The removal or replacement of a portion of the pelvis and femur (thigh bone) that constitute our hip joint is hip replacement surgery. It is performed to give pain relief to patients. Such types of procedures are used to treat some injuries and an improperly developing hip joint. The hip joint is a ball and socket joint in which a ball at the top of our femur, called the femoral head and a socket in the pelvis are joined. This ball and socket joint allows a wide range of movement for the leg allowing forward, backward and rotatory movements when the ball moves in the socket.
In a healthy hip, cartilage covers the ball and socket to help them to glide smoothly. If this cartilage is damaged, the bone underlying the cartilage in the head and the socket may come in contact. This condition is called osteoarthritis, which causes pain and disturbance in motion. Walking with a hip with arthritis is painful. If we are diagnosed with hip arthritis, we need not have surgery. The symptoms are first treated with medicines and when not enough relief is obtained with medicines alone, surgery for hip replacement can be considered.
- Total Hip Replacement: This type of hip replacement surgery is most common in which the damaged part of the hip is replaced with artificial implants. The socket is replaced with a durable plastic cup which may be a titanium metal covering. The femoral head is replaced with a ball made of ceramic. The new ball is attached to the top of the femur.
- Partial Hip Replacement: This is also called hemiarthroplasty, which involves replacement of only one side of the hip joint, the femoral head. This is mostly performed on the patients with a fractured hip bone.
- Hip resurfacing: In this type of surgery, the femur head and the pelvic socket are not replaced but only covered with an implant. This is preferred in younger and more active patients.
There are two hip replacement surgery techniques which are included:
- The posterior approach (most common)
- The anterior approach (mini anterior approach)
To start the operation, the surgeon makes an incision either on the posterior or anterior side.
Need of Hip Replacement
Hip replacement surgery is considered if a person has severe pain that is not relieved by medication and causes a disturbance in walking, sleeping and everyday activities.
- Hip stiffness and pain that causes difficulty in walking
- Difficulty in routine work
- Inflammation or swelling in hip joint
- There are some steps that a patient should follow before and after the surgery to improve recovery and for better results. It is necessary for the patient to follow the instructions given by the orthopedic surgeon.
- Most patients stay in the hospital for one or two nights after surgery. Some patients return home on the same day if the doctor allows.
- Most of the total hip replacement surgery takes half or one hour.
Most hip replacement surgeries are safe when performed in healthy individuals. Sometimes there are risks such as:
- Blood clotting in the legs and pelvis
- Accidental hip dislocation after or during surgery
- Loosening of the implant
- Change in length of leg
- Infection can occur at site of incision
Hip Replacement Surgery Recovery
The rehabilitation process begins within 24 hour after the surgery. Most of the patients who undergo hip replacement surgery are able to walk with a cane or a walker soon after surgery. As the days progress patients become able to walk a greater distance with and/or without support and with more ease.
Post-surgery recovery process
- Recovery begins in the post anesthesia care unit, where the medical team manages the pain and monitors the symptoms.
- After recovery from anesthesia, patients are referred to an in-patient room for monitoring.
- The drainage tube inserted after surgery is removed after monitoring the fluid collection.
- The surgeon provides guidance about when and how to start walking. It is usually started slowly with a walker or a cane.
- Physical therapy is started after discharge from the hospital and continues for 6-8 weeks. After this therapy, the patient is able to perform daily activities as usual if there are no other complications.
Prevention of Progress of Hip Arthritis
Hip replacement surgery is a useful treatment for hip arthritis but usually not the first option for most patients. There are exercises that can be done to strengthen the hip and slow progression of the disease:
- Low impact exercises: It is necessary for people to incorporate some low impact activity into their daily lives that causes minimal strain to the hip joints. They should try to walk or ride a bike slowly instead of running. These low impact activities keep the hip joint in neutral rotation and stabilize the hip joints while strengthening the muscles around it.
- Lunges: Most people think that lunges are thigh strengthening exercises but they also strengthen the hips and help avoid surgery. Step forward with one foot and lower your body as far as possible. These exercises focus on hip flexors, which strengthen over time and provide additional support to the hip joints. Keep your movement slow and focus to control hip flexors.
- Leg Presses: Leg presses focus on building leg strength and hip strength. Firstly, seated at the leg press machine, spread the feet as wide as possible on the plate to focus on the inner hips. To focus on building outer hip strength, shift your position to place the feet closer together.
- Standing Hip Flexor stretches: Standing hip flexor stretches strengthen the small muscles in the hip which are responsible for lifting our leg up. This exercise can be done easily at home. To begin, stand behind a sturdy chair with just enough room to pick up our leg. Hold onto the chair with both hands, stand up erect, and raise one leg up toward the chest with the knee bent. Slowly bring the leg back down, and then repeat with the other leg.
- Hip Abductors: Hip abductors help with balance. You are less likely to suffer a fall if you have strong and stable hip abductors therefore avoiding a fall that can injure the hip joint requiring replacement surgery. To perform this exercise, sit on a chair, tie a resistance band right above the knees, and slowly spread both legs apart using the hip muscles. This exercise is a simple yet effective way to prevent the need to undergo surgery.
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