Hip Replacement Surgery.
Over the last twenty five years, major advancements in hip replacement surgery have improved the outcome greatly. Hip replacement surgery is becoming more and more common place as the population of the world begins to age demanding more from their bodies.
This operation is typically carried out for people with hip joint damage resulting from arthritis, disease, or an old injury.
The Hip replacement is an operation designed mainly to relieve severe pain. Also improves the function of your hip allowing patients to resume normal life.
At least 50,000 hip replacements are carried out each year in Britain, usually on adults aged over 65. Women are more likely to need a hip replacement than men.
The natural hip joint is made up of two components, the ball (head of femur) and the cup (the acetabulum). The joint surface is covered with a smooth cartilage, which allows the surfaces to glide smoothly without causing friction.
Why do I need a hip replacement?
The most common reason for a hip replacement is to repair damage caused by degenerative diseases such as osteoarthritis/arthrosis (wear and tear). Other causes include rheumatoid arthritis and auto immune diseases i.e.: psoriasis. The smooth joint surfaces of bone and cartilage become damaged and broken causing friction on the opposing sides of the joint. The joint becomes deformed over a period of years and even including the growth of bony spurs around the joint.
Occasionally the patient can have an accident resulting in a fracture within or close to the hip joint. If the smooth hip surfaces are damaged irreparably sometimes it becomes necessary to remove the broken joint and carry out a full hip replacement.
is another cause of degeneration of the hip joint. In this condition, the femoral head (the ball portion) looses some of its blood supply and some of the femoral head “dies” and the ball joint becomes malformed. This can lead to collapse of the femoral head and failure of the joint. This disease has been linked to some hip fractures, dislocations of the hip, to alcoholism and the long term use of cortisone treatment for other diseases.
There are several conditions which cause mechanical abnormalities of hip joint thus affecting its general function. Abnormalities can result from previous fractures of the hip that have left the joint with some deformity.
Some types of congenital (from birth) hip conditions that progress and can also lead to degeneration many years after. Minor grades of hip dysplasia (a congenital deformity) can remain un-diagnosed in childhood and into later in life when the symptoms arise.
When to seek specialist advice:
As the joint becomes more deformed and the disease progresses it becomes increasingly more inflamed and painful.
The medication for pain becomes less effective and does little to control the severe levels of pain.
After a period of time loss of movement and severe pain reduce significantly the patient’s mobility. It becomes more difficult to walk, limping becomes more pronounced, and the pain keeps the patient awake at night. At this stage most patients seek specialist advice.
The doctor will need to take a complete medical history and carry out a physical examination. Then to confirm the diagnosis he may need to ask for some investigations. The most common being an X-ray of the affected joint.
In some cases an MRI scan may be needed to examine the joint more closely to confirm why the hip is failing. The specialist will discuss the test results and offer the most appropriate treatment.
Not all hip conditions require surgery as the initial treatment. Your doctor may suggest several alternative treatments to delay replacing the hip as long as possible. Using a cane may help alleviate some of your pain and allow you to walk more comfortably.
You may be sent for physiotherapy treatment under your specialist’s guidance.
Different combinations of Anti-inflammatory medications may reduce the inflammation from the arthritis and reduce your pain.
The Hip Replacement Surgery.
A hip replacement is the final and most effective treatment. It is a very common operation normally with very good results.
The surgeon makes an incision and opens up the capsule of the hip joint.The upper part of the femur (thigh bone) is removed and the natural socket for the head of the femur is hollowed out. A new socket is fitted into the hollow in the pelvis. A short, angled metal shaft with a smooth ball on its upper end (to fit into the socket) is placed into the hollow of the thigh bone. The cup and the head will be fitted into place.
The prosthesis are made from various materials that include high density poliethilene, ceramics and metals (Titanium, Crome Cobalt, Steel, etc). The implants may be fixed with special cement or the more modern may be uncemented.
The hospital stay is generally 5 nights, after which you will be discharged home to continue your recovery under the guidance of a physiopherapist.
On discharge from hospital you will be walking with the aid of crutches and by the end of a six week period you will be able gradually to resume normal activities. At three months you shoud have recovered your normal daily activities.
Your specialist will see you for regular follow up appointments during your recovery period. One year after the operation you normally will attend a final check up and x-ray.
Complications of Hip Replacement Surgery.
One of the complications like in any operation is the risk of infection. The risks are minimal with less then 1% of cases reported. Today surgery is performed with clean air flow operating theatres together with the use of prophylactic (preventative) anti-biotics to reduce the risk further.
The surgery also carries a risk of blood clots and DVT( deep vien thrombosis). A combination of medication, early mobilization, and TED stockings or Pneumatic Compression Device reduces the risks to a minimum.
Dislocation (popping out of place) of your new hip prosthesis is a risk especially during your recovery period. You will be advised of any movements to avoid IE: Flexing the hip over a 90% angle, stooping or bending low to pick up objects from the floor, sitting down too low, and crossing your legs. Over time the risks diminish as the joint capsule heals tightens offering increased stability and protecting the hip from dislocation.
Failure over time due wearing out of your prosthetic hip joint. At the moment with normal use the hip components are designed to last about 15-20 years. At some point you may wear out the new hip with normal everyday use. The tissue around the hip prosthesis becomes inflammed and this causes pain, limping and will lead to patients to seek specialist advice. At this stage you may need to revise or replace your hip prosthesis. This operation is referred to as a “revision hip”.
Another serious complication that can arise after a hip replacement is loosening of the prosthesis. This can be caused by the shaft of the prosthesis becoming loose in the hollow of the thigh bone, or due to thinning of the bone around the implant. Also this can result after a prosthesis is fitted incorrectly. The loosening of the prosthetic components allow them to start moving and this may cause intense pain. In this case again the option would be to carry out a revison hip replacement.
The Revision Hip Replacement.
The operation to revise your hip replacement is carried out for prosthetic hips that have failed. Meaning that either you have worn out your new hip or your hip prosthesis is loosening from its original position.
Another example of failure is a hip replacement which repeatedly dislocates (popping-out of place). A dislocated hip stretches the capsule , the muscles and support tissue around the hip and it becomes each time easier to dislocate.The hip joint becomes more unstable. A new larger prosthesis will to needed to fill out the joint space and stabilise the hip joint.
In the case of loosening your specialist will have to rule out the possibility of a low grade or slow growing infection around the hip prosthesis. A special scan will confirm or rule out the presence of infection. Otherwise loosening can be aseptic, or non infective ,which means you lose the bone previously holding the implant firmly in its place.
The consultant will guide you through the investigations and discuss the results with you. Depending on the cause of your hip failing you may be offered the operation to revise your hip replacement.
The operation is longer, more complicated and traumatic.
Firstly the surgeon needs to remove the old hip prosthesis and secondly the surgeon needs to fit a new prosthesis.
Revision Hip Surgery potencially carries more complications, and the recovery time may be longer. The recent techniques, and new surgical materials have improved greatly the success rate.
