Hip Replacement Surgery

Overview

The hip joint is the ball and socket joint, which is the point of articulation between the head of the femur and the acetabulum of the pelvis. It forms the major joint in our human body. 

Hip replacement surgery, popularly known as hip arthroplasty, is one of the most common surgeries performed in the orthopedic department. During the hip replacement procedure, a damaged hip joint is replaced with an artificial one called a prosthesis. 

According to research studies, it is estimated that around 1 million procedures are performed every year. 

Causes  

Hip replacement surgery is generally recommended for conditions when the hip joint is worn out or damaged, which will result in restricting the movement of the hip joints and cause severe pain even during rest.

A few of the causes for hip replacement surgery are listed below:

• Osteoarthritis
• Rheumatoid arthritis
• Post-traumatic arthritis
• Hip fracture
• Septic arthritis
• Bone dysplasia (a condition where there is an unusual bone growth)
• Osteonecrosis (avascular necrosis)
• Tumor in the hip joint
• Hip replacement surgery can also opt-in conditions when there is severe pain in the hip joint during rest, persistent pain despite using painkillers, worsening pain during walking, interference with sleep, difficulty in climbing stairs, etc.

Risks that are associated with hip replacement surgery

Various risks can be associated with hip replacement surgery, which include:

• Blood clots
• Bleeding
• Infection
• Dislocation
• Fracture of the hip joint
• Delay in the healing process
• Change in leg length
• Nerve damage due to post-operative complications
• Loosening 
• May require second hip replacement surgery

What are the main goals of hip replacement surgery?

The main goals of hip replacement surgery include:

• Relieve pain in the hip joint
• Improve the function of the hip joint
• Increase in mobility of the hip joint

What are the steps following hip replacement surgery?

Before surgery

Whenever the patient notices any abnormalities in the hip joint, one should consult the doctor immediately. The doctor initially will record the history of the patient. To confirm the condition, the doctor will perform a couple of tests, which include:

• Physical examination: during the physical examination, the doctor will examine the hip joint of the patient carefully. The doctor will do a couple of tests to confirm the cause and condition of the patient.
• Medical history of the patient: which includes history of trauma of the patient or any other surgical history, history of medications 
• Investigational scans: x-ray of the pelvis. It will help in identifying the cause
• Other tests include an MRI scan of the pelvis, routine blood tests before the surgery
• Physician fitness before the surgery.

Once the cause of the patient’s condition is identified, the doctor will advise the patient to undergo hip replacement surgery. The doctor will counsel the patient and their relatives regarding the procedure in detail, explain the complications associated with it, and get the consent form signed by the patient and their relatives.

Once the patient receives the fitness from the physician or anesthetist, the doctor will advise the patient to stop using a few medications, such as blood thinners, diabetic medications, etc., for a duration of a few days, depending on the type of medication the patient is taking. The doctor will also advise the patient to quit smoking and alcohol consumption pre- and post-surgery. 

During the surgery

Once the patient is medically fit for the procedure, the patient is advised to stay nil per oral 6-8 hours before the surgery. This procedure is usually performed under general anesthesia or regional anesthesia. During the surgery, the doctor will make an incision over the hip through multiple layers of the tissue. The surgeon removes the diseased or damaged bone and cartilage, leaving the healthy bone in place. The doctor replaces the damaged or diseased bone with an implant in the pelvic bone. The surgeon implants a metal stem into the top of the thigh bone, which is then topped with a replacement ball. 

After the surgery

Post-surgery, the patient is shifted to the recovery room, where the patient's vitals are monitored closely. Later, the patient is shifted to the ward for further management and care. During the hospital stay, the patient is advised to stay on a few medications, such as painkillers, antibiotics, blood thinners, and other medications if required. The doctor will closely monitor the blood pressure, pulse, alertness, pain, and comfort levels of the patient. The patient is later to undergo physiotherapy and wear compression stockings for the patient’s improvement and recovery. 

Once the patient is hemodynamically stable, the patient can be discharged and advised to have a regular follow-up with the doctor so that the doctor can monitor the patient's overall condition. 

FAQs

1. How painful is hip replacement surgery?
A. Hip replacement surgery is generally performed under regional or general anesthesia. Post-surgery, the surgeon usually prescribes painkillers, which include NSAIDs, opioids, acetaminophen, and local anesthetics. 

2. How long is the rehab required after the hip replacement surgery?
A. The total recovery of the patient depends upon a variety of factors, including the patient's age, their co-morbidities, the cause of the surgery, and the overall condition of the patient. The patient may require rehab for 4-6 weeks, based on the patient's condition. 

3. What are the types of hip replacement surgery?
A. The types of hip replacement surgery include:

• Total hip replacement surgery- The entire ball and socket are replaced during this procedure
• Partial hip replacement surgery- During this procedure, the ball (head of the femur) is replaced
• Anterior, posterior, and lateral hip replacement surgery
• Minimal invasive hip replacement surgery
• Hip resurfacing- It is considered an alternative to hip replacement surgery

4. How long does the hip replacement surgery take?
A. The procedure may last 1.5 to 2 hours. 

5. How long does the hip replacement surgery last?
A. The hip replacement surgery lasts for 10-15 years. The patient is later advised to undergo revision surgery.