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Information on hip replacements


Total Hip Replacement - OrthoInfo

Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes:

  • How a normal hip works
  • The causes of hip pain
  • What to expect from hip replacement surgery
  • What exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities

If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.

If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.

Hip replacement surgery is one of the most successful operations in all of medicine. Since the early 1960s, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 450,000 total hip replacements are performed each year in the United States.

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.

A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

Normal hip anatomy.

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

  • Osteoarthritis. This is an age-related wear and tear type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
  • Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed inflammatory arthritis.
  • Posttraumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
  • Osteonecrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called osteonecrosis (also sometimes referred to as avascular necrosis). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause osteonecrosis.
  • Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

In hip osteoarthritis, the smooth articular cartilage wears away and becomes frayed and rough.

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

  • The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone.
  • A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
  • The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
  • A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

(Left) The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip.

 Watch: Total Hip Replacement Animation

The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation.

When Surgery Is Recommended

There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

  • Hip pain that limits everyday activities, such as walking or bending
  • Hip pain that continues while resting, either day or night
  • Stiffness in a hip that limits the ability to move or lift the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

Candidates for Surgery

There are no absolute age or weight restrictions for total hip replacements.

Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

An evaluation with an orthopaedic surgeon consists of several components:

  • Medical history. Your orthopaedic surgeon will gather information about your general health and ask questions about the extent of your hip pain and how it affects your ability to perform everyday activities.
  • Physical examination. This will assess hip mobility, strength, and alignment.
  • X-rays. These images help to determine the extent of damage or deformity in your hip.
  • Other tests. Occasionally other tests, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your hip.

(Left) In this X-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This X-ray of an arthritic hip shows severe loss of joint space.

Talk With Your Doctor

Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.

In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.

Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.

Realistic Expectations

An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.

With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.

Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.

With appropriate activity modification, hip replacements can last for many years.

Medical Evaluation

If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.

Tests

Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.

Preparing Your Skin

Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for treatment to improve your skin before surgery.

Medications

Tell your orthopaedic surgeon about the medications you are taking. They or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.

Weight Loss

If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.

Dental Evaluation

Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.

Urinary Evaluation

Individuals with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before having surgery.

Social Planning

Although you will be able to walk with a cane, crutches, or a walker soon after surgery, you may need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.

If you live alone, a social worker or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.

Home Planning

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

  • Securely fastened safety bars or handrails in your shower or bath
  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoehorn for putting on and taking off shoes and socks without excessively bending your new hip
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
  • Removal of all loose carpets and electrical cords from the areas where you walk in your home

You will either be admitted to the hospital on the day of your surgery or you will go home the same day. The plan to either be admitted or to go home should be discussed with your surgeon prior to your operation.

Anesthesia

Upon arrival at the hospital or surgery center, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

Implant Components

Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic, or metal, which may have an outer metal shell).

The prosthetic components may be "press fit" into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on several factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.

Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.

(Left) A standard non-cemented femoral component. (Center) A close-up of this component showing the porous surface for bone ingrowth. (Right) The femoral component and the acetabular component working together.

(Left) The acetabular component shows the plastic (polyethylene) liner inside the metal shell. (Right) The porous surface of this acetabular component allows for bone ingrowth. The holes around the cup are used if screws are needed to hold the cup in place.

Procedure

The surgical procedure usually takes from 1 to 2 hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip.

X-rays before and after total hip replacement. In this case, non-cemented components were used.

After surgery, you will be moved to the recovery room where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room or discharged to home.

The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery.

Pain Management

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that, although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues in the U.S. It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain begins to improve. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Wound Care

You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.

Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.

Diet

Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.

Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.

Your activity program should include:

  • A graduated walking program — initially in your home and later outside — to slowly increase your mobility, 
  • Resuming other normal household activities, such as sitting, standing, and climbing stairs
  • Specific exercises several times a day to restore movement and strengthen your hip. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery

Physical therapy will help restore strength and mobility to your hip,
Thinkstock © 2011

The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications do occur, they can prolong or limit full recovery.

Infection

Infection may occur superficially in the wound or deep around the prosthesis. It may happen within days or weeks of surgery. It may even occur years later.

Minor infections of the wound are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

Blood Clots

Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program which may include blood thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early mobilization.

Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.

Leg-length Inequality

Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopaedic surgeon will make every effort to make your leg lengths even but may lengthen or shorten your leg slightly to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.

Dislocation

Hip implant dislocation.

This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.

Loosening and Implant Wear

Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a second surgery called a revision may be necessary.

Other Complications

Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. A small number of patients continue to experience pain after surgery.

Recognizing the Signs of a Blood Clot

Follow your orthopaedic surgeon's instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. They may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

Warning signs of blood clots. The warning signs of possible blood clot in your leg include:

  • Pain in your calf and leg that is unrelated to your incision
  • Tenderness or redness of your calf
  • New or increasing swelling of your thigh, calf, ankle, or foot

Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Preventing Infection

A common cause of infection following hip replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections.

Following surgery, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter the bloodstream. Your orthopaedic surgeon will discuss with you whether you need to take preventive antibiotics before dental procedures.

Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible hip replacement infection:

  • Persistent fever (higher than 100°F orally)
  • Chills
  • Increasing redness, tenderness, or swelling of the hip wound
  • Drainage from the hip wound
  • Increasing hip pain with both activity and rest

Avoiding Falls

A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.

Your orthopaedic surgeon and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

Other Precautions

To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement.

Your surgeon and physical therapist will provide you with any specific precautions you should follow.

How Your New Hip Is Different

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.

Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated. 

Protecting Your Hip Replacement

There are many things you can do to protect your hip replacement and extend the life of your hip implant.

  • Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
  • Make sure your dentist knows that you have a hip replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
  • See your orthopaedic surgeon periodically for routine follow-up examinations and X-rays, even if your hip replacement seems to be doing fine.

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Hip replacement - Mayo Clinic

Overview

Artificial hip

Hip prostheses are designed to mimic the ball-and-socket action of your hip joint. During hip replacement surgery, your surgeon removes the diseased or damaged parts of your hip joint and inserts the artificial joint.

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 hip replacement.

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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 down stairs
  • Makes it difficult to rise from a seated position

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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.

What you can expect

When you check in for your surgery, you'll be asked to remove your clothes and put on a hospital gown. You'll be given either a spinal block, which numbs the lower half of your body, or a general anesthetic, which puts you into a sleep-like state.

Your surgeon might also inject a numbing medicine around nerves or in and around the joint to help block pain after your surgery.

During the procedure

The surgical procedure can be completed within two hours. To perform a hip replacement, the surgeon:

  • Makes an incision over the hip, through the layers of tissue
  • Removes diseased and damaged bone and cartilage, leaving healthy bone intact
  • Implants the replacement socket into the pelvic bone
  • Inserts a metal stem into the top of the thighbone, which is then topped with a replacement ball

After the procedure

After surgery, you'll be moved to a recovery area for a few hours while your anesthesia wears off. Medical staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.

You'll be asked to breathe deeply, cough or blow into a device to help keep fluid out of your lungs. How long you stay after surgery depends on your individual needs. Many people can go home that same day.

More information

  • Outpatient joint replacement: Is it a safe option?

Blood clot prevention

After hip replacement surgery, you'll temporarily be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:

  • Moving early. You'll be encouraged to sit up and walk with crutches or a walker soon after surgery.
  • Applying pressure. Both during and after surgery, you might wear elastic compression stockings or inflatable air sleeves on your lower legs. The air sleeves squeeze and release your legs. That helps keep blood from pooling in the leg veins, reducing the chance that clots will form.
  • Blood-thinning medications. Your surgeon might prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you might need blood thinners for several weeks after surgery.

Physical therapy

Daily activity and exercise can help you regain the use of your joint and muscles. A physical therapist can recommend strengthening and mobility exercises and can help you learn how to use a walking aid, such as a walker, a cane or crutches. As therapy progresses, you'll gradually increase the amount of weight you put on your leg until you're able to walk without assistance.

Home recovery

Before you leave the hospital, you and your caregivers will get tips on caring for your new hip. For a smooth transition:

  • Arrange to have a friend or relative prepare some meals in advance
  • Place everyday items at waist level, so you won't have to bend down or reach up
  • Consider getting a raised toilet seat and a shower chair for your recovery at home
  • Put your phone, tissues, TV remote, medicine and books near the area where you'll be spending most of your time during recovery

Results

Full recovery from a hip replacement varies from person to person, but most people are doing well three months after the surgery. Improvements typically continue during the first year after surgery.

The new hip joint can reduce pain and increase the hip's range of motion. But don't expect to do everything you could do before the hip became painful.

High-impact activities, such as running or playing basketball, might be too stressful on the artificial joint. But in time, most people can participate in lower-impact activities — such as swimming, golfing and bicycle riding.

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Hip pain is most often the result of osteoarthritis and can seriously affect your ability to lead a full and active lifestyle. Osteoarthritis of the hip joint in medicine is called coxarthrosis.

Hip arthroplasty will help you get rid of pain and return to a full life. Over the past 20 years, thanks to the introduction of new materials and techniques into practice, the results of arthroplasty operations have significantly improved.

Hip arthroplasty joint is becoming more and more common as the world's population getting old. Currently, hip replacement surgery is most frequently performed in the world.

Hip arthroplasty joint is a total or selective replacement of parts of the joint, directly in contact with each other during movement.

Total hip arthroplasty joint is a complete replacement of the head and neck of the femur and acetabulum with artificial.

ANATOMY OF THE HIP JOINT

The hip joint is spherical in structure, so movements in it are possible in many planes. The joint is formed by the acetabulum, forming, as it were, a deep bowl and the head of the femur, which has the shape of a ball.

The femoral head is connected to the main part of the femur (diaphysis) by a short section of bone called the femoral neck. Strong and thick muscles and tendons surround the joint.

Surfaces the acetabulum and the head of the femur are covered with articular cartilage. Articular cartilage thickness near the floor centimeters in large joints. Articular cartilage is a hard and smooth material, covering the bones in the joint area. Articular cartilage allows covered with it bones to slide smoothly over each other without being damaged. by color articular cartilage is white and shiny.

The joint is surrounded by a dense waterproof capsule, inside which a special fluid is produced that lubricates the articulating surfaces. The bones in the joint hold tight ligaments and muscles together. The design of the hip joint allows for extremely high mobility while maintaining satisfactory stability.

Powerful muscles all around joints allow us to move in an upright position for a long time, and also, if necessary, to make accelerations when running and jumping. Also around Important nerves and blood vessels pass through the joint.

WHEN DOES IT NEED TO BE REPLACED?

The main indications for hip arthroplasty are arthrosis of the hip joint (coxarthrosis), fracture of the femoral neck, aseptic necrosis of the femoral head.

Arthrosis degenerative changes occur in the articular cartilage, which ultimately leads to cartilage wear. Bone growths around the joint (osteophytes).

Due to wear cartilage, a decrease in its thickness, a significant decrease in smoothness, as well as change in the shape of the articular surfaces, friction in the joint increases, which leads to pain and progressive impairment of movement in the joint.

Aseptic necrosis of the femoral head is another cause of hip joint destruction. In this disease, the head of the femur loses its blood supply and actually collapses. The shape of the femoral head changes, the bone tissue that makes up the head is resorbed.

Articular surfaces of the acetabulum and head the femur no longer correspond to each other in shape, pain appears and impaired joint movement. Causes of the disease may be past hip dislocations, trauma at birth, long-term treatment corticosteroids, and some infections.

Primary purpose of joint replacement for any of degenerative diseases to artificial is a reduction in pain and return of movement. To do this, damaged surfaces are replaced artificial, resulting in the return of smoothness and painlessness movements in the joint.

Fracture of the femoral neck is also an indication for joint replacement surgery.

In case of fractures of the neck of the femur, the blood supply to the head is disturbed, in connection with which its gradual destruction occurs.

Fracture union under these conditions is impossible, surgery is the only way to reactivate the patient and bring him back to daily activity.

PREPARATION FOR HIP REPLACEMENT

The decision to operate is made by the doctor together with the patient. After clarifying the history of the disease, the doctor performs a thorough clinical examination to measure the current range of motion, the level of pain, the patient's functionality. During the examination of the patient, the surgeon examines radiographs, as well as data from CT and MRI studies.

You will also need a thorough and complete medical examination before surgery. This is done so that during the operation minimize the risk of complications. If long-term surgery or the patient's hemoglobin level is below normal, after or a blood transfusion may be required during surgery. Necessarily prevention of thromboembolic complications is prescribed.

TYPES OF ENDOPROSTHESES

There are several main types of endoprostheses - cementless and cement.

Cemented endoprostheses are held in the bone with a special cement that fixes the metal to the bone. The surface of cementless prostheses is made in such a way that the bone tissue grows into it over time, due to which the prosthesis is held in the bone. In order for the endoprosthesis to grow, the bone is processed with special tools.

Both types of endoprosthesis fixation are widely used in medical practice. Also, in some cases, a combination can be used, when, for example, the acetabular component (cup) is fixed with cement, and the femoral component (pedicle) is cementless. The decision to use a cemented or uncemented endoprosthesis is made by the surgeon based on the patient's age, lifestyle, and bone quality.

The endoprosthesis consists of two main parts.

The acetabular component (cup) replaces the articular surface of the acetabulum. The shell of the acetabular component is made of metal, inside of which is placed a plastic or ceramic insert that is in direct contact with the femoral component.

Femoral component replaces the head and neck of the femur, usually made entirely of metal. In some endoprosthesis designs, the head can be made of ceramic.

Endoprosthetics can be total when both components are replaced, and unipolar. At unipolar arthroplasty (hemiarthroplasty), only the femoral component. Hemiarthroplasty is usually performed for femoral neck fractures. bones in elderly and debilitated patients.

With this type of arthroplasty, the earliest verticalization of the patient is allowed, the very next day. This significantly reduces the risk of thromboembolic and hypostatic complications in elderly debilitated patients with femoral neck fractures. Also important is the shorter operation time in hemiarthroplasty compared to total arthroplasty, which also reduces the risks during anesthesia and blood loss during surgery. Currently, our clinic uses modern cemented bipolar endoprostheses of the hip joint. A bipolar endoprosthesis is a modern version of a unipolar prosthesis, in which the head is double.

This design of the endoprosthesis increases the service life of the prosthesis, increases its stability and range of motion.

MORE ABOUT HIP REPLACEMENT

The surgeon accesses the hip joint, the skin incision is made in the upper third of the thigh. Once the hip joint is exposed, surgeons dislocate the worn head of the femur from the acetabulum.

Then the damaged head is resected and neck of the femur with a special electric saw.

Next, the acetabulum is processed using special cutters. During the treatment, worn cartilage is completely removed and a hemisphere is formed into which the acetabular component will be implanted.

After the acetabular socket has been formed, the surgeon fills the socket with bone cement and places an appropriately sized acetabular component. At this stage, the correct spatial orientation of the acetabular component at the correct angle is important. This affects the service life of the endoprosthesis and the likelihood of complications in the postoperative period.

After setting the cement and fixing the acetabular component, the surgeon proceeds to the femur. At this stage, the bone canal of the femoral canal is developed with special rasps to the required size.

Cement is placed in the prepared femoral canal and the femoral component is placed.

The head of the required size is selected and the femoral component is inserted into the acetabular.

The surgeon then checks the hip stability and range of motion.

Once the surgeon is satisfied that everything is set properly, the wound is sutured in layers. Drains are installed for a day. The patient is sent to a special room in the post-operative department.

The patient's rehabilitation begins from the first day.

HOW WILL THE POSTOPERATIVE (REHABILITATION) PERIOD GO?

The terms of rehabilitation depend primarily on the type fixation of the endoprosthesis components. When cemented, full load possible almost immediately after surgery.

If cementless fixation was used it is recommended to limit the load on the operated limb for 8-12 weeks after the operation, you need to walk at this time with the help of crutches, with the purpose of bone tissue ingrowth into the surface of the endoprosthesis components, then you can go to full load.

Main risk after total arthroplasty is a dislocation of the head of the femoral component of the endoprosthesis. That's why combination of hip flexion and abduction is contraindicated for 6 months after surgery (the period of recovery of the hip joint capsule dissected during surgical treatment), sit on low sofas and couches, avoid deep slopes through the thigh to the floor. Avoid crossing the operated lower limb with a healthy, being in the position of the foot to the foot. Driving car possible after 6 weeks from the date of operation.

Recovery is possible after 6 weeks (if the work is not associated with increased physical activity and prolonged standing), 12 weeks for patients whose labor associated with physical activity.

Hip replacement

The hip joints are the largest joints in the human body. The hip joints connect the legs to the body. The hip joints are heavily loaded. An injured and diseased hip joint brings great suffering to a person.

The hip joint consists of the pelvic bone, acetabulum, femoral head and femoral neck. Along the edges of the acetabulum is, strengthening the hip joint, the acetabular lip (fibrous cartilaginous formation).

Inside the acetabulum is the head of the femur, connected by a neck. Below the neck of the femur - large and small skewers, femoral and gluteal muscles.

Strengthen the hip composition of the ligament of the joint capsule. The head of the femur is covered with articular cartilage, which allows it to glide smoothly. The spherical surface of the head allows for circular rotation of the thigh.

Articular cartilage between bones plays an important role as a shock absorber when walking, jumping and running. Cartilage breakdown exposes bones. This results in severe pain and limits movement.

There are several causes of cartilage destruction:

  • Injuries and bruises of the hip joint
  • Bone erosions (osteoarthritis thins cartilage)
  • Rheumatoid arthritis, gout and other systemic diseases
  • Autoimmune diseases
  • Lack of collagen, etc.

Generally, all components of a joint work together to produce a smooth movement. But due to the fact that the hip joint experiences a large weight load of the whole body when walking, running and carrying heavy loads, it wears out, is exposed to various risk factors and diseases.

The causes of damage to the hip joint are:

  • Injuries and bruises, fractures of the femoral neck
  • Femoral head necrosis
  • Inflammation of the joints (infectious complications)
  • Hormonal changes
  • Diabetes mellitus
  • Joint overload
  • Complete destruction of the femoral head
  • Worn cartilage
  • Dysplasia (congenital deformities of the hip joint)
  • Arthrosis and arthritis of the hip joint
  • Overweight
  • Osteoporosis
  • Metabolic and circulatory disorders
  • Systemic diseases
  • Chronic stress etc.

Hip problems can occur at any age. Pain in the hip joint can be caused by serious neurological diseases of the spine, inguinal hernias and pathological processes in the abdominal cavity.

Should I change the hip joint?

In Israel, more than 90% of patients are satisfied with the results of hip arthroplasty. People have the opportunity to move freely, lameness has completely disappeared, pain in the joint has been eliminated, and the need to use additional supports has disappeared.

Having completed a full course of rehabilitation after hip arthroplasty in Israel, patients can move independently: walk, swim, play golf, even ride a bike. It is important to remember that hip replacement, especially if it is associated with arthritis, will not allow you to play hard sports, run, ski and jump. The artificial joint has a limited range of motion compared to a healthy hip joint. But in everyday life - simple movements, walking without pain and crutches significantly increase the quality of life. Artificial hip joint implants are designed for 15-20 years of operation. After this period, they are replaced by new ones.

Currently, there are about 70 different designs. The success of the hip arthroplasty procedure depends on the strict implementation by patients of a special rehabilitation program and the doctor's recommendations. The patient is given instructions on how to exert dosed loads on the operated leg with physical exercises.

How is an arthroplasty performed?

Hip arthroplasty is the most common type of hip replacement. This complex, high-tech, minimally invasive arthroscopic operation requires the skill of an orthopedic surgeon and the experience of his assistants.

Depending on the nature of the joint lesion, the orthopedic surgeon decides which type of endoprosthesis design to use for each particular patient. Before surgery, the general health of the patient, the causes of joint disease, etc. are studied.

Minimally invasive hip arthroplasty surgery lasts 2-3 hours. The patient lies on his side, the leg is bent and fixed to the table.

The first stage of hip arthroplasty is preparation of access to the joint. A very important step. A longitudinal incision 15-20 cm long is made along the joint. Modern technology allows you to minimally injure muscles and tissues. In the future, this will help to quickly restore the motor functions of the limb. During this stage of the operation, an orthopedic surgeon removes damaged bones, joint cartilage, etc. with special minimally invasive instruments. Bone structures are prepared for implant placement.

The second stage of the hip arthroplasty is the installation of an artificial prosthesis. The endoprosthesis can be metal, ceramic, plastic or a combination (depending on the problem of the joint). The endoprosthesis of the hip joint consists of a stem, a head, a cup and an insert - each of the parts has its own size. First, a metal rod is inserted in the center of the upper part of the femur. Then, the head and liner are inserted, providing movement of the leg.

An orthopedic surgeon adjusts the head, checks the length of the limb, the range of motion, selects and installs (by size) the endoprosthesis of the hip joint. The friction node is selected and the endoprosthesis material is selected. After initial fixation and checking the length of the limb, the hip endoprosthesis is fixed with a special surgical bone cement or a special substance (without cement) that adheres to the bone. Sometimes, during one operation, two joints are replaced - the hip and knee.

The third stage of the hip arthroplasty is the final one. The wound is thoroughly washed with antiseptics, the tissues are sutured in layers. Special staples are applied to the top layer of the skin.

What kind of anesthesia is used during arthroplasty?

In most cases, hip arthroplasty in Israel is performed under general anesthesia. The patient is completely pain-free during deep medical sleep. Anesthesiologists take into account the particular health status of each patient. Sometimes, preference is given to epidural anesthesia, in which the patient is in clear consciousness throughout the operation. Combined spinal-epidural anesthesia is also used. In any case, the high level of protection of the patient's body is always taken into account. The patient is under anesthesia for 1 to 2 hours. The anesthesiologist constantly monitors the patient's condition. In very rare cases, there is a sharp drop in pressure and pulse or allergic reactions.

During hip arthroplasty, drugs are used to prevent infectious complications.

What are the complications of arthroplasty?

Any surgical intervention is not immune from the risks of complications. With 95% of successful hip arthroplasty surgeries, there are also complications.

  • Internal surgical complications (1-2 cases per 100 operations).
    - Infections of surrounding muscles
    - Damage to neighboring organs
    - Bleeding
    - Problems with urination
    - Fractures during surgery
    - Thrombus formation
    - Nerve damage
    - Heart attack
    - Stroke
    - Limitation of range of motion, etc.
  • Dislocation of a hip prosthesis is the most common complication.
  • Inflammation around the implant.
  • Penetration of infections (dental problems) through the blood into the area of ​​the prosthesis can lead to repeated replacement of the joint.

How to prepare for arthroplasty?

When preparing for a hip arthroplasty, you must bring your doctor's report, diagnosis, and list of medications you are taking. Blood tests: quantity, biochemistry and coagulation; ECG results, X-ray of the hip joint in two projections. Sometimes, to clarify the diagnosis, additional images of the diseased or injured joint are required. For visual diagnostics, MRI and computed tomography are used.

Chronically ill patients must bring authorization from specialist doctors. For example, from a cardiologist - patients with cardiovascular diseases, if you have had a stroke, then you need permission from a neurologist, etc.

Anticoagulants such as aspirin and PLAVIX and other blood-thinning drugs should be stopped one week before hip replacement surgery. Be sure to inform the surgeon or attending physician about this.

Stop eating 6 hours before hip replacement surgery. Do not smoke.

Immediately before the operation, it is necessary to remove dentures, jewelry, etc. With the permission of the anesthesiologist, you can take a sedative to reduce feelings of anxiety.

What happens after the operation?

After a hip arthroplasty surgery, the patient remains in the intensive care unit under observation until the effect of anesthesia wears off.

The patient is then transferred to the ward. After a few hours, he is helped out of bed, and the network is in a chair. After 1-2 days, the patient can already stand steadily and walk with support. All this time the patient receives the necessary anti-inflammatory and analgesic medicines.

The correct behavior of the patient with a replacement joint will allow you to easily go through a long recovery period - from 3 to 6 months. It all depends on the type of surgery, general health and a successful rehabilitation program.

The patient learns to tense the thigh and ankle muscles. Exercise increases blood flow to the muscles and helps prevent swelling and blood clots. Exercises are performed under the guidance of an experienced physiotherapist.

Hospitalization after hip arthroplasty usually lasts about 7 days.

What happens after you leave the hospital?

After leaving the hospital, the patient already knows that the recovery process can be accelerated if everything is done correctly. After discharge from the hospital, the patient continues to use crutches or a walker.

During the recovery period after hip arthroplasty, cleanliness and hygiene are essential - especially around the incision area.

A few months after hip arthroplasty, the patient continues to be under the supervision of an orthopedist and a physiotherapist. Thus, the patient's skills are fixed, balance and stability when walking increases.

If you suddenly develop the following symptoms after surgery:

  • signs of infection: fever, fever
  • swelling does not go away
  • the pain doesn't stop
  • bleeding and discharge from incision
  • persistent nausea
  • numbness, tingling and tingling in the legs
  • blood in urine

Seek immediate medical attention!

After hip arthroplasty, it is advisable to tighten the thigh muscles while still in the hospital and do breathing exercises under medical supervision.


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