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Hip Replacement
Overview
During hip replacement, a surgeon removes the damaged sections of the hip joint and replaces them with parts usually constructed of metal, ceramic, and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.
Also called total hip arthroplasty, hip replacement surgery might be an option if hip pain interferes with daily activities and nonsurgical treatments haven’t helped or are no longer effective. Arthritis damage is the most common reason to need a hip replacement.
Best Hip Replacement Surgeon in Mumbai
What is Hip Replacement?
Hip replacement is the removal and replacement of portions of the pelvis and femur (thighbone) that form your hip joint. It is performed primarily to relieve hip pain and stiffness caused by hip arthritis.
This procedure is also sometimes used to treat injuries such as a broken or improperly growing hip, and for other conditions.
How do you know if you need a hip replacement?
If you have these arthritis symptoms, you should consider a hip replacement:
- severe hip pain that is not relieved by medication and that interferes with your work, sleep, or everyday activity
- hip stiffness that restricts motion and makes it difficult to walk
Hip Anatomy
The hip is a ball-and-socket joint. The ball, at the top of your femur (thighbone), is called the femoral head. The socket, called the acetabulum, is a part of your pelvis. The ball moves in the socket, allowing your leg to rotate and move forward, backward, and sideways.
In a healthy hip, soft tissue called cartilage covers the ball and the socket to help them glide together smoothly. If this cartilage gets worn down or damaged, the bones scrape together and become rough. This condition, osteoarthritis, causes pain and restricts motion. An arthritic hip can make it painful to walk or even to get in or out of a chair. If you have been diagnosed with hip arthritis, you may not need surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or physical therapy may provide relief. But, if these efforts do not relieve symptoms, you should consult an orthopedic surgeon.
Why it's done
Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:
- Osteoarthritis. Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.
- Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.
- Osteonecrosis. If there isn’t enough blood supplied to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone might collapse and deform.
Hip replacement may be an option if hip pain:
- Persists, despite pain medication
- Worsens with walking, even with a cane or walker
- Interferes with sleep
- Affects the ability to walk up or downstairs
- Makes it difficult to rise from a seated position
Risks
Risks associated with hip replacement surgery can include:
- Blood clots. Clots can form in the leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to the lung, heart, or rarely, the brain. Blood-thinning medications can reduce this risk.
- Infection. Infections can occur at the site of the incision and in the deeper tissue near the new hip. Most infections are treated with antibiotics, but a major infection near the new hip might require surgery to remove and replace the artificial parts.
- Fracture. During surgery, healthy portions of the hip joint might fracture. Sometimes the fractures are small enough to heal on their own, but larger fractures might need to be stabilized with wires, screws, and possibly a metal plate or bone grafts.
- Dislocation. Certain positions can cause the ball of the new joint to come out of the socket, particularly in the first few months after surgery. If the hip dislocates, a brace can help keep the hip in the correct position. If the hip keeps dislocating, surgery may be needed to stabilize it.
- Change in leg length. Surgeons take steps to avoid the problem, but occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contracture of muscles around the hip. In these cases, progressively strengthening and stretching those muscles might help. Small differences in leg length usually aren’t noticeable after a few months.
- Loosening. Although this complication is rare with newer implants, the new joint might not become solidly fixed to the bone or might loosen over time, causing pain in the hip. Surgery might be needed to fix the problem.
- Nerve damage. Rarely, nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness, and pain.
Need for second hip replacement
The artificial hip parts might wear out eventually, especially for people who have hip replacement surgery when they’re relatively young and active. If this happens, you might need a second hip replacement. However, new materials are making implants last longer.
How You Prepare
Before the operation, you’ll have an exam with the orthopedic surgeon. The surgeon may:
- Ask about your medical history and current medications
- Examine your hip, paying attention to the range of motion in your joint and the strength of the surrounding muscles
- Order blood tests and an X-ray. An MRI is rarely needed
During this appointment, ask any questions you have about the procedure. Be sure to find out which medications you should avoid or continue to take in the week before surgery.
Because tobacco use can interfere with healing, it’s best to stop using tobacco products. If you need help to quit, talk to your doctor.
Tests Before The Surgery (Pre-operation Work-up)
Once you have decided to get operated we should do some blood tests to prepare your body for this surgery. This involves a check-up by an anaesthetist and a physiotherapist. These visits are geared to intimate you about the procedure followed during surgery and prepare you for a faster recovery. We will need to get some tests done. They are:
- Complete Blood Count
- ESR – Erythrocyte Sedimentation Rate
- CRP – C Reactive Protein
- Blood Sugar – Fasting
- LFT – Liver function Test including S. Proteins and enzymes.
- S. Creatinine
- BUN
- S. Electrolytes
- HIV
- HbsAg
- HCV
- Blood Grouping
- Bleeding / Clotting time
- Prothrombin time / Index
- Urine – Routine / Microscopy
- Urine – Culture sensitivity
- ECG
- 2D Echo
- Xrays – Chest PA view – Both Knees – AP standing and lateral
- Special tests: Additional tests
- Blood sugar PP (2 hrs. After Lunch) – Diabetes
- Pulmonary function tests – Asthma
Admission to the Hospital
Click Here To Download the Instructions in PDF Format.
- Do not eat or drink anything from ________ time onward to ________ a date prior to surgery. This includes Water, tea coffee, etc. Do not drink alcohol or smoke 24 hrs before the surgery.
- All Pain medications like Voveran and Brufen should ideally be stopped 7 days before the Surgery. Blood Thinning Medicines like Aspirin (2 Days) or Clopedogrel need to be stopped 7 days before the surgery.
- Please removes all Jewellery before getting admitted to the hospital.
- Please get admitted with a Toothbrush, Tooth Paste, and Dettol/ Savlon Soap. Towel, Glasses, Hearing aids, Reading material, and Dentures.
- Please Get a list of all the medicines that you are taking daily and the time. Also, Get 1 strip of each medicine you are taking.
- Please get a list of the 2 closest relations, their relationship with you, and their Home/Office and mobile contact number and hand it to the sister to put on Indoor Hospital Paper.
- Please bring along all your blood tests and reports and CT/MRI films.
- Please get your Walker / Crutches if needed.
Precautions For First 2 Months After Surgery
The following restrictions are used to apply to all patients after hip replacement except when we have used an implant with a large diameter femoral head which allows nearly normal movement.
1. Don’t bend your operated hip beyond 80 degrees.
- Don’t raise your knee higher than your hip.
- Don’t sit on sofas or low chairs. Put cushions down first. Use an elevated toilet seat.
- Don’t lean forward while sitting. Get assistance for lower extremity dressing.
- When you sit down, back up until you feel the bed or chair against your legs. Reach back for the bed or armrests of the chair and slide your operated leg straight out in front of you. Don’t lean forward as you sit! When you stand up, push up from the bed/chair keeping your operated leg straight out in front of you. Raise yourself without leaning forward. It is in standing up from sitting that you have to concentrate the most on not bending your hip more than 80 degrees.
2. Don’t allow your legs to slouch or cross.
- Keep a pillow or abduction wedge between your legs when you lie down. Keep your legs 3 to 6 inches apart while sitting or use your wedge or pillow. Put a pillow between your legs when you lie on your side. Do not sleep on your side until 2 months after surgery.
Restrictions To Prevent Dislocation
For at least 2 months after your operation
These precautions apply to the OPERATION side of your body
Home Exercises For The First 8 Weeks
AFTER TOTAL HIP REPLACEMENT
Try To Do At Least 3 Exercise Sessions Per Day,
Very little physical therapy is needed after hip replacement unless you have specific muscle weakness. Your absolute best exercise after hip replacement is to walk as much as you can, starting as soon as you get home from the hospital. However, if you want to add exercises to your walking program, the following are recommended.
Ankle Exercise:
- lie fat in bed
- Point your toes toward the foot of the bed.
- Point your toes toward your knee.
- Move your ankle in a circle.
Knee Isometric:
- Lie on your back with the legs straight.
- Tighten your thigh muscles thinking as you do so that you are pushing your knee into the bed.
- Hold the contraction for 5 counts and then release.
- Do this 5 times.
Buttock Isometric:
- While lying, squeeze your buttock muscles together for a count of 5 and then release.
- Do this 5 times.
Hip Flexion:
- While lying, slide the operated side foot up toward your buttock and then slide back.
- Do this 5 times.
How Long Do Joint Replacements Last?
A new joint usually lasts about 10 to 15 years. But everyone has different results after arthroplasty. Talk to your provider about what you can do to take care of your new joint. If your joint replacement wears out after 15 years, it may be possible to revise it with a new joint.
FAQ
Most frequent questions and answers
Modern hip replacement implants are marvels of engineering. As with most manmade objects sensible and judicious use can prolong the life and utility of the implant. The life of Hip replacements is dependent upon the type of bearing material used. The Ceramic on ceramic bearings due to their low wear will last the longest, followed by Ceramic on crosslinked Poly, Metal on Metal. Metal on crosslinked poly and finally the Metal on Poly. Please see the choose your implant section to see which implant is best for you. The metal on Poly implants used 20 years ago has lasted in 97% of people as per reports available. So it is expected that the use of newer bearings, will prolong the life of implants EVEN FURTHER. In many people, the implants will last a lifetime.
In most people, Hip replacement is needed after the age of 60 years. However, for people who are suffering pain very badly and have exhausted all other non-surgical options, it is cruel to deny a patient a Hip replacement on basis of his/her age. Sometimes Hip replacement may be required in very young or very old individuals.
Knee replacement can be done any time after the age of 18 years. Unfortunately in diseases such as Juvenile Rheumatoid arthritis, Chondro epiphyseal dysplasia and hemophilia and tumors the the patient is faced with the option of staying in bed for their life or undergoing surgery and resuming a fulfilling lifestyle.
I would like you to meet Mrs. Meena Jain, 45 years, housewife and mother of 2 active children. She is 45 years old and has been put on 10 kgs in the last 2 years due to her inability to walk. She has suffered from pain associated with osteoarthritis for the last 10 years. She has been on all kinds of medicines allopathic, Homeopathic, and ayurvedic. She has also taken multiple injections in her knee. She has to take a painkiller tab every day and has been doing so for the last many years. Her X-rays show severe disease for which the only option is knee replacement. She demands a pain-free life and a medicine-free life. Do you feel it’s right to deny her this due to her age?
After discussing various options with her, she chose knee replacement. She is now 47 years old she can walk as much as she desires and can go marketing and shopping alone as she is pain-free. Previously she was dependent on her husband and his scooter for going out of the house. She plays dandiya with her daughter and Competed in the parent’s 50 m run in her son’s school.
Since younger patients are more active, they will wear out a replacement at an earlier age. In such a condition, there is a chance that they will require a knee replacement again. This procedure called revision Knee replacement Is done very successfully even today. However, this event is at least 15-20 years from now, and if such a surgery is required then by that time I expect a lot of revolutionary changes and technological advances which will make the follow-up procedure easier safer, and even longer-lasting. The advantage is that the patient can lead an active life rather than that of an old person starting today.
Usually, if you get operated on a single side then you are discharged 3rd -4th day after surgery. Doing Both knees together, people usually go home 5-6 th day.
On the day of the surgery, by evening you can sit in bed and are encouraged to move your knees and ankles. The next day, You will stand and take a few steps. On the third day, all the Intravenous medicines and catheters are removed and you can start walking with a walker. Depending on your age and activity level, you will need a stick or a walker for a few days.
Special pneumatic pumps will be applied to your legs in the recovery room and will be kept in place for several days. They massage your calves every forty-five seconds. Most patients find them very comfortable. You may also wear special stockings. The pedaling exercise, the pumps, and the stockings all help to prevent blood clots from forming in your legs.
By the time you leave the hospital, we like you to have at least 90 degrees of knee motion and good control of muscles about your knee. Most patients by the second or third day after surgery no longer have an IV and are feeling quite well.
You will be allowed to go home when your temperature is normal and you are able to get in and out of bed by yourself and go to the bathroom by yourself. Some patients reach this goal within 3 days.
Patients with these conditions can safely undergo knee replacement. These conditions need to be well-controlled prior to the surgery.
The recovery after surgery differs from patient to patient. Most people can fully recover in 1 month.
A knee replacement surgery allows you to be as active as you would have been if you had natural knees. All the activities that you love doing but you cannot do now due to knee pain are possible. I would like you to meet Mrs. Natalia Menezes Who has been operated on both knees 5 years back she is now 68 yrs old. She regularly travels in local trains in the rush hours from Virar to churchgate carrying with her fruits and vegetables grown at her farmhouse in Virar. She is a regular participant in the senior citizens run for the Mumbai marathon and has done parasailing, and motor scootering on the visit to Bangkok. She loves climbing mountains and is an amazing woman.
The limp in a patient with knee pain is due to loose ligaments and pain while walking. After the surgery, both are corrected, and The limp vanishes.
Replacement surgery does not weaken bone. So If you fall, then the chances of developing a fracture is the same and depends on the severity of the fall.
Knee replacement techniques and Implants have changed for the better and this is a continuous process. Modern techniques and Implants allow a normal knee movement and can bend their knee fully within 2 mths of surgery. A lot of my patients can bend their artificial knees more than my natural knee. You have to remember that the knee replacement Implant is manmade and cannot compare to a natural knee. So you have to use it carefully.
The Indian Custom of sitting on the ground and using of Indian commode places a lot of strain on the implant and is best avoided. You can sit cross-legged on a couch but not on the ground. Having said that, sitting on the ground rarely for an occasion is acceptable.
As with any surgery, the chances of infections are 1%. Infection control starts before the surgery. We will do certain tests to localize the site of infection that is present in skin, urine, or teeth. Longstanding infection in these areas has to be eliminated. If any dental/ urinary surgery is required is performed or delayed for 6 months till after knee replacement.
I am a great believer in physiotherapy. The physiotherapist is a paramedical professional who does a lot of essential activities. He/she plays the following roles.
- Motivates the patients and encourages activity
- Answers questions the patient may have about the procedure and post-operative period
- Develops a friendly and approachable relationship with the patient
- Looks for red flag signs suggestive of problems and notifies the doctor
- Dressing changes and removal of stitches
- Shows patient stairs climbing other activities of daily use
- Accompanies patient on roads till they regain confidence
- Co-ordinates with a doctor for medicines and informs recovery of the patient
Usually, a patient will require 7 sessions of physiotherapy once a day after surgery, then 7 sessions on alternate days to recover from this surgery.