Why is Total Hip Replacement Surgery Required?
Any health condition which renders hip joint on the either side to function incompletely or improperly, needs to be treated. Sometimes, medication, physiotherapy, exercises, can be useful in restoring the hip joint functions. However, at times these treatment methods may not help in recovery of the hip joint. There may be widespread damage of the hip joint which cannot be treated with conventional methods alone. Such conditions call for surgical intervention. If the hip joint is damaged beyond repair, a replacement surgery is considered. Some of the indications of hip joint replacement surgery are mentioned below:
- Arthritis:
Hip joint arthritis tends to occur commonly as this joint is always under some action when leg movement occurs. The pelvic bone and thigh bone form the hip joint. At the point of contact of these bones, is a layer of cartilage which acts as a cushion and prevents friction of bony surfaces. Constant use of a joint leads to wear and tear of the cartilage which begins to erode. This tends to development of arthritis. It will slowly progress and cause further degeneration of the cartilage and later the bones. Arthritis limits the person's ability to move properly. If the damage is extensive and does not respond to any treatment, surgery will be needed to replace the joint.
- Avascular Necrosis of the Hip Joint:
The structure of hip joint is such, that a rounded protrusion of the thigh bone fits into a spherical cavity of the pelvic bone. It is a compact structure. Blood vessel to this structure might get interrupted sometimes. This can lead to degeneration of hip joint. Surgery to replace the entire degenerated joint is the best choice of treatment for these cases.
- Unresolved Symptoms:
Hip joint diseases will cause symptoms like pain while walking or performing hip movements, stiffness, weakness of legs due to overuse of muscles, inability to squat or sit down, difficulty while sitting from a standing position or vice versa. If the hip joint disease progressively worsens, the symptoms will increase in frequency or intensity.
- Failed Arthroscopy
Arthroscopy involves inserting a video camera inside the hip joint and visualizing the internal structures. If there is any diseased cartilage, bone, unhealthy debris deposited in the joint, it is eliminated during arthroscopy. This helps to restore normal joint functions. If arthroscopy fails to provide relief, total hip joint replacement surgery may be considered.
A complete physical examination of the patient and detailed history of the disease will help the orthopedic surgeon to ascertain the need for total hip replacement surgery. Once this is done, the surgeon will proceed to plan the surgery.
Pre-operative Preparation
- Planning the Surgery
It is important for the surgeon and patient to discuss the pre-planning, actual surgical procedure, its advantages and disadvantages, post-operative care and other related factors. A signed consent is taken from the patient before finalizing the decision to perform surgery.
- Choosing the Prosthesis
What a prosthesis is, has been described previously in the article. This is manufactured artificially in a medical laboratory. Material used to make a prosthesis has to be chosen carefully. There should be no adverse reaction of the body fluids or other organs to the artificial joint. Prosthesis has to be specially designed for every patient depending on their height, weight, stature.
- Investigations
Several blood tests are performed before total hip replacement surgery. Blood sugars, white cell count, renal function tests, liver functions tests are performed. Surgery cannot be performed if any of these tests give an abnormal result. Levels have to be brought to normal with medication or other treatment methods and then surgery can be scheduled. Blood group determination is done. Blood matching with the patient's type is kept ready. In case of excessive blood loss, transfusion is done to restore fluid volume in the body. An ECG is done before any major surgery. This is for assessment of cardiac function. A chest X-Ray is done to visualize the lungs. This will provide an idea about the respiratory functions.
- Physiotherapy
Patients who undergo joint surgeries, are advised to undergo physiotherapy sessions prior to the operation. This is done to strengthen the muscles around the joint which are to be operated upon. This prevents joint problems after surgery.
Day Before Surgery:
Patients are advised to be admitted to the hospital a day prior to surgery. Physical examination is done in detail with more emphasis on hip joint evaluation. Blood pressure, pulse rate, body temperature, breathing are monitored. The patient will be asked not to eat anything since the night before surgery.
A laxative may be given to empty the bowels. Antacids are given to prevent development of acidity. This is done because, the patient will be under general anesthesia during surgery.
The digestive tract is in a state of temporary paralysis during anesthesia. If the patient has eaten just before surgery, there is possibility that stomach contents may come out in the reverse direction, out of the esophagus and enter into the lungs. This can cause respiratory complications. The patient is advised not to undergo physical stress prior to surgery.
Procedure Day
On the day of surgery, the patient is transferred to the operating room. The patient wears a sterile surgical gown. Sterile cloth is used to drape the patient during surgery. The patient is positioned in suitable manner so that the hip joint which is to be replaced is easily accessible during surgery. Anesthetic medicines are administered in the form of an injection into the vein or via nasal route. The skin which will be used as access point for surgery is shaved off all hair. It is cleaned with an anti-septic solution to eliminate all microorganisms. Once anesthesia has set in and the person is unconscious, the surgery can begin.
Methods/ Techniques of Total Hip Replacement Surgery
Procedure to replace the diseased hip joint is only one, but it can be performed either by open method or minimally invasive methods. Both the methods have been explained in detail below:
- Open Surgery
This is an invasive procedure. A long cut of about 6-8 inches is made along the side of the hip which is to be replaced. The underlying muscles, fat, nerves and blood vessels are separated taking care not to damage them. The upper part of the thigh bone which is a ball like structure is cut with an orthopedic saw.
The remaining healthy thigh bone is attached with the selected prosthesis which is made out of metal or plastic. A strong adhesive is needed to fit the joint. Any diseased cartilage, loose debris are removed from the surface of hip. The artificial socket is attached to the hip surface. The artificial ball like structure of the thigh bone and the new artificial socket are then fit into one another. The surgeon checks if the artificial joint has been fit properly. The muscles which were separated earlier are repositioned. The skin incision is closed using a surgical thread.
- Minimally Invasive Surgery
The procedure is different from open method in the size and number of surgical incisions involved. Instead of a single long incision, multiple small incisions are given on the side of the hip which is to be replaced. Surgical instruments are inserted through these cuts. An arthroscope is used to visualize the internal organs. The further procedure remains same as is done in open surgery. Minimally invasive surgery has an advantage of lesser damage to surrounding structures and lesser bleeding.
Though there is some difference between both the procedures, conclusion is the same. At the end of surgery, a new artificial joint is placed instead of the old degenerated one. Some after care instructions are given to the patient. They facilitate easy recovery.
After the surgery, patient is moved to a recovery room. It will take a while before consciousness is regained. For a few weeks after surgery, some restrictions and measures of care have to be followed. They have been mentioned below.
Post Procedure
Patient needs to stay in the hospital for a day or two post partial knee replacement surgery. Though your stay in the hospital will be monitored by nurses, you need to take care of yourself once you have been given discharge. The list of dos and don't s have been mentioned below that will help you in speedy recovery post surgery.
- Hospital Care:
Soon after the effects of anesthesia wear off, the patient becomes conscious and alert. The surgeon will then perform a physical examination. The surgical wound is checked and covered in cotton and bandage. The patient is advised not to perform movement or weight bearing at the operated hip joint for a day or two after surgery. The patient is likely to remain in hospital for 4-6 days after surgery.
- Physiotherapy:
For strengthening the muscles around the newly placed hip joint, physiotherapy is essential. It is started soon after surgery depending on the patient's recovery. Light exercises are prescribed to the patient.
- Home Care:
Post-surgery care will continue even after the patient has been discharged to go home. It is advised to avoid twisting, turning or bending the hip joint excessively. Activities which will put a load on the operated hip of the patient are strictly not allowed. The patient should observe the surgical wound for signs of infection and bleeding regularly. It should be kept clean and dry and covered with soft surgical dressing. Walking aids are advised to be used by the patient for 4-6 weeks after surgery. Weight bearing is to be done only with the surgeon's and physiotherapist's instructions.
- Post-operative Medication
It is very likely that a patient may develop pain or infection at the site of surgical incision after hip replacement surgery. These can be treated with pain killers and antibiotics.
Following these measures after surgery will ensure a speedy recovery without many complications or health problems.
Risks and Complications
Every surgery is associated with some risk factors. It is essential to have knowledge about these factors along with the treatment methods for each of them. Some prominent complications have been mentioned below:
- Bleeding:
This is the most commonly occurring complication associated with any major surgery. For hip replacement surgery, the surgeon has to access the deep tissues. A blood vessel could be damaged during this procedure. This can lead to excessive bleeding. Accumulated blood can obstruct the surgeon's view while operating and it is drained using a tube attached to a pump. If it is excessive, the blood loss is replenished by transfusion.
- Clot Formation:
Bleeding may result in clot formation. Sometimes, if the clots are big, they can be removed mechanically. Smaller clots however are difficult to eliminate. They can enter some veins in the legs and may block it. Blood thinning medicines are then prescribed for dissolving the clots. However, dosage of these medicines needs to be monitored carefully.
- Dislocation of New Joint:
If the patient indulges into a lot of physical activity or puts pressure on the operated hip joint, there is possibility that the artificial joint may get displaced from its position. This might need another correctional surgery.
- Altered Leg Length
Sometimes, the dimensions of the prosthesis do not match the size of the natural hip joint of the patient's other limb. In this case, there is difference between the leg length. If the difference is negligible, it can be corrected by wearing specially made shoes. The shoe worn on the shorter leg will be fitted with a heel to correct the difference. If the difference is considerable, another surgery might be needed for length correction.
Each of these complications will not essentially occur in every patient who undergoes hip replacement surgery. All of the complications described above can be successfully treated as well. The procedure has many benefits. If it is performed successfully and all post-operative instructions are followed well, it is of great benefit to the patient.
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