 1 to 2 hours to complete.
Benefits
The benefits of the Total Hip Replacement are:
There will be immediate and substantial improvement in your pain, functional status, and overall health-related quality of life. Promising clinical evidence suggests that these immediate improvements persist in the long term.
Over the last two decades, complications associated with Total Hip Replacement have declined significantly:
• Prophylactic antibiotic therapy has helped to prevent infection.
• Use of anticoagulants in the peri-operative period has reduced the incidences of deep venous thrombosis and pulmonary emboli.
Who is an ideal candidate?
An ideal candidate for the Total Hip Replacement should be
• 50 or younger
• normal weight based on body mass index
• healthier than candidates for traditional surgery
Who is not an ideal candidate?
An ideal candidate should not meet the following criteria:
• Suffer from angina (chest pains) or shortness of breath that limit your walking more than your hip pain.
• Suffer from a urinary infection. This may result in infection of your new hip. Your urine will be checked. If it is infected, antibiotics will be given before your operation. The same applies to other infections. They have to be cleared before you have your operation.
• Suffer from prostate problems. If you have poor urinary flow, it is better to have this investigated and treated before your hip is replaced.
Recovery
Usually, people do not spend more than 3 to 5 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, your overall health and the success of your rehabilitation. During the recovery period, you will be allowed only limited movement immediately after the surgery. While in bed, the hip usually is braced with pillows or a special device that holds the hip in the correct position. You may receive fluids through an intravenous tube to replace fluids lost during Total Hip Replacement surgery. There also may be a tube located near the incision to drain fluid and a tube (catheter) may be used to drain urine until you are able to use the bathroom. Your doctor will prescribe you medicine for pain or discomfort.
Preparing your surgery
Once you have decided to undergo the surgery, you should prepare yourself in the following ways:
• Stop smoking and get your weight down if you are overweight.
• If you know that you have problems with your blood pressure, your heart, or your lungs, inform your surgeon to keep them under control.
• Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT.)
• Find someone to take you home and look after you for the first week after the operation.
• Bring all your tablets and medicines with you to the hospital.
• On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.
Anesthesia
General or spinal anaesthetic will be used for performing the Total Hip Replacement.
Risks / Complications / Side effects
Usually, the risks and complications after the surgery may include:
Formation of blood clots in leg veins - These clots can form either as a result of decreased movement of your leg after the surgery or from injury to the veins during surgery. To prevent this from happening, your doctor usually prescribes blood-thinning medications after your surgery. Compression devices such as elastic stockings and exercise to increase blood flow through the veins in your legs can also reduce your risk.
Infection - Infections can occur at the site of incision and in the deeper tissue near your new hip joint. Most of these infections can be treated with antibiotics. However, if the pocket of infection is close to your prosthesis, then surgery may be required to replace the prosthesis or remove it completely.
Dislocation of hip joint - Certain positions at the hip joint can cause the ball of your prosthesis to become dislocated. To avoid this, refrain from bending more than 90 degrees at the hip or from allowing your leg to cross the midline of your body.
Loosening and stiffening of your hip joint - Over time, your new joint may loosen or the soft tissues around your joint may harden as a result of a process of ‘ossification’. This may cause pain and stiffness in your hip and may make it difficult to move.
Breakage of the prosthesis - Your artificial hip can break several years after surgery. In that case, another Total Hip Replacement surgery would be required to replace the broken joint.
Change in length of your leg - Your surgeon takes special precautions during the Total Hip Replacement surgery to avoid this problem, but occasionally, your new hip may make your leg longer or shorter than the other one. This may result from weakness in the muscles surrounding your hip. This problem can be resolved by strengthening those muscles.
However, the most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint).
After your surgery
On the day after surgery or sometimes on the day of surgery, therapists will teach you exercises to improve recovery. A respiratory therapist may ask you to breathe deeply, cough or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.
As early as 1 to 2 days after surgery, you may be able to sit on the edge of the bed, stand and even walk with assistance.
A physical therapist may teach you exercises such as contracting and relaxing certain muscles, which can strengthen the hip. Because the new, artificial hip has a more limited range of movement than a natural, healthy hip, the physical therapist also will teach you the proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to your new hip.
Post operative care
During the post operative care, you should be careful of the following:
• Follow the doctor's instructions.
• Work with a physical therapist or other health care professional to rehabilitate your hip.
• Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.
• Use a long-handled "reacher" to turn on lights or grab things that are beyond arm's length.
Decision
Before deciding for the Total Hip Replacement surgery, you must accept the risks and complications. Your decision must be based upon weighing the benefits of the Total Hip Replacement surgery against the risks. You may wish to discuss the surgery with your own doctor or even get a second opinion. All your doubts should be cleared before you decide to have the operation.
Price range
BHT 430,000-460,000