Total hip arthroplasty is a surgical procedure in which the hip joint is replaced by a prosthetic implant. This surgery relieves pain from most kinds of hip arthritis, which helps in improving the quality of life for a large majority of patients.
Patients commonly undergo total hip arthroplasty after non-operative treatments have failed to provide relief from arthritis symptoms. Most scientific studies that have followed patients for more than 10 years have found “success rates” of 90 percent or more following traditional total hip arthroplasty.
Total hip replacement was first performed in the early 1960’s
The hip joint is made of two parts, the acetabulum (socket) and the ‘ball’ or head of the femur (thigh bone), The operation involves surgically removing the arthritic parts of the joint (cartilage and bone) replacing the “ball and socket” part of the joint with smooth artificial components made from metal alloys and placing high-performance bearing surface between the metal parts. The procedure is designed to relieve pain, reduce stiffness and improve your ability to walk.
Arthritis means “inflammation of a joint” multiple conditions that cause joint inflammation also go on to cause permanent destruction of the weight-bearing surface of the hip which is called cartilage, about 80 percent of patients with hip arthritis will have some pain in the groin or the front of the thigh; other typical pain patterns include pain in the back of the thigh the side of the thigh or the buttock and randomly as knee pain, patients with hip arthritis limp while walking sometimes with a “lurching” gait towards the weak arthritic side.
Some of these common medically diagnosed conditions are-
- Osteoarthritis – (OA or degenerative arthritis) is a joint disease caused by cartilage loss in a joint. Joint stiffness and pain are symptoms.
- Post-traumatic arthritis: Post–traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, a vehicle accident or any other cause
- Rheumatoid arthritis: This is a condition in which the body’s own cells attack joint surface cartilage. It may affect any joint in the body.
- Avascular necrosis (osteonecrosis) of the Thighbone (Femur) Head: This is not exactly a type of arthritis but rather a condition in which the circulation to the “ball” of the “ball and socket” part of the hip joint becomes impaired.
Other medically diagnosed conditions include spinal stenosis (or spinal arthritis), Bursitis of the hip (greater trochanteric bursitis). Non-orthopedic conditions include many diverse conditions, which can cause pain in the hips thighs or buttocks like peripheral vascular disease (hardening of the arteries).
In India most people above 60 years suffer from some kind of bone and joint disease and many of them have an immediate need for joint replacement surgery. High prevalence of arthritis and increasing prevalence of osteoporosis among post-menopausal women in urban areas who follow a sedentary lifestyle have stimulated the growth of the number of joint replacement surgeries.
Total hip Arthroplasty has a proven track record in increasing mobility, reducing pain, and improving quality of life in people with hip pain and dysfunction, Hip replacement surgery not only improves quality of life but is also associated with increased life expectancy, compared to people of similar age and sex.
Symptoms and Diagnosis
History and physical examination- An orthopedic surgeon will begin the evaluation with a thorough history and physical exam. Based on the results of these steps, a plain X-ray maybe advised.
X-rays– If you have arthritis of the hip it will be evident on routine X-rays of the joint. X-rays taken with you standing up are more helpful than those taken with you lying down. That’s because the way your joint functions under load (i.e. standing) provides important clues about the severity of the arthritis to your physician.
Other tests- If your orthopedic surgeon suspects a problem with the hip joint but does not identify the source of the problem on plain X-rays you might be asked to undego another test such as a Magnetic Resonance Imaging (MRI) study or a bone scan. These are more commonly advised in the evaluation of conditions that are related to arthritis–such as avascular necrosis (osteonecrosis) but are not always treated using the same techniques.
Schedule and timing of surgery
Total hip replacement for arthritis is elective surgery. With few exceptions it does not need to be done urgently and can be scheduled around your other important life events.
There is good evidence that the experience of the surgeon performing total hip replacement affects the outcome. It is important that your surgeon not only be an experienced orthopedic surgeon but also should have a high level of skill and experience.
Average duration of the surgery
No two hip replacements are alike and there is some variability in operative times but the range is typically between one and two hours of actual operative time.
Use of medications
Short and long acting analgesic medicine, stool softeners, anti-inflammatory pain medicine, Antibiotics Anti-nausea and Blood thinning medicines (anti-coagulation) are given pre and post-operative period.
The average hospital stay is one to four days in length after a total hip replacement.
Patients are encouraged to walk using a walker crutches or cane as needed. Immediate weight bearing is permitted in most cases depending on other surgical circumstances.
Patients who live alone or who feel they would benefit from the extra support or attention usually are able to go to an inpatient rehabilitation hospital or an extended-care facility after hospital discharge.
Following hospital discharge (or discharge from inpatient rehabilitation) patients who undergo total hip replacement will participate in either home physical therapy or outpatient physical therapy to a location close to home.
All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process.
Usual healing time
On average, patients walk with a walker (or two crutches) for about 3 weeks then a cane for another month or so.
Returning back to normal activities
The goal of total hip replacement is to return patients to a good level of function without hip pain. The large majority of patients are able to achieve this goal.
What is recommended:
- Cycling or stationary bike
- Light labour (Jobs that involve driving walking or standing but not heavy lifting)
- Sedentary occupations (desk work)
What is not recommended:
- Impact exercises
- Sports that require twisting
- Contact sports
- Heavy labor
In a nutshell, like any major procedure there are risks to total hip surgery and the decision to have a hip replacement must be considered a quality-of-life choice that individual patients make with a good understanding of what those risks are.
Hip replacement is a surgical technique that has many variables; like most areas of medicine ongoing research will continue to help the technique evolve. It is important to learn as much as possible about the condition and the treatment options that are available before deciding whether – or how – to have a hip replacement done.