Hip replacement

There are various conditions, which damage the hip joint and give rise to a need for hip replacement surgery. Some of these conditions are as mentioned.

• Osteonecrosis of femoral head - This condition is related to the insufficient supply of blood to the ball joint of the hip. This may result in collapsing and deformation of the bone.
• Rheumatoid arthritis – This is a condition, which arises due to an over-reactive immune system. In this condition, there is inflammation observed in the joints, which causes the erosion of the cartilage and bone, along with deformity in the joints.
• Ankylosing spondylitis
• Osteoarthritis – This is also known as wear and tear arthritis, which causes damage to the slick cartilage that provides a covering at the end of the bones and assists the joints in moving smoothly.
• Congenital hip joint abnormality – Secondary to congenital hip joint disorders like perthes disease & dysplasias
• Any trauma to the hip joint in the past.

There are some risks associated with the hip replacement surgery, as mentioned below.

• Infection – Infections can be seen at the site of the incision and even deep into the tissue near the new artificial hip joint. Some of the minor infections can be treated with antibiotics but if the infection is severe near the operated site, then another corrective surgery is needed and a new hip joint is replaced.
• Blood clots – Blood clots can be formed in legs which can dislarged to the lungs called Pulmonary Embolysim. This can be fatal for the patient. The doctor may prescribe blood-thinning medications to prevent the risk of blood clots.
• Dislocation – Some positions can result in the dislocation of the ball portion of the new hip joint. Hence, after the hip replacement surgery, the patient is advised not to cross the leg beyond the midline of the body and not to bend the hip joint beyond 90 degrees at the artificial hip joint. If the hip joint dislocates, then the doctor advises wearing braces to keep the hip in place. Even after multiple precautions taken, if the hip joint dislocates, a surgery is needed to be performed in order to stabilize it.
• Fractures – There may be some fractures caused to the healthy areas of the hip joint. Some fractures are very small and heal on their own. However, some fractures may be big and require to be fixed with pins, bone grafts, and wires.
• Loosening – The loosening of the hip joint is a rare complication especially with the new artificial joint parts. Sometimes, the new hip joint does not fix to the bone properly or may begin to loosen over a period of time. This results in pain in the hip. In such cases, another corrective surgery may be needed to treat the problem.
• Change in the length of the leg – Measures are taken to prevent this problem but in some cases, the leg of the patient may become shorter or longer after the surgery. This problem may also result from muscle weakness in the hip. In such cases, stretching and strengthening of the leg and hip muscles are helpful.

Blood clot prevention can be done by early mobilization, where the patient is made to walk on the same day after surgery.

In some scenarios, the need for a second hip surgery may arise. This usually occurs when the artificial hip joint wears out over a period of time. In such cases, the doctor advises going for another hip replacement surgery, especially if the patient has had the previous hip surgery while he/she was young. However, with the advancement in the technology, the newly introduced materials are increasing the life of the prosthesis and eliminating the requirement of the second hip replacement surgery.

Present bearing of choice is ceramic on poly, mainly other can also be used, some cases metal on poly or ceramic on ceramic.

The doctor will discuss the hip replacement procedure, along with its benefits and risks, with the patient in detail.

Before the procedure:

• The doctor will take a complete medical history of the patient and would ask the patient about all the conditions, allergies, any bleeding disorders, or surgeries if the patient had undergone in the past. Also, the doctor will ask about if the patient is taking any medications currently or has taken in the past.
• The patient is also asked to go through some blood tests and X-rays scans to access the affected area to be treated and to examine the damaged part in the hip.
• A complete physical examination (physical & radiological) is done by the doctor, especially focusing on the hip problem, to monitor the range of motion, strength, and stability. The physical test helps the doctor to closely examine any other concerning signs.
• The patient is advised to inform the doctor if he/she is taking any blood thinning medications or any supplements. Accordingly, the doctor would decide if the medication is to be stopped or can be continued. The patient is also advised to inform the doctor is he/she is diabetic and is taking insulin.
• The patient is advised to quit smoking as it delays the healing process after the treatment. The patient is also asked to avoid alcohol.
• The patient is also advised not to eat or drink after midnight before the surgery day, depending on the time of surgery.
• The patient must ask the doctor about the hospitalization after the surgery.
• The patient usually stays in the hospital for a day or two, after the surgery. The patient is advised to bring a companion along to take care of the patient after the surgery and drive back home safely when discharged.
• The patient is asked to change into the hospital gown, before the start of the surgery.

 During the procedure:

• Spinal block or general anesthesia is given to the patient to numb the area below the waist or make the patient completely unconscious.
• An incision is then made in the posterior part of the patient’s hip and the layers of the tissue are opened up.
• The surgeon then removes the damaged cartilage or the bone area of the patient. Only the healthy part of the bone is left behind.
• The affected removed part is replaced by the artificial hip joints and the prosthesis is placed in the femur or the pelvis part.
• The round tip of the femur bone is replaced from the top with an artificial ball joint. This is attached to a stem that further fits into the thighbone part.
• Nowadays, new minimally invasive surgical techniques are evolving, which may decrease the recovery time and the associated pain in comparison to the previous hip replacement standard surgery techniques.

After the procedure:

• After the Hip replacement surgery, the patient is shifted to the recovery room until the patient gains consciousness. The patient is kept under continuous monitoring and observation in the recovery room.
• The vital signs of the patient including the pulse rate, body temperature, oxygen levels or breathing rate, and heart rate are monitored continuously, where patient is made to walk on the same day or next day.
• The patient is usually allowed to go home in 2 to 3 days, in case there are no complications after the procedure.
• Initially, the patient also feels pain for which the doctor prescribes some painkillers.
• During the stay in the hospital post surgery, the doctors advise the patient to move the leg, as much as possible, which helps in improving the blood flow in the legs and thus, prevents from clots or swellings. The patient is asked to move with crutches or walker initially after the surgery in a day or two.
• The doctor advises the patient to wear elastic compression stockings or inflatable air sleeves, which is similar to the blood pressure cuff, in the lower part of the legs. This prevents the pooling of the blood in the veins of the legs, thus, preventing blood clots.
• The doctor may also advise blood-thinning medicines depending upon the condition of the patient, activeness of the patient and the risk of having blood clots.
• By 6 weeks to 12 weeks, patient is returned to normal activities.

Physiotherapy:

• The physiotherapist can be recommended during the hospital stay post-surgery and or at home and assists in the quick recovery of the patient.
• The patient is asked to perform these exercises regularly.
• The exercises help the patient in the following ways:
• Increase the range of motion of the hips.
• Strengthening exercises for the thigh muscles.
• Enhance the balance while walking.
• The patient is also taught on how to use the walker, crutches or canes. Eventually, by doing exercises regularly the patient will be able to walk without any assistance.
• The doctor asks the patient to come for follow-up visits, to closely monitor the condition of the patient and the progression of the treatment.
• The complete recovery after the hip replacement surgery occurs within a year (6 to 12 months).

After the hip replacement surgery, the patient regains a full range of motion and reduced symptoms of pain from the damaged portions in the hip. The doctors advise the patients not to perform strenuous exercises as it may not have a good impact on the new artificial joint. Some light physical activities are allowed, however, the patients are advised to consult the doctor before, starting an exercise regime.

Q1. Why does a patient undergo hip replacement surgery?

A1. A person might consider undergoing hip replacement surgery, if the following hip pain problems are observed.

• Interference during the sleep
• Uncontrollable pain even after taking painkiller medicines.
• Difficulty to climb or walk down the stairs.
• Pain and discomfort during walking, in spite of the walker or cane.
• Discomfort in getting up from a sitting position.

Q2. How to take care of the patient at home after a hip replacement surgery?

A2. There are some pointers, which the patient and the relatives can take care of to improve the life of the patient at home after a hip replacement surgery:

• The patient is advised to not climb multiple stairs at a time. The patient is recommended to climb up and come down the stairs once or twice in a day.
• The patient is advised to sit with the back straight and in a firm position.
• Avoid jumping & running.
• It is preferable to use an elevated toilet seat. This will prevent the excessive bend of the hips.
• The patient is asked to stay away from over-enthusiastic pets.