What is Total Hip Replacement Surgery?

Hip Replacement/Total Hip Replacement (THR) surgery is a surgical procedure in which the damaged hip is replaced with an artificial implant. Total hip replacement (THR) surgery is also known as total hip arthroplasty. This procedure helps in relieving hip pain due to fracture, trauma, or injury when medicines or physiotherapy fails to relieve the pain. Also, if a person is over 60 or 65 years of age and has severe hip pain while sitting or sleeping, then hip replacement surgery is recommended. Let us tell you in detail about Total Hip Replacement Surgery through this article.

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• What are the reasons for total hip replacement surgery?
• What are the symptoms that require total hip replacement surgery?
• Which prosthesis is used for total hip replacement surgery?
• What Diagnostic Medical Procedures Are Performed Before Total Hip Replacement Surgery?
• What tests are done before total hip replacement surgery?
• What care steps are taken before total hip replacement surgery to reduce complications?
• What is the procedure for Total Hip Replacement Surgery?
• What are the things to keep in mind after total hip replacement surgery?
• What are the risks and complications of total hip replacement surgery?
• What are the alternative treatments for Total Hip Replacement Surgery?

What are the Reasons for Total Hip Replacement Surgery?

• Total hip replacement surgery is recommended depending on the severity of symptoms. Some of the conditions that may require a hip replacement include:
• Gout – Arthritis is an inflammation of a joint that causes pain, swelling, and decreased range of motion.
• There are types of arthritis.
• Osteoarthritis: a degenerative joint disease that affects older patients.
• Rheumatoid arthritis – chronic non-infectious inflammation
• Post-traumatic arthritis – is a type of arthritis that occurs after an injury. (Read more – What are home remedies for arthritis?)
• Hip fracture – This is a serious injury or breaks in the upper part of the thigh bone. This is mostly due to weak bones (osteoporosis) in elderly people, due to long-term medications that weaken bones, due to calcium and vitamin D deficiency, chronic medical conditions like thyroid disorders, etc.
• Bone cancer – a primary bone tumor of the hip rarely occurs. The most common bone cancer involving the hip joint is chondrosarcoma which may require surgery to replace the hip joint. (learn more about bone cancer)

What are the symptoms that require total hip replacement surgery?

Patients experience a range of symptoms when their hip joints are either infected or damaged due to trauma. The common symptoms experienced are as follows.

• Hip joint stiffness.
• Acute chronic pain in the hip joint or groin area.
• Inability to perform routine daily activities such as walking or bending over.
• Inability to move or lift the leg.
• Inability to put body weight on the leg on the side of the injured hip.
• Swelling and bruising around the injured hip.
• Pain that does not go away even after the use of anti-inflammatory drugs or therapy.

Which prosthesis is used for total hip replacement surgery?

• During total hip replacement surgery, the surgeon removes damaged or diseased parts of the hip joint and replaces them with artificial components to improve function and reduce pain. These artificial components tend to be metals, ceramics, or very hard plastics. For total hip replacement surgery, two components of the hip joint are replaced. The prostheses used for these two parts are as follows:
• Cups made of high-density polyethylene are used to replace the cup-shaped depression of the hip bone called the acetabulum.
• Metal alloys such as cobalt-chromium are used to replace the head of the long bone of the thigh bone called the femur.

What are the diagnostic medical procedures done before Total Hip Replacement Surgery?

• When a patient goes to the doctor complaining of symptoms such as pain and immobility in the hip joint, a number of procedures are followed by the doctor along with the hospital staff. The important initial formalities for diagnosis and treatment are as follows.
• Medical History – Upon arrival, the doctor takes a complete medical history of the patient starting with the main complaints of the condition. It is then inquired about the onset, duration, and progression to better understand the relationship between symptoms and disease. The most common symptoms include pain and restriction of movement. It also includes questions about the patient’s general health, addictions—alcohol, smoking, relevant genetic history, and past surgical and medical history.
• Physical Test – This will assess mobility, strength, and alignment of the hip.
• A provisional diagnosis is made based on the initial evaluation of the patient by the doctor.
• X-rays are used to assess the extent of damage or deformity by looking for structural changes, signs of joint erosion, loss of cartilage, etc.
• Other investigations such as magnetic resonance imaging (MRI) scans are used to assess the condition of the bone and soft tissues of the hip.

What are the tests done before Total Hip Replacement Surgery?

Once the final diagnosis is explained in the report, a treatment plan is made by the doctor. If the treatment plan includes surgery, a certain set of tests will need to be conducted before performing total hip replacement surgery. Some of them are included in the tests.

• electrocardiogram (ECG)
• Complete Blood Count (CBC)
• urine analysis.
• Coagulation studies (PT / PTT).
• Additional tests may be done to rule out other health conditions or/or comorbidities.

What are the steps of care taken before a Total Hip Replacement Surgery to reduce the complications?

• Total hip replacement surgery is a major surgery performed to reduce pain and improve function. It includes the largest joint in the body and one that is responsible for our daily mobility.
• A few things are recommended to ensure a better recovery experience. they include.
• Lifestyle changes – Lifestyle changes are advised based on the patient’s habits. These include eating a balanced diet, reducing your intake of fatty foods, eating foods rich in iron and protein, and regular physical activity.
• Pre-hab or prehabilitation – Physical therapy is exercise prior to surgical intervention so that patients can bounce back after surgery with minimal downtime. It also improves overall health, boosts metabolism, and reduces the risk of complications.
• Avoiding the use of narcotics, alcohol, and smoking – Smoking sets off a cascade of effects on the body that begins with the constriction of blood vessels, resulting in delayed healing and a slow recovery. Narcotics and other drugs can also cause complications.

What is the procedure of Total Hip Replacement Surgery?

• Good quality artificial joints are imported for the success of this operation.
• Apart from importing joints, and training surgeons, ensuring a good standard of operation theater and postoperative care is paramount for speedy recovery and rehabilitation.
• The entire surgical procedure takes a few hours. There are steps in the process.
  Before undergoing total hip replacement surgery, the patient is given general or local anesthesia (a numbing agent). For general anesthesia, medication is injected using an IV attached to a vein in the arm. In local anesthesia, medication is injected at the site of surgery. The purpose of anesthesia is to numb the body so that the patient does not experience any pain during the surgery.
• Before surgery, a catheter is passed through the bladder and placed there for the collection of urine.
  During surgery, an incision (cut in the skin) is made by the surgeon to expose the hip joint.
• Once the incision is made, the diseased or damaged bone and cartilage are removed, leaving healthy bone intact.
  To replace the damaged parts of the bone, the surgeon fits prosthetic components into the bone. In total hip replacement surgery, both the components of the hip joint are replaced. The two components include the opening in the hip bone called the acetabulum and the head of the long bone attached to the acetabulum. Both components are held in place, either with or without the use of bone cement. A decision has to be taken on whether to use cemented or non-cemented joint replacements. Generally, cemented arthroplasty is used in the elderly, with an expected life of 10–15 years, while in the younger generation, replacement without joints is used.

What is the care to be taken after Total Hip Replacement Surgery?

After hip replacement surgery, the patient is taken to the recovery room, where his pulse is monitored regularly. Depending on the situation, the patient may be discharged from the hospital in three to four days. Doctors recommend the following tips for quick recovery at home.

• Prevent the wound from getting wet.
• Include iron-rich foods in your diet.
• Indulge in light physical therapy that usually begins on day one and gradually progresses to activities such as walking and climbing.
• Practice slow and gradual movement of the leg to prevent blood clots from forming.
• To prevent falling into the house, keep a chair, table, or long wire out of your way.
• Do not do high-intensity exercise unless your doctor says so.
• Take medicines at the prescribed time.
• Visit the doctor for follow-up appointments as scheduled by your doctor. (Read more: Physiotherapy)

What are the risks and complications of Total Hip Replacement Surgery?

Total hip replacement surgery does involve some risk. they include.

• Formation of blood clots at the site of the hip joint.
• Infection at the site of the incision.
• Excessive bleeding.
• Severe reaction to anesthesia (rare)
• Some of the complications specific to total hip replacement surgery are as follows.
• Deep vein thrombosis– This is a blood clot in the deep veins of the limb (legs) due to stagnation (blockage) of blood in the veins due to unintentional manipulation of the thigh during surgery and immobility. (Read more – What is Deep Vein Thrombosis?)
• Nerve palsy – This occurs due to injury to the nerve causing partial weakness or paralysis of the surrounding area. The sciatic nerve is the most common nerve affected.
• Injury to a blood vessel – this can lead to uncontrolled blood loss (internal or external).
• Fracture – occurs when a prosthesis is being placed during surgery. (Read more – What is a fracture?)
• Dislocation– Occurs due to deformity of the limb (leg) during the postoperative period.
• Infection – This can occur at the site of the incision or implant.
• Heterozygous or new bone formation around the placed components.
• Pulmonary thromboembolism– This occurs when a blood clot travels from the deep veins of the leg to the lungs.

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