Hip Replacement Surgery

Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.

Who should undergo hip replacement?

People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis, rheumatoid arthritis, osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

Why Do People Have Hip Replacement Surgery?

For the majority of people who have hip replacement surgery, the procedure results in:

A decrease in pain
Increased mobility
Improvements in activities of daily living
Improved quality of life.

Diagnosis

X-ray, MRI, CT and Ultrasound
Procedure/ Treatment plan

The hip joint is located where the upper end of the femur, or thigh bone, meets the pelvis, or hip bone. A ball at the end of the femur, called the femoral head, fits in a socket (the acetabulum) in the pelvis to allow a wide range of motion.
Process of hip replacement

During a traditional hip replacement, which lasts from 1 to 2 hours, the surgeon at Manipal makes a 6- to 8-inch incision over the side of the hip through the muscles and removes the diseased bone tissue and cartilage from the hip joint, while leaving the healthy parts of the joint intact. Then the surgeon replaces the head of the femur and acetabulum with new, artificial parts. The new hip is made of materials that allow a natural gliding motion of the joint.

In recent years, smaller incisions and a shorter recovery time than traditional hip replacement is being followed. Candidates for this type of surgery are usually age 50 or younger, of normal weight based on body mass index and healthier than candidates for traditional surgery. Joint resurfacing is also being used.

There are two types of hip replacement:

Unilateral Hip replacement- procedure where only one of the hip joints are replaced
Bilateral hip replacement- procedure where both the hip joints are replaced

Preparing for Surgery
Medical Evaluation

If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure
Tests

Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.
Preparing Your Skin

Your skin should not have any infections or irritations before surgery.
Blood Donations

You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.
Medications

Tell your orthopaedic surgeon about the medications you are taking.
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, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery.
Urinary Evaluation

Individuals with a history of recent or frequent urinary infections should have 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.
Home Planning

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

A raised toilet seat
A stable shower bench or chair for bathing
A long-handled sponge and shower hose
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 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 for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
Removal of all loose carpets and electrical cords from the areas where you walk in your home.

Post-operative care

Patients are closely monitored by the staff.
Looking after your new hip

With care, your new hip should last well. The following tips will help you care for your new hip:

avoid bending your hip more than 90° (a right angle) during any activity
avoid twisting your hip
do not swivel on the ball of your foot
when you turn around, take small steps
do not apply pressure to the wound in the early stages (so try to avoid lying on your side)
do not cross your legs over each other
do not force the hip or do anything that makes your hip feel uncomfortable
avoid low chairs and toilet seats (raised toilet seats are available)

Possible Complications of Surgery

The complication rate following hip replacement surgery is low.

The most common complication of hip replacement is that something goes wrong with the joint, which occurs in around 1 in 10 cases. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.
Infection

Infection may occur superficially in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later.
Blood Clots

Blood clots may form in the leg veins or pelvis.
Leg-length Inequality

Sometimes after a hip replacement, one leg may feel longer or shorter than the other.
Loosening and Implant Wear

Over years, the hip prosthesis may wear out or loosen. Loosening of the joint can occur at any time, but it normally occurs 10-15 years after the original surgery was performed.
Other Complications

Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. In a small number of patients, some pain can continue or new pain can occur after surgery.
Dislocation

This occurs when the ball comes out of the socket.
Wear and tear

Another common complication of hip replacement surgery is wear and tear of the artificial sockets.
Joint stiffening

The soft tissues can harden around the implant, causing reduced mobility.