Total Hip Replacement

What is Arthritis?

Arthritis is inflammation of the joints resulting in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability.

Common Types of Arthritis

The three most common types of arthritis that affect the hip are:

• Osteoarthritis: It is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage wears down, the bone ends rub against each other and cause pain in the hip.
• Rheumatoid arthritis: This is an autoimmune disease in which the tissue lining the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). This leads to loss of cartilage causing pain and stiffness.
• Traumatic arthritis: This is a type of arthritis resulting from a hip injury or fracture. Such injuries can damage the cartilage and cause hip pain and stiffness over a period.

Symptoms of Arthritis

The most common symptom of hip arthritis is joint pain and stiffness resulting in limited range of motion. Vigorous activity can increase the pain and stiffness which may cause limping while walking.

Diagnosis of Arthritis

Diagnosis is made by evaluating medical history, a physical examination and X-rays.

What is Total Hip Replacement?

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. The hip joint is one of the body's largest weight-bearing joints, located between the thighbone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint.

Indications of Total Hip Replacement

Several diseases and conditions can cause damage to the articular cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.

Total Hip Replacement Procedure

Surgery may be recommended, if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms.

The surgery is performed under general anaesthesia. During the procedure, a surgical cut is made over the hip to expose the hip joint and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone is removed using a reamer. The acetabular component is inserted into the socket using screws or occasionally bone cement. A liner made of plastic, ceramic or metal is placed inside the acetabular component. The femur or thighbone is then prepared by removing the arthritic bone using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place using special cement. The muscles and tendons around the new joint are repaired and the incision is closed.

Postoperative Care following Total Hip Replacement

After undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. Some of the common precautions to be taken include:

• Avoid combined movement of bending your hip and turning your foot inwards
• Keep a pillow between your legs while sleeping for 6 weeks
• Never cross your legs and bend your hips past a right angle (90)
• Avoid sitting on low chairs
• Avoid bending down to pick up things, instead a grabber can be used to do so
• Use an elevated toilet seat

Risks and Complications of Total Hip Replacement

As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement include:

• Infection
• Dislocation
• Fracture of the femur or pelvis
• Injury to nerves or blood vessels
• Formation of blood clots in the leg veins
• Leg length inequality
• Hip prosthesis may wear out
• Failure to relieve pain
• Scar formation
• Pressure sores

Pre-op and Post-Op Hip Guidelines

Planning for your hip surgery prepares you for the operation and helps to ensure a smooth surgery and easier recovery. Here are certain pre-operative and post-operative guidelines which will help you prepare for hip surgery.

Pre-operative guidelines

When your surgeon decides that surgery is the best option to overcome hip pain and restore movement, you will be briefed about the procedure and can start preparing yourself for the surgery.

• Prior to surgery, you should inform your doctor about all the medications you are taking, so that your doctor can decide if any medications can interfere with the procedure and ask you to stop using them. You will be asked to stop using aspirin, inflammatory and herbal medications before surgery as they can lead to bleeding.
• You will be asked to quit smoking prior to surgery.
• Your doctor will explain all the possible risks and complications involved with the surgery.
• You may also be advised to consult your general physician to confirm on any other health conditions that may cause complications during surgery.
• Based on your medical history, ongoing medications and a physical examination, the different options for anaesthesia will be explained to you.
• Your surgeon may also recommend a strengthening program, which includes exercises to improve your strength and flexibility prior to surgery to help you in your post-operative recovery.

Before you go for your surgery, it is advisable to plan for coming home from the hospital.

• Remove loose rugs and anything that can obstruct your walking path and cause falls or accidents. If necessary, you can widen the walking path to accommodate your walker or cane that you will be using during your recovery period.
• Place all items that you regularly use, such as remote controls and medications, in easy-to-reach places.
• Un-tuck your bedding so that it is easier to move in and out of bed. If your bedroom is situated in one of the higher floors, it is advisable to relocate to the lower floor to avoid climbing stairs.
• Opt to have some assistance after your surgery for a few days.
• Prepare single serving meals so that they can be quickly heated and easily cleaned.

Postoperative guidelines

After your surgery, you will be shifted to the recovery room where your vitals will be monitored. X-rays will be taken to determine the success of the surgery. Once you are in a stable condition, you will be shifted back to the ward. Drains will be removed, and you can start walking depending on your comfort and surgeon’s advice. Your physiotherapist will help you move around better by teaching you certain post-operative hip exercises. You will be discharged around 5 to 7 days after the surgery. Your doctor will give you a recovery plan that you should follow.

During the first few weeks at home, you should take care of your operated hip. You should avoid crossing your legs while sitting or standing, and do not allow your knees to come higher than your hips. Also, avoid sitting in low sofas or chairs. It is always helpful to have some assistance while walking. Your doctor may recommend you continue the post-operative exercises until your complete recovery. It is important to keep up your three, six, nine months and annual follow-ups with your surgeon.