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Total Hip Replacement

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Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier.

Total hip replacement (THR) is a treatment option for late-stage degenerative hip disease, also known as osteoarthritis or degenerative arthritis. THR is one of the most successful and common surgical procedures in orthopedic surgery. In addition to marked reduction in pain, most people regain range of motion, physical ability, and quality of life.

  • The hip joint is composed of a ball and socket, with the surface of each covered by cartilage.
  • A number of conditions and diseases can cause the cartilage surfaces to degenerate, which in turn leads to pain, stiffness, loss of hip joint range of motion, and disability.
  • Surgeons replace both the ball (femoral head) and socket (acetabulum) during total hip replacement surgery.

A) Getting Ready For Hip Replacement

B) Medical Evaluation:
You will be asked to have a complete physical examination before hip replacement surgery to assess your health. These tests will also help to identify any condition that could interfere with your knee surgery

C) Tests:
You may need to get several laboratory tests done like Blood analysis, Urine analysis and cardiac work-up. This will help your doctors to plan your surgery.

D) Preparing your Hip:
You should not have any external or internal infection; especially your hip and groin should be devoid of any skin infection or irritation.

E) Blood Donation:
A transfusion may be necessary after surgery; therefore you may wish to donate blood prior to surgery.

F) Other important points to remember:

  • You have to be physically healthy, which means you should not have any fever or any other active infection, etc.
  • Tell your doctor about any treatment/medication you may be taking. Your doctor may ask you to stop taking medications which may interfere with your surgery.
  • Tell your doctor about any treatment of significance, such as dental extractions or peri-odontal work, that you may be scheduled for, during the peri-operative period.

G) Preparation for the Hospital:

  • Clothing
  • Walking aids
  • Insurance information

H) Evening before Surgery:

  • Do not eat or drink after midnight ( as per Doctor`s advice)
  • Shower (with 5 min scrub to surgical area with special liquid/soap provided)
Total Hip Replacement Surgery
  • You will arrive at the hospital usually on the day or a prior of surgery.
  • An anesthesiologist will meet with you to discuss various options for anesthesia.
  • You may have general anesthesia, in which you will be completely unconscious.

    You may have regional anesthesia that will numb you from the waist down and keep you moderately sedated.

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  • The surgeon will expose your hip joint and dislocate the ball from the socket.
  • The doctor removes the head from the femur (thighbone) and reams away the surface of the socket.

    The doctor secures in place a prosthetic cup (socket) made of polyethylene.

    The surgeon then secures a metal head (ball) and stem into the femur either by a press fit or with bone cement.

    The doctor places the ball into the cup and takes your new hip through a range of motion to ensure proper stability and mobility.

    The surgeon closes your incision, and you are brought to the recovery room.

What Happens After Hip Replacement Surgery?

You will likely stay in the hospital for four to six days and may have to stay in bed with a wedge-shaped cushion between your legs to keep the new hip joint in place. Physiotherapy usually begins the day after surgery and within days you can walk with a walker, crutches, or a cane. You will continue physiotherapy for weeks to months following the surgery.

Recovery after Total Hip Replacement

After the four to seven days of hospital care, you will be sent either home or to a rehabilitation center.

  • Your destination will depend on how quickly your new hip heals and on your ability to get around and perform your daily activities.
  • Therapy will continue at home or at the rehabilitation center and may last for weeks to months after your surgery. This therapy will be designed so that you will gain the most benefit from your replacement hip.
  • Ask your doctor about other instructions and precautions and when to come back for a checkup.
Do`s during recovery period
  • Keep the wound area clean and dry
  • If your wound appears red or begins to drain, inform the doctor
  • Inform your doctor immediately if you have calf pain, chest pain, or shortness of breath
  • Regular physiotherapy to strengthen muscles around operated hip joint
  • Practice regular walking with a walker/crutches
  • Keep stairs climbing to a minimum. Make the necessary arrangements so that you will only have to go up and down the steps once or twice a day.
  • Sit in a firm, straight-back chair. Recliners should not be used.
  • To help avoid falls, remove all throw rugs and keep floors and rooms clutter free.
  • Use an elevated toilet seat. This will help keep you from bending too far at the hips.
  • Keep enthusiastic pets away until you have healed completely.
Don’ts during recovery period
  • Do not play high impact sports
  • Avoid gaining weight
  • Avoid fall
  • Do not take bath or shower until the sutures are removed. This may take 10 to 14 days after surgery
  • For anywhere from six to 12 months after hip replacement surgery, pivoting or twisting on the involved leg should be avoided
  • You should also not cross the involved leg past the midline of the body nor turn the involved leg inward and you should not bend at the hip past 90 degrees. This includes both bending forward at the waist and squatting.

Your physiotherapist will provide you with techniques and adaptive equipment that will help you follow any of the above guidelines and precautions while performing daily activities. Remember, by not following your therapist's recommendations you could dislocate your newly replaced hip joint and may require another surgery.

PREVENTING COMPLICATIONS

In a small percentage of patients, as with all major surgical procedures, complications can occur which may be:

  1. 1) DVT/Pulmonary Embolism: When the blood clots in large veins of leg (DVT) and in some instances, may get dislodged from there and travel to lung capillaries and cause Pulmonary embolism. Steps to minimize this complication are:
  2. a) Foot and ankle excercises to increase blood flow and enhance venous return in the lower leg

    b) Blood thinning agents

    c) Elastic stockings

    d) Early Mobilisation

If you develop swelling, redness, pain and tenderness in the calf muscle, report to the doctor at the earliest

  1. 2) Infection: Although great precaution is taken before, during and after operation, infections do occur in a small percentage of patients following knee replacement surgery. Steps you can take to minimize this risk:
  2. a) Immediately report any redness, swelling, tenderness, increased drainage, persistent fever above 100 deg

    b) Take your medications as directed

    c) Strictly follow incision care guidelines

Other less common concerns are:

  • Your legs may not be of equal length after the surgery.
  • You must be careful not to cross your legs or not to sit too low because the joint may be dislocated.
  • Pieces of fat in the bone marrow may become loose, enter the bloodstream and get into the lungs, which can cause very serious breathing problems.
  • Nerves in the hip area may be injured from swelling or pressure and can cause some numbness.
  • The replacement parts may become loose, break, or become infected.
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