What Is Hip Replacement

Hip replacement surgery or Total Hip Replacement Surgery is a surgery in which the hip joint, or the joint between the upper end of the leg and pelvis, is replaced by an artificial implant, or a prosthetic replacement. Hip replacement surgery can be done for patients with severe osteoarthritis and rheumatoid arthritis, who cannot manage the pain and restricted mobility through medication alone. In cases of Avascular Necrosis, after a fracture has cut off the blood supply to the head of the femur, the detached head of the femur undergoes necrosis. In these cases, total Hip joint replacement is the best alternative, especially if secondary joint degeneration has started.

BEFORE Hip Replacement PROCEDURE

Hip replacement is not an uncommon procedure. Before surgery, it’s advised that you familiarize yourself with a basic outline of the how the procedure is done. While there is information available on the internet, it is good to discuss details of your implant with your doctor as well. Before the surgery, you will need a complete preparatory lab work up. This will include the following tests:

  • Complete blood picture - to estimate your blood cell counts. If you are anemic or weak, you might need a blood transfusion.
  • Hemoglobin estimation
  • Platelet count to estimate if your blood is clotting at the normal rate.
  • ECG graphs will be taken, and an ECG monitor will be attached to you throughout the surgery.
  • Blood pressure monitoring to make sure that you are not hypertensive - or if you are hypertensive, then your blood pressure is in control.
  • Blood sugar estimation, both on an empty stomach and after eating, to check your blood sugar levels.
  • If you are diabetic, then your blood sugar will need to be in control
  • Detailed clear X rays of the affected hip joint, to identify the exact points that have been affected. X rays are taken both before and after surgery, as well as radiological imaging during the surgery to make sure that the implants fitted in with the bones correctly.
  • Urine examination is done to confirm good renal function.

Make sure you bring a list of any regular medication you’re on. Before the surgery, you’ll be given an enema to minimize the chances of infection or contamination during surgery. You’ll also have a urinary catheter put in.

How it is performed

In the surgery, the joint is exposed in a way that the head of the femur as well as acetabulum are visible. The head of the femur, the upper bone of the leg, is exposed, and depending upon the surgery being performed, it may be resurfaced or removed completely from the neck. The acetabulum is then reshaped so to make it deeper and more smooth, so that a ‘cup’ can be implanted. This cup will form the new socket. Within the cut surface of the femur, a ‘stem’ is created which will form the new ball. Both these are then fixed with PolyMethylMethacrylate, or PMMA. In some cases, the cup is fixed with a metal surface behind it, and the parts are hammered in instead of ‘cemented’. This is called an uncemented hip replacement, which is preferred for younger patients, but can be done for anyone. The rest of the wound is closed, sutured and bandaged, and cared for till it heals.

Procedure Duration - Normally, a hip replacement surgery takes 1-2 hours.

Recovery

After your hip replacement surgery, you’ll be advised to restrict any movement in your legs and from the waist. Patients are usually propped up and have to maintain little to no movement for at least 1-2 days, after which you can start moving around and walking with assistance, provided that you keep your hip positioned in the right way. Healing is slow, but if the blood supply is good, healing is faster than it would in a joint with compromised blood supply. In addition, controlled blood sugar and blood pressure accelerate healing too. While in the hospital, physiotherapy will begin and the physical therapist will show you all the correct exercises you need to do regularly to strengthen the joint, and the surrounding muscles. Especially with total hip replacement surgeries, the newly implanted hip joint will have a slightly more restricted range of movement, so you will have to learn the new methods of controlling movement and implementing it into your day to day activities. You will be on prophylactic antibiotics to prevent any infection from occurring, as deep tissue infections can be devastating, but if you maintain hygiene especially around the wound, the chances of infection occurring are minimal. Full recovery can take up to 3-6 months. The more carefully a patient implements dietary restrictions, exercise, and lifestyle modifications as advised, the sooner recovery will occur. With improper care, the wound will have no ‘rest’ to recover, and healing will be slower. This is why doctors advise that you should avoid high impact activities which put a lot of strain on the hip joint, as well as contact sports, which have a higher likelihood of causing dislocation. Exercises like swimming are ideal because they give you moderate to high intensity cardio without putting stress on the replaced joint.

Potential Risks

With the advent of new procedures and technology, there are very few complications associated with hip replacement surgery. Probably the most commonly seen issue is dislocation of the newly implanted ball and socket, if yu push the joint beyond its limit of mobility, such as pulling your knees to your chest or hyperextending your legs. There is also risk of later complications like inflammation around the surgical site, but this is usually countered by keeping the patient on antiinflammatory drugs like corticosteroids. There is also risk of complications like blood clots forming in the veins of the lower limb, which can lead to Deep Vein Thrombosis, or formation of irregular bone around the cut edges of the bone, but again, these are minimal risks. Even if these conditions occur, they can be caught early on by consulting a doctor about any unusual redness, pain or tenderness around the surgical site, swelling in the ankles or prominent dilated veins in the leg.

Cost for Hip Replacement

US from $40,000
UK from $13,900
India from $6,000
Thailand from $12,500

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