FAQ – Hip Replacement Surgery

FAQ – Hip Replacement Surgery 

The hip joint is one of the largest weight-bearing joints in the human body. Most activities like walking, jumping, sitting, squatting, dancing, swimming, climbing etc. depend on your hip bones to provide the necessary mobility and stability. Unfortunately, once it gets damaged, the hip becomes stiff causing pain every time you walk. You may be forced to restrict your activities or even be unable to walk.  

Replacement of hip joint is a well-established surgery in which the diseased hip joint is replaced with an artificial hip joint to remove pain and stiffness and improve the quality of your life. 

What is a normal hip joint? 

The normal hip joint consists of a round head (ball) of thighbone joining the acetabulum (socket / cup) at the pelvis in a ball-and-socket arrangement. A healthy joint is a remarkable mechanism due to the perfect matching of ball with the socket. A smooth and strong layer of articular cartilage like a velvet lining acts as a padding to absorb stresses and ensure almost frictionless movements of your hip joint. Your hip joint is designed to withstand a lifetime of strenuous activity. However, arthritis of hip joint causes erosion of the cartilage layer, leading to pain, shortening of limb or severe stiffness and therefore difficulty in walking and activities of daily living. 

This conditions could be attributed to the following: 

•   Avascular Nercosis (damage to the cartilage wall and joint due to obstruction of blood flow to the ball of the hip joint) is a very common cause in the young people. This could be a consequence of prolonged treatment with steroids, chronic alcoholism, trauma, etc. 

•  Ankylosing Spondylitis (a condition leading to damage and stiffness of hip) is a very common cause in young people necessitating a hip replacement 

•   Besides these, Rheumatoid Arthritis, severe injury to the hip joint, etc., are the other common reasons 

What is an artificial hip joint? 

The artificial hip joint also consists of two parts like the normal hip joint: 

•  Sockets (or cup) made of special plastic to give smooth surface to the head of femur  

•   Head (or Ball of femur) made of special stainless steel alloy to fit perfectly into the cup 

What are the different types of artificial hip joint? 

The artificial hip joints are classified based on the method of fixation with the bone. When the components are fixed in pelvis and thighbone with bone cement, it is called Cemented Total Hip.  

In Uncemented Total Hip Prosthesis, no cement is used, but it is snugly fit. The surface of the implant has the potential to allow bone to grow in the interface providing anchor and is therefore preferred in younger patients. In some cases only femur may be fixed with cement and the socket is cementless. This type of surgery is known as Hybrid Total Hip. Hip Resurfacing is a technique wherein, minimal bone is resected, which is an advantage over conventional replacement. 

How do I know if I need a total hip replacement surgery? 

Total Hip Replacement is not an emergency operation but an elective surgery. It is usually done for a hip joint that is damaged or painful. It should be considered only when no alternative solutions are available or working. Some of the indications when you can consider this operation are as follows: 

•  Severe arthritis 

•  Severe pain, unaffected by anti-inflammatory medicines (pain killers), doing physiotherapy or walking with help of walking aids 

•    Stiffness of the hip joint restricting your mobility, including daily routine activities 

•   Failed prior surgery of hip joint 

•  Tumours around hip joint, etc. 

Total Hip Replacement is not ideal for paralytic / spastic conditions but exceptions do exist. 

What are the benefits of total hip replacement surgery? 

Total Hip Replacement is a well-established operation with high degree of successful outcome. The benefits include dramatic relief from joint pain and being able to perform normal activities again. Restoration of limb length of the leg is also an important advantage of this operation, but it must be remembered that artificial hip joint though a good hip is not a normal hip. While swimming and brisk walking is considered safe, heavy labour jobs or repeated heavy impact should be avoided e.g. jumping, tennis, volley ball, dancing etc. 

What is the right age for total hip replacement surgery? 

This surgery is age independent, with the use of advanced techniques and durable materials. The indication of hip replacement is only severe pain where no other treatment option works. In a younger age group, it is considered when the patient is severely crippled due to secondary arthritis or injury. 

Can I undergo replacement for both my hips at the same time? 

Yes, both the hips can be replaced at the same sitting if you are medically fit and there are no contra indications for bilateral hip surgery. Normally this is performed in younger patients. The essential advantage is, the entire process is completed in one sitting that enables early and faster rehabilitation. 

What are the risks involved in this operation? 

Total Hip Replacement is a very safe surgery today. Average risks are the similar to other operations.  

Specific concerns include: 

•  Deep Vein Thrombosis 

•  Infection (an appropriate environment with complete pre-operative evaluation reduces the risk to less than 0.5 to 1 %. 

How long does an artificial hip joint last? 

Artificial hip joint is a good hip joint but not a normal one. The successful outcome of this surgery with newer long lasting durable material and standardized techniques is excellent. Over the years, remarkable advances have been made in joint replacement technology to improve durability. 

Experience for the last 40 years shows that 90% of hip joints are doing well at 12 to 15 years. The major reason necessitating revision operations is mainly the wear of the plastic material of the cup. 

Newer alternative wear resistant materials are available today, like cross linked polyethylene, metal on metal replacements, ceramics hip joint, oxinium, etc. With the use of these materials, the major source of wear, namely, the polyethylene is eliminated and it is expected that these joints will perform well for a much longer time. This is especially suited for younger individuals. 

What is hip resurfacing? 

Hip Resurfacing or Birmingham Hip Replacing is a type of hip replacement which replace the two surfaces of the hip joint, rather than replacing the total joint. The head of the femur is reshaped to accept an anatomically sized metal sphere and the acetabulum (the socket) is also replaced with a metal implant, which is press fit directly into the bone. 

The resurfacing components are made of ‘cast’ cobalt chrome which is finely machined to produce a very high quality surface with a low friction finish, resulting in low wear. It also enables a better range of movement since the size of the ball is of the native bone. This is essentially a bone conserving operation treatment suited for painful arthritis without significant damage to the structure of the joint. Conditions that have resulted in extreme deformity of either the head of the femur or the acetabulum are not suited for this procedure. 

How do I prepare for hip joint replacement surgery? 

•  Before surgery, your surgeon will like to ensure that your condition is well enough to undergo this operation. He will also like to exclude certain conditions likely to affect this surgery 

•   Being overweight, smoking and consuming alcohol in large quantities will affect the outcome  of your surgery. Lose excess weight and control other factors 

•   Inform your doctor about any focus of infection e.g. dental, throat, boil/furuncule (skin infection), urinary tract infection etc. They must be treated before the surgery. 

•   You may have to stop anti-rheumatoid medicines, painkillers etc. before your operation. Seek your doctor’s advice for the same.  

What happens before and after the operation during the hospitals stay? 

Medical and Lab evaluation: You, would be admitted a day prior to the surgery and will be examined by your surgeon and a team of anaesthetist, physician and physiotherapist. All investigation including blood, urine, X-ray Chest & ECG will be taken and a fresh X-ray of the affected hip will also be taken. You will be advised some basic exercise for the hip, knee and chest. 

You may be given spinal-epidural anaesthesia or general anaesthesia. The duration of the surgery routinely is about two hours. You may have to stay in the ICU for the monitoring of vital parameters for a day. 

Immediately after the operation, for few days, a triangular pillow will be placed between the legs. It is a must, though it may be little uncomfortable. The drainage tubes are removed on the second post operation day. You will be allowed to sit up in the bed from second day onwards. 

A Physiotherapist will help you do hip and knee exercise and chest physiotherapy. 

What kind of rehabilitation exercises will I be required to do after the operation? 

The initial rehabilitation generally takes 5-7 days during the hospital stay. It will gradually begin on the third day with standing, followed by taking a few steps with the aid of a walker or crutches. In case of cemented total hip, you will be allowed to take full weight on the operated limb from the beginning. However in case of hybrid / uncemented total hip replacement, full weight bearing on the operated limb may take up to three months. Most patients with a stable hip and good muscles will be able to walk with a stick and will also be able to climb stairs before discharge from the hospital. 

The other part of initial rehabilitation includes learning to sit and get up from the chair, commode shifting and physical therapy to further strengthen your muscle and improve your movements. 

You will also have to observe a few basic precautions: 

• Do not cross your leg 

• Do not bend the operated hip excessively 

• Do not twist the operated leg in or out 

• Do not roll or lie on un-operated side without a pillow in between the legs 

• Do not squat or sit cross leg 

• Do not use Indian type commode 

What will I have to do after I go home? 

Medicines: Follow as mentioned in your discharge summary. 

Activity/Therapy: Follow the same protocol, which has been explained during the hospital stay. If you do not feel confident you may call a physical therapist at home to help you become independent in walking, going up and down stairs, getting in and out of bed, and doing exercise to improve the range of movement and strengthen your hip joint. 

Care of wound: Do not try to interfere with your dressing or wet your hip area till stitches are removed. 

Do call your surgeon if you notice any of the following symptoms: 

• Increased hip pain 
• Pain or swelling in calf or leg 

• Unusual redness, heat or drainage at the incision site 
• Trouble in breathing; shortness of breath 
• Fever over 100°  F 
• Follow up with your doctor: Your first appointment will be two weeks after the day of operation for removal of stitches. You will be called again after four weeks for hip X-ray and examination. Subsequent follow up will be at 3 months, 6 months and at 1 year. This is then followed by yearly check-ups. 
• Return to work: You can usually return to work after about 3 months or as advised by your surgeon. It is usually earlier in cased of cemented hip prosthesis, Car driving etc. is possible after 3 months. 

What else should I be careful about? 

•  Avoid putting on extra weight 

•  Avoid heavy labour jobs 

• Avoid too strenuous activities like dancing, jogging, playing sports etc. 

•    Do regular exercise of your hip and knee muscles 

•     Be dilligent in preventing infection in any part of the body 

•   Keep your diabetes under good control 

•     If you are suffering from collagen disorders like rheumatoid arthritis, then take proper disease modifying drugs to keep the disease under control 

Benefits of hip revision surgery? 

Relief from pain is the main benefit of having hip revision surgery. Many patients may find that hip revision surgery improves mobility, strength and coordination of the torso and leg, in addition to improving the appearance of the hip and leg. Revision surgery may enable patients to return once again to normal activity with a pain-free hip. But keep in mind that successful hip revision surgery is also contingent on the patient’s diligence with his or her rehabilitation program following surgery. 

Clinical outcomes of hip revision surgery? 

Majority of patients can put full weight on the revised total hip replacement. A small number are given a brace to wear for six weeks. A successful Revision THR offers relief from the symptoms that necessitated the procedure. Revision THR is a more complicated procedure than a first time THR, and so the risks of the procedure are higher. However, when performed by an orthopaedic surgeon who is specially trained to perform this type of surgery, the outcome is good. 

The pain of a loosened THR and the unpredictability of an unstable THR that dislocates repeatedly can be cured. Deeply infected THRs can be cured in over 90 percent of cases.