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Total Hip Replacement

What is a Total Hip Replacement

Total Hip Replacement Surgery Procedure

The process by which the destroyed cartilage and bone of the hip joint is substituted along with metallic plates or other artificial materials are referred to as total hip replacement.
In a total hip replacement (also called total hip Arthroplasty) the broken ball and socket joint is removed and a metallic or ceramic ball also called femoral prosthesis is inserted in its place which goes into the hollow centre of the femur bone and a plastic cup socket also called ace tabular prosthesis is inserted which allows smoother movement. The prosthesis, after insertion, is fixed with bony cement called methyl Meta cry late. For younger patients, the cement prosthesis is avoided, instead a porous prosthesis is used which allows bony growth from their original femur into the stalk of the prosthesis.

Total Hip Replacement: When to go for it?

Conditions where the hip joint is severely damaged and is characterized by unbearable continuous pain in or near the hips, which does not go away even after resting, difficulty in sitting, walking, climbing or doing other normal activities, this surgery is prescribed. This surgery is no wonder difficult, and not all patients can be subjected to the surgery depending on a lot of factors like age, obesity, medical history like those suffering from diabetes, heart, liver or kidney ailments etc. Replaced hip joints can fall off or break with time, so the surgery often might lead to a second operation. So in extreme cases when pain becomes so intense that daily activities are hampered and pain does not subside even after taking pain medications, this remains the last resort. Some common factors that account to hip joint damage are as follows:
1. Osteoarthritis(degenerative arthritis) of the hip joint
2. Age
3. Obesity
4. Prior trauma or fractures of the hip joint
5. Rheumatoid arthritis and death of the hip bone

Causes of knee replacement

The most common reason for knee replacement surgery is Osteoarthritis which is a degenerative joint disease.
Lower Vitamin D levels may cause greater knee pain and difficulty walking in patients with osteoarthritis.
Other conditions that cause knee damage include rheumatoid arthritis, hemophilia etc.

Risks associated with Total Hip Replacement

The main risk associated with total hip replacement includes blood clots that can occur at the site of surgery and can travel to the lungs (pulmonary embolism). Pulmonary embolism can cause pain in the chest while breathing, lightheadedness or low oxygen in the body, palpitations, dry cough etc. Extreme cases can rarely cause death too. Other risks include urinary tract infection, difficulty in maturation, nausea and vomiting (usually related to pain-relieving drugs), problem in moving the hip joint, skin infection near the hip joint, nerve damage, blood vessel injury, opening or loosening of the prosthesis and sometimes even re-surgery has to be done due to infection in the hip. Rarely, the use of anesthesia during surgery can have adverse effects on the functioning of liver, heart and lungs.

Preoperative evaluation

Prior to surgery, all medications that the patient is taking are thoroughly checked to avoid post operative complications. Blood-thinning and anti-inflammatory medications, if taken, are stopped in most cases as they affect the platelet count and blood clotting mechanism adversely. Liver function, renal function and urine tests are mandatory as before any surgery. Blood test is done to check for anemia, electrolytes (sodium, potassium chloride), or any other infection. Chest X-ray and ECG are performed to rule out significant heart and lung disease that may create complication during or after surgery. Sometimes mild physiotherapeutic treatment may be advised to the patients to increase muscle flexibility which can help in faster recovery post surgery.

Postoperative evaluation and recovery

A maximum of three hours might be needed for the total hip joint replacement surgery. After surgery the patient is kept under observation and when the condition stabilizes, they are shifted to normal hospital room. One major drawback of the surgery, like any other surgery is the passage of urine for which a catheter is required to be inserted until the patient can walk on his/ her own and at least go to the washroom.

Post surgery patients are given Intravenous (IV) fluids to replenish the lost electrolytes from the body. Using the same IV route, antibiotics and pain relievers are given for the first three days. One major concern after the operation is the formation of blood clots in the lower extremities. Compression stockings can help in normal blood flow in the legs. Moderate exercise of the lower part of the body can reduce the chances of blood clot.

Rehabilitation Process after the surgery

The right therapy is physical therapy which is the most significant procedure of the recovery process. Right after the surgery, patients are subjected to mild exercise which they can do even by sitting, which are followed by stepping, walking, climbing up stairs etc. Although, initially patients will face extreme difficulty in performing them, gradually they will seem easier and will comfort their pain. Any strenuous exercise like running, lifting heavy weights is a strict no for a long time after the operation as they can dislocate the hip joint. Wrong sitting postures, like sitting cross-legged can also impose risk on the replaced joint. Bending, twisting, leaning on the operation side must be strictly avoided, patients are even advised to use pillow between their legs while lying down so that the operated lower extremity do not cross the midline.

Instructions patients need to follow after the Total Hip Replacement Surgery

1. Supportive devices like walkers, crutches, wheelchairs etc can be continued for sometime till the patient is fully able to do without them.
2. Medications that reduce the chances of blood clots in the legs may have to be taken for a longer time as prescribed by the physician. Additional medicines, for pain, sleep, muscle relaxation, constipation, nausea etc can also be given which patients might have to continue long after the surgery.
3. Patients are advised to be extremely alert relating to any sign of infection, swelling, pus oozing out from the wound or unbearable pain at the surgical site with elevated body temperature, which should be immediately reported to the doctor. 4. Patients should be made aware of the pros and cons of such type of surgery which will make it easier for them to deal with the outcomes.
5. Any activity that can re-injure the replaced hip joint should be strictly avoided.
6. Swimming in most cases has proved beneficial to patients who have undergone this surgery as this improves the muscle strength around the hips. 7. Patients should always notify any doctor they visit again that they have an artificial joint to avoid any further complication.
8. During any further surgery elsewhere in the body of such patients, antibiotics are highly recommended to prevent bacterial infection in the joint.
9. With time, the metal portions of hip replacement may wear away. An MRI of the hip can rule out the development of pseudo tumor.

Among all the surgeries related to joints, Total Hip Joint Replacement and knee joint replacement surgery is one of the most successful ones giving long-term good results to patients. With the advancement of medical science and the invention of latest technologies scientists are trying to lengthen the longevity of these metal devices with minimum side effects.