Hip Replacement

Hip Joint is a ball and socket joint which is formed by the rounded head of the femur(thigh bone) and the cup of the pelvis. This usually offers a high range of motion with excellent stability. The concept of Total Hip replacement is to replicate the anatomy of the normal hip in all possible terms.

This is achieved by removing the affected bone and replacing it with a prosthesis on both sides i.e. the cup and the ball. The patients usually present with a painful restriction of range of motion at the hip joint which disables them from performing activities of daily living. This is compensated by the joints of the knee and spine to some extent where after the patient develops a permanent deformity/soft tissue contractures in the related weight bearing axes.

The patient might complain of a refered knee pain also in these cases. Usual indications of a hip replacement include:

  • Osteo-arthritis
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Post-Traumatic/Surgical Arthritis
  • Avascular necrosis of the femoral head.

The main components involved are:

  • A Femoral Stem: Placed into the thigh bone to anchor the Head
  • An Acetabular cup: Socket adjusted in the worn out cup
  • A Poly/Liner: plastic cup inserted in the metallic acetabular cup to allow smooth motion between head.
  • A Femoral Head: a mettalic or ceramic head to replace the normal ball of the joint.

The procedure may be cemented or uncemented depending upon your patient demand and profile. Patients with limitations in activities of daily living and painful restriction of range of motion are the ideal candidates for a total hip replacement surgery.

The procedure requires a detailed clinico-radiological evaulation for assessment of patient. Usually requires the following investigations:

  • Complete medical examination
  • Complete hematological(blood) and urine examination
  • Radiological examination of both knees
  • A pre- anaesthesia checkup for all associated comorbidities
  • Control of metabolic derangements with medical treatment
  • Home and Social planning and councelling

No Surgery stands free of risks and one of the most important FAQ is how much is my patient going to benefit from surgery?

The answer to this question is indivisualised and depends on symptomatic status of the patient. The more the patient is symptomatic, the better is the pain relief post procedure. The risks associated with the procedure include:

  • Infection
  • Blood Clotting (thrombosis)
  • Limb length discrepency
  • Dislocation
  • Mechanical complications: Loosening & subsidence
  • Delayed wound healing
  • Immunosuppression in cases of Rheumatoid arthritis
  • Chest Infections

There always exists a difference between the expectations and result with most patients meeting the two by end of 6-8 weeks if there is no associated complication. The patients may have a restricted range of motion with flexion not reaching more than a 90-100 degrees and inability to squatt and sit cross-legged post surgery.

Post-surgical precautions include regular physiotherapy as advised, protected weight bearing, good nutritional status and protecting wound from any contamination.

Most patients do well with excellent functional rehabilitation at 6 weeks time. Achieving quadricep & abductor strength after range of motion is achieved remains imperative. Exercises might need to continue for a year post surgery. For any related querries please feel free to contact our orthopedic team. A personal consultation with the patient and records is essential for tailoring the needful treatment for the patient.

Few exercises that should be followed both pre and post operatively for early recovery and rehabilitation. The aim of these is speedy functional outcome. The patient morbidity increases with recumbency and should be avoided.

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