Total Hip Replacement
Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. The hip joint is one of the body's largest weight-bearing joints, located between the thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint.
Several diseases and conditions can cause damage to the articular cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.
Arthritis is inflammation of the joints resulting in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability. The three most common types of arthritis that affect the hip are:
- Osteoarthritis: It is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage wears down, the bone ends rub against each other and cause pain in the hip.
- Rheumatoid arthritis: This is an autoimmune disease in which the tissue lining the joint (synovium) becomes inflamed, resulting in the loss of cartilage causing pain and stiffness.
- Traumatic arthritis: This is a type of arthritis resulting from a hip injury or fracture. Such injuries can damage the cartilage and cause hip pain and stiffness over a period.
The most common symptom of hip arthritis is joint pain and stiffness resulting in limited range of motion. Vigorous activity can increase the pain and stiffness which may cause limping while walking.
Diagnosis is made by evaluating medical history, physical examination and X-rays.
Surgery may be recommended, if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms.
The surgery is performed under general or spinal anaesthesia.
During the procedure, a surgical cut is made over the hip to expose the hip joint and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone is removed using a reamer. The acetabular component is inserted into the socket. Rarely screws are used, and occasionally bone cement is inserted. A liner made of plastic or ceramic is placed inside the acetabular component. The femur or thigh bone is then prepared by removing the arthritic bone using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. The muscles and tendons around the new joint are repaired and the incision is closed.
You will stand and walk on your new hip within hours of the surgery, assisted by a physiotherapist.
Discharge from hospital is achieved when you are safe using crutches and are able to go up and down stairs. This is usually between days two and four post-operatively. Rarely is an inpatient stay in the rehabilitation unit required, however it is useful for those who are more incapacitated and have greater difficulties at home.
After undergoing total hip replacement, you must take reasonable care to prevent the new joint from dislocating and to ensure proper healing of the soft tissues and the bones. In the first six weeks, it is critically important to allow your bones to grow onto and bond with your prostheses, and for any ligaments and muscles to repair and strengthen.
Some of the common precautions to be taken include:
- Avoid combined movement of bending your hip and turning your foot inwards
- Keep a pillow between your legs while sleeping for 6 weeks. (It is okay to sleep on your side)
- Avoid crossing your legs, and bending your hip past a right angle (90 degrees) for the first six weeks
- Avoid sitting on low chairs for the first six weeks
- Avoid bending down to pick up things from the floor for the first six weeks. It may be useful to use an extended grabber can to do so
- It may be helpful to use an elevated toilet seat for the first six weeks
As a general guide, it is safest to act like an old person for six weeks, and then a slightly less old person for another six weeks. You want your hip replacement to last as long as possible, and treating it very well in the first three months is a very good investment. Attempting to beat your neighbour to walking around the block, or to performing star-jumps, might risk great sadness. Better to be patient – your hip replacement is for life.
As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. Some of the possible complications after total hip replacement include:
- Death: This is rare - somewhere between one in one thousand for younger fitter people and one in one hundred for older sicker people
- Infection: This is of the order of one in two-hundred and fifty. People with diabetes, morbid obesity and those who smoke have higher rates
- Dislocation - somewhere between one and three percent
- Fracture of the femur or pelvis
- Injury to nerves or blood vessels
- Formation of blood clots in the leg veins and/or the lungs
- Leg length inequality (this risk is reduced by accurate templating, and the use of intra-operative checks)
- Hip prosthesis may wear out
- Failure to relieve pain
- Scar formation
- Pressure sores
- Heart attack or stroke
Total hip replacement is one of the most successful orthopaedic procedures performed for patients with hip arthritis. This procedure can relieve pain, restore function, improve your movements at work and play, and provide you with a better quality of life. Dr Wheatley will do everything within his power to manage your risk profile. The risks can be minimised, but never fully excluded.