HIP Replacement

Hip Replacement

Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier.

Various types of arthritis may affect the hip joint:

• This is a degenerative joint disease that affects mostly middle-aged and older adults. It may cause the breakdown of joint cartilage and adjacent bone in the hips.
• Rheumatoid arthritis. This type of arthritis causes inflammation of the synovial lining of the joint and results in excessive synovial fluid. It may lead to severe pain and stiffness.
• Traumatic arthritis. This is arthritis resulting from an injury. It may also cause damage to the hip cartilage.

Diagram showing a normal hip joint compared to a hip joint with arthritis, which has damaged cartilage

The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged and to relieve hip pain that can’t be controlled by other treatments.

A traditional hip replacement involves an incision several inches long over the hip joint. A newer approach that uses one or two smaller incisions to perform the procedure is called minimally invasive hip replacement. However, the minimally invasive procedure is not suited for all people who need hip replacement. Your doctor will determine the best procedure for you.

How it is done?

A hip replacement is done under anaesthetic. Usually you are given a general anaesthetic, so you are completely asleep during the operation. It is also sometimes done under a spinal anaesthetic, which means you are awake but completely numb from the waist down. The operation itself takes about two hours. The surgeon will make a cut (incision) about 20-25 cm long usually downs the outside of your thigh, although increasingly surgeons are using an incision in your groin. Then they cut out the part of your hip joint that is being replaced. The hip joint is a ‘ball and socket’ joint; sometimes it’s the ‘ball’ that needs to be replaced, sometimes the ‘socket’, but usually it’s both.

Once you’ve recovered from the effects of the anaesthetic you will be seen by a physiotherapist – usually the day after your operation. Your physiotherapist will help you to get back on your feet and show you exercise that you will need to do to strengthen your muscles. Most people are able to go home after three to five days. To begin with you will need crutches to walk with but you should be able to get rid of these (if you have been doing your exercises regularly) within four to six weeks. Normally you can be back to light work and be able to drive after about six weeks.

 

Before surgery

Hip fractures can be very painful. During diagnosis and treatment, you should be given medication to relieve your pain. At first pain relief is usually given intravenously (through a needle into a vein in your arm), with a local anaesthetic injection near the hip.

Before your operation you’ll be given antibiotics. This is to reduce the risk of your wound becoming infected after surgery.

Surgery carries the risk of a blood clot forming in a vein, so steps will be taken to reduce this risk. For example, you may have injections of heparin, which is an anticoagulant that reduces the blood’s ability to clot.

You’ll continue to be monitored for blood clots during your stay in hospital. You may still need medication after you’re discharged.

During Surgery

Hip replacement surgery can be performed traditionally or by using what is considered a minimally-invasive technique. The main difference between the two procedures is the size of the incision.

During standard hip replacement surgery, you are given general anaesthesia to relax your muscles and put you into a temporary deep sleep. This will prevent you from feeling any pain during the surgery or have any awareness of the procedure. A spinal anesthetic may be given to help prevent pain as an alternative.

The doctor will then make a cut along the side of the hip and move the muscles connected to the top of the thighbone to expose the hip joint. Next, the ball portion of the joint is removed by cutting the thighbone with a saw. Then an artificial joint is attached to the thighbone using either cement or a special material that allows the remaining bone to attach to the new joint.

The doctor then prepares the surface of the hipbone — removing any damaged cartilage — and attaches the replacement socket part to the hipbone. The new ball part of the thighbone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.

While most hip replacement surgeries today are performed using the standard technique (one 8 to 10 inch cut along the side of the hip), in recent years, some doctors have been using a minimally-invasive technique. In the minimally-invasive approach, doctors make one to two cuts from 2 to 5 inches long. The same procedure is performed through these small cuts as with standard hip replacement surgery.

The small cuts are thought to lessen blood loss, ease pain following surgery, shorten hospital stays, reduce scar appearance, and speed healing.

However, it’s important that the surgeon be highly skilled in this technique. Research has shown the outcomes with minimally-invasive approach may be worse than with standard hip replacement surgery if done by a doctor who is not very experienced with this technique.

Since there can be some blood loss during hip replacement surgery, you may need a blood transfusion, so you may want to consider donating your own blood before the procedure.

Why might I need hip replacement surgery?

Hip replacement surgery is a treatment for pain and disability in the hip. The most common condition that results in the need for hip replacement surgery is osteoarthritis.

Osteoarthritis causes loss of joint cartilage in the hip. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain due to degenerative joint disease may be unable to do normal activities that involve bending at the hip, such as walking or sitting, because they are painful.

Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a hip injury, can also lead to degeneration of the hip joint.

Hip replacement may also be used as a method of treating certain hip fractures. A fracture is an injury often from a fall. Pain from a fracture is severe and walking or even moving the leg is difficult.

If medical treatments are not effectively controlling arthritis pain, hip replacement may be an option. Some medical treatments for degenerative joint disease may include:

• Anti-inflammatory medications
• Glucosamine and chondroitin sulphate
• Pain medications
• Limiting painful activities
• Assistive devices for walking (such as a cane)
• Physical therapy

There may be other reasons for your healthcare provider to recommend a hip replacement surgery.

What are the risks of hip replacement surgery?

As with any surgical procedure, complications can occur. Some possible complications may include:

• Bleeding
• Infection
• Blood clots in the legs or lungs
• Dislocation
• Need for revision or additional hip surgery
• Nerve injury resulting in weakness or numbness

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider prior to the procedure.

What Activities Should I Avoid After Hip Replacement Surgery?

For anywhere from six to 12 months after hip replacement surgery, pivoting or twisting on the involved leg should be avoided. You should also not cross the involved leg past the midline of the body nor turn the involved leg inward and you should not bend at the hip past 90 degrees. This includes both bending forward at the waist and squatting.

Your physical therapist will provide you with techniques and adaptive equipment that will help you follow any of the above guidelines and precautions while performing daily activities. Remember, by not following your therapist’s recommendations you could dislocate your newly replaced hip joint and may require another surgery.

Is Hip Replacement Surgery Safe?

Hip replacements surgery has been performed for years and surgical techniques are being improved all the time. As with any surgery, however, there are risks. Since you will not be able to move around much at first, blood clots are a particular concern. Your doctor will give you blood thinners to help prevent blood clots from occurring. Infection and bleeding are also possible, as are risks associated with using general anaesthesia.

Other less common concerns that you and your doctor must watch out for are:

• Your legs may not be of equal length after the surgery.
• You must be careful not to cross your legs or not to sit too low because the joint may be dislocated.
• Pieces of fat in the bone marrow may become loose, enter the bloodstream and get into the lungs, which can cause very serious breathing problems.
• Nerves in the hip area may be injured from swelling or pressure and can cause some numbness.

The replacement parts may become loose, break, or become infected.

How Long Will My New Joint Last After Hip Replacement Surgery?

When hip replacement surgeries were first performed in the early 1970s, it was thought that the average artificial joint would last approximately 10 years. We now know that about 85% of the hip joint implants will last 20 years. Improvements in surgical technique and artificial joint materials should make these implants last even longer. If the joint does become damaged, surgery to repair it can be successful but is more complicated than the original procedure.

Most hip replacements last for 10, 15 or sometimes 20 years. How long yours lasts will depend a bit on how hard it has to work. Keeping your weight down and doing exercises to keep the muscles around your hip strong are really important.

A hip replacement isn’t a minor operation and there are risks. How big the risk is for you will depend on how old you are, how fit you are and whether or not you have any other medical problems, such as diabetes or obesity.