Total Hip Replacement
Total hip replacement in general is a very good operation in terms of relieving pain. Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition.
Hip joint connects your thigh bone to pelvic bone. This is a ball and socket type of joint where a smooth ball connected to your thigh bone moves inside a socket situated in your pelvic bone.
3D Scan and corresponding X ray showing left hip joint
This joint can be damaged in various conditions commonly known as arthritis or wear and tear. Total hip replacement is an operation where ball and sockets are replaced with artificial material. Purpose of this operation is pain relief and hence improving your mobility and the level of activity.
This operation is one of the most effective operations known and should give you many years of freedom from pain.
Hip replacement is performed for persistent pain arising from hip joint due to variety of reasons most commonly because of arthritis. Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The joint surface is covered by a smooth layer of a substance known as cartilage that allows pain free movement in the joint. This layer can be damaged in many conditions, leading to bone rubbing on the bone, causing pain. This happens in following conditions
- Osteoarthritis- most common condition. It is seen in old people, exact cause of which is not known.
- Childhood hip problems – Trauma, dislocation, Perthes’s disease, slipped epiphysis, DDH (CDH) infection etc.
- Fractures of hip
- Growth disorders of the joints and bones
- Avascular necrosis (loss of blood supply)
- Rheumatoid arthritis
The diagnosis of osteoarthritis is made on your symptoms, medical examination & X-rays. Scans are usually not necessary and some general blood tests and ECG are performed preoperatively for operation.
X ray showing bad osteoarthritis in the right hip and a total hip replacement on left.
- We will diagnose the condition and do appropriate tests to confirm the diagnosis, extent of the disease and your general fitness for the operation. Depending on your medical fitness we may arrange for consultation with a physician, cardiologist or an anaesthetist
- Stop aspirin or anti-inflammatory medications 7 days prior to surgery as they can cause bleeding.
- Stop smoking as long as possible prior to surgery
- If you are on blood thinning agents like we may have to stop them or substitute them prior to surgery.
- We will admit you to hospital a day before the operation.
- You will not take any food or drink (From previous midnight )
- We will instruct you regarding your routine medications. Some of them may have to be taken normally even with empty stomach.
- Don’t take any food, drinks, or tablets without confirming with a nursing staff.
You will be transferred to operation theatre about 30 min prior to surgery. First you will enter the anaesthetic and preparation room. You will then be taken to operation room and will be positioned on an operating table.
A cut will be made over outer side of your hip to expose the hip joint. Length of the cut will vary depending on the complexity of the case and your body weight. First we prepare the socket. This is done with the help of a special instrument called a reamer (Similar to coconut grater !). The artificial socket is then placed and secured with either cement or screws. A liner which can be made of plastic, metal or ceramic material is then placed inside the socket.
The thigh bone is then prepared. The ball of the arthritic thigh bone is cut and removed. Canal of this bone is then prepared using special instrument to accommodate specific sizes of the metal components (femoral component). This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality, age etc.
Then the ball is put back in to the socket. Range of movement and stability are then tested. Then we will stitch different layers of the wound.
You will be taken to a recovery ward where you may stay for 1-2 hours. Once you are in the ward you will be given something light to eat and drink. From the first day after the operation you start mobilising with the help of physiotherapists. By about day 3 you will be able to manage most of your personal work and will be ready to go home by day 4-6.
- Remember this is an artificial hip and must be treated with care (made of a precious metal !!)
- Dislocation is the main risk which can be avoided by carefully modifying your daily activities. You should avoid the combined movements of bending your hip and turning your foot inwards.
- 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.
- You can take shower once the wound has healed.
- Any problems with the wound, fever, leaky wound etc you should contact us.
Even though this is one of the most successful operations, as with any major surgery there may be some complications. And hence decision to operate should not be taken lightly. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. Complications may be general associate4d with anaesthesia and your medications or specific to hip surgery. Specific complications are infection (less than 1%), dislocation (1-3%), Blood clots (Deep Venous Thrombosis), damage to other structures like nerves, leg length, Limp due to muscle weakness