Total Hip Replacement
Hip replacement has become necessary for your arthritic hip: this is one of the most effective operations known and should give you many years of freedom from pain.
Once you have arthritis which has not responded to conservative treatment, you may well be a candidate for Total Hip Replacement surgery.
Age related degeneration(osteoarthritis)
Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons, often the definite cause is not known. When the articular cartilage wears out, the bone ends rub on one another and cause pain. There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always, it affects people as they get older (Osteoarthritis).
Other causes include
Inflammation e.g., Rheumatoid arthritis
Childhood disorders e.g., dislocated hip, Perthe’s disease, slipped epiphysis etc.
Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
Trauma (fracture)
Avascular necrosis (loss of blood supply)
Infection
Inactive lifestyle- e.g., Obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time
In an Arthritic Hip
The cartilage lining is thinner than normal or completely absent
The degree of cartilage damage and inflammation varies with the type and stage of arthritis
The capsule of the arthritic hip is swollen
The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
Bone spurs or excessive bone can also build up around the edges of the joint
The combinations of these factors make the arthritic hip stiff and limit activities due to pain or fatigue
The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis)
THR is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatment.
You should consider a THR when you have
Arthritis confirmed on X-ray
Pain not responding to analgesics or anti-inflammatories
Limitations of activities of daily living including your leisure activities, sport or work
Pain keeping you awake at night
Stiffness in the hip making mobility difficult
Prior to surgery you will usually have tried some simple treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, walking sticks, physiotherapy.
The decision to proceed with THR surgery is a cooperative one between you, your surgeon and your family . Benefits of surgery include
An incision is made over the hip to expose the hip joint
The acetabulum (socket) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented. A liner which can be made of plastic, metal or ceramic material is then placed inside the acetabular component.
The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference.
The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic.
The hip is then reduced again.
The muscles and soft tissues are then closed carefully.
Avoid the combined movement of bending your hip and turning your foot in. This can cause Dislocation. Other precautions to avoid dislocation are 🙁 at least for the first 6-9 months)
You should sleep with a pillow between your legs for 6 weeks. Avoid crossing your legs and bending your hip past a right angle
Avoid low chairs
Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes
Elevated toilet seat helpful
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.
It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) or specific to the hip
Medical Complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.
Medical (General)
Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:
Allergic reactions to medications
Blood loss requiring transfusion with its low risk of disease transmission
Heart attacks, strokes, kidney failure, pneumonia, bladder infections Complications from nerve blocks such as infection or nerve damage Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death.
Specific complications include
Infection
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%, if it occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
Dislocation
This means the hip comes out of its socket. Precautions need to be taken with your new hip. It a dislocation occurs it needs to be put back into place with an anesthetic. Rarely this becomes a recurrent problem needing further surgery.
Blood clots (Deep Venous Thrombosis)
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Damage to nerves or blood vessels
Also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.
Wound irritation
Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.
Leg length inequality
It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg is deliberately lengthened to make the hip stable during surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side.
Wear
All joints eventually wear out. In general 80-90% of hip replacements survive 20-25 years.
Failure to relieve pain
Very rare but may occur especially if some pain is coming from other areas such as the spine.
Unsightly or thickened scar
Limp due to muscle weakness
Fractures (break) of the femur (thigh bone) or pelvis (hipbone)
This is also rare but can occur during or after surgery. This may prolong your recovery, or require further surgery.
Surgery for some people with arthritis, could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan- it may help to restore function to your damaged joints as well as relieve pain.
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