Total Hip Replacement
The Hip Joint
The hip joint is a ball and a socket joint that connects the pelvis and the thigh bones. The hip socket is called the acetabulum and actually forms a deep cup that surrounds the ball of the upper thigh bone or femoral head. The surface of the femoral head and the inside of the acetabulum are covered with a smooth shiny cartilage that cushions, protects and at the same time allows near frictionless movement.
Cartilage, which contains no nerve endings or blood supply, receives nutrients from a moisturizing lubricant ( synovial fluid ) produced by the synovial lining surrounding the hip joint. If damaged, the cartilage is incapable of repairing itself .
Strong fibres (ligaments) connect the bones of the hip joint and provide necessary stability to the joint and elasticity for its movement. Muscles and tendons also play an important role in keeping the hip joint stable and mobile .
Arthritis
Arthritis literally means joint inflammation. Arthritis is not a single disease. Arthritis refers to the wear and tear of the cartilage with symptoms like stiffness, aches and pain in joints.
Types of Arthritis
Osteoarthritis:
This is perhaps the commonest type of Arthritis where cartilage simply wears out due to over use or old age, much like a car tyre .Over 20 million people in the United States are affected by Osteoarthritis. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females.
Rheumatoid arthritis:
This is an auto-immune disease where body’s immune system which is designed to fight infections and helps in healing wounds , goes haywire and attacks its own tissues ,especially joints.This is more commonly found in the young adults . The joints , usually the fingers swell and become more painful.
Infective Arthritis :
Infectious arthritis, which is sometimes called septic arthritis or pyogenic arthritis, is a serious infection of the joints characterized by pain, fever, occasional chills, inflammation and swelling in one or more joints, and loss of function in the affected joints. It is considered a medical emergency.
Traumatic arthritis
Injuries to the joints may damage the lining of cartilage. The cartilage develops cracks, which do not heal with original quality tissue. This becomes a weak spot, which gradually wears and follows a course akin to osteoarthritis, tough at a much younger age.
Osteonecrosis-also called Avascular Necrosis
Osteonecrosis occurs when your bones lose their blood supply. The bones die and eventually collapse, leading to pain and arthritis. You can have osteonecrosis in one or several bones. It is most common in the upper leg. Other common sites are your upper arm and your knees, shoulders and ankles. The disease can affect men and women of any age, but it usually strikes in your thirties, forties or fifties.
Treatment :
Various Surgical interventions are available depending upon the severity of patietn’s condition and the doctor’s judgement.The treatment include:-
- Femoral Hemiarthroplasty (Replacement of half a hip)
- Total Hip Replacement
- Cemented prosthesis
- Un-Cemented prosthesis
- Hybrid Total Hip Replacement
Benefits of Total Hip Replacement (THR):
After the surgery ,once the artificial hip joint has healed, the patients normally benefits from it. Following are the benefits of Total Hip Replacement :
- Reduced joint pain
- Increased movement mobility and stability
- Increased leg strength
- Correction of deformity
- Improved quality of life due to the ability to return to normal activities which the patient was unable to do prior to total hip replacement
What is Total Hip Replacement ?
Total hip joint replacement involves surgical removal of the diseased ball and socket, and replacing them with a metal ball and stem inserted into the femur bone and an artificial plastic cup socket. The metallic artificial ball and stem are referred to as the "prosthesis." Upon inserting the prosthesis into the central core of the femur, it is fixed with a bony cement called methylmethacrylate. Alternatively, a "cementless" prosthesis is used which has microscopic pores that allow bony ingrowth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is considered especially for younger patients.
Almost a million people in the developed world undergo total hip replacement surgery every year as a means of diminishing pain and restoring.
Hip Hemiarthroplasty
Femoral Hemiarthroplasty is done instead of a total hip replacement, when the socket cartilage is normal. The socket is not replaced. The femur component is similar to that of a total hip replacement but its ball is large and fills the normal socket, bearing directly against the cartilage.
Surface Replacement Hip
This is the most modern concept in hip joint replacement wherein only the worn out surfaces of hip joint are replaced with metal capping. It doesn’t require moving pieces of the bone from the thigh bone. It’s a long lasting joint that permits complete range of movement including squatting and sitting across legged on the floor.
The surgery is most suited for young patients.
Proxima Hip
Surface Hip Replacement can only be employed in certain specific conditions that can be judged by X-rays of the affected hip.The Proxima Hip counters these limitations as it can be applied in many extended conditions that preclude surface replacement .
It is less invasive, does not breach the core of the thigh bone (thus reducing blood loss), is easily changeable to the full hip (if required in the future) and at the same time affords all the advantages of the Hip Resurfacing.
It is undoubtedly the hip of the future especially for the young patients who are not suitable for the traditional hip resurfacing.
Who is a candidate for Hip Replacement ?
When the pain is chronic and is a hindrance in doing everyday activities such as walking, climbing stairs and even arising from a sitting position….you’ll know its time to consider a total hip replacement. Because replaced hip joints can fail with time, whether and when to perform total hip replacement are not easy decisions, especially in younger patients. Replacement is generally considered after pain becomes so severe that it impedes normal function despite use of antiinflammatory and/or pain medications.
Preparing for surgery
Medical Evaluation. If you decide to have hip replacement surgery, you may be asked to have a complete physical check up before your surgery. This is needed to assess your health and find conditions that could interfere with your surgery or recovery.
Tests. Several tests such as blood samples, a cardiogram, chest X-rays and urine samples 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 a program to improve your skin before your surgery.
Blood Donations. You may be advised to donate your own blood prior to surgery. It will be stored in case you need blood after surgery.
Medications. Tell your orthopaedic surgeon about the medications you are taking. Your doctor will advise you which medications you should stop or can continue taking 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, you should consider getting treatment for significant dental diseases (including tooth extractions and periodontal work) 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 and older men with prostate disease should consider a urological evaluation before surgery.
Social Planning. Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing and laundry. A short stay in an extended care facility during your recovery after surgery also may be arranged.
Home planning
Here are some items and home modifications that will make your return home easier during your recovery.
- 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 shoe horn 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 to sit on that keep your knees lower than your hips for your chairs, sofas and car
- Removal of all loose carpets and electrical cords from the areas where you walk in your home
Surgical procedure
The surgical procedure takes a few hours. Your orthopaedic surgeon will remove the damaged cartilage and bone, then position new metal, plastic or ceramic joint surfaces to restore the alignment and function of your hip.
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 a 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).
Special surgical cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint.
A non-cemented prosthesis has also been developed which is used most often in younger, more active patients with strong bone. The prosthesis may be coated with textured metal or a special bone-like substance, which allows bone to grow into the prosthesis.
A combination of a cemented ball and a non-cemented socket may be used.
Your orthopedic surgeon will choose the type of prosthesis that best meets your needs.
After surgery, you will be moved to the recovery room where you will remain for one to two hours while your recovery from anesthesia is monitored. After you awaken fully, you will be taken to your hospital room.
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 to 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. You may ask your orthopaedic surgeon for a card confirming that you have an artificial hip.
To receive an approximate idea of cost and other information regarding treatments, please contact us.
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Medical Treatment - Total Hip Replacement in India