THE HIP JOINT –

The hip joint is ball and socket joint. The thigh bone has a round head (Ball) which fits in saucer shaped socket (Acetabulum) in Pelvic bone.

The surface of the head of the thigh bone and the socket are covered by specialised tissue called articular cartilage.

The joint cavity is lined by a membrane called the synovium which secretes synovial fluid into the joint and allows smooth movement of the ball within the socket.

Choosing the right Implant –

The doctor will decide about the best material to be used in your case. This selection will depend upon factors such as –

• You’re age.
• Normal level of Activity
• Degree of damage
• Arthritis of your Hip Joint

Although a replaced hip joint may continue to function successfully for 15-20 yrs or more, it will not last forever. Careful consideration is therefore necessary before replacing the hip of someone in their forties or fifties, as they are likely to require revision surgery in future. In such conditions cementless prosthesis may be most appropriate.

Femoral Component:

Femoral component prosthesis replaces the head of the femur. It contains ball shaped head & a stem which is fixed into the shaft of femur.

Femoral component is made of a variety of metals.

• Stem: Stem is fixed in Thigh bone

It can be –

Cemented or Uncemented Stem

• Head: Head is fixed on the stem. It is made of any one of the following metals.

Cobalt Chrome, Zirconium, Ceramic

Acetabular Component:

It is fixed to the socket. It can be-

Uncemented, Cemented

Who is offered hip replacement surgery?

You may be offered hip replacement surgery if:

• You have severe pain, Swelling and Stiffness in your hip joint and your mobility is reduced.
• Your hip pain is so severe that it interferes with your quality of life and sleep.

Everyday tasks, such as shopping or getting out of the bath, are difficult or impossible.

• You’re feeling depressed because of the pain and lack of mobility.
• You cannot work or have a social life.

How the operation is done –

Hip replacement surgery is usually done either under general anaesthetic (you’re asleep throughout the procedure) or under spinal anaesthetic (you’re awake but have no feeling from the waist down).

Sometimes you may have an epidural, which is similar to a spinal anaesthetic.

Once you’ve been anaesthetised, the surgeon makes a cut (incision) on the side of your hip.

The upper part of your thigh bone (femur) is removed and the natural socket for the head of your femur is hollowed out.

A socket is fitted into the hollow in your pelvis. A short, angled metal shaft (the stem) with a smooth ball on its upper end (to fit into the socket) is placed into the hollow of your femur. The cup and the stem may be pressed into place or fixed with bone “cement”.

The operation takes up to 1-2 hours.

POSSIBLE RISKS –

As with any operation, hip replacement surgery has risks as well as benefits. Most people who have a hip replacement do not have serious complications.

After having a hip replacement, contact your doctor if you get:

Hot, Reddened, Hard or Painful areas in your leg in the first few weeks after your operation. Although this may just be bruising from the surgery, it could mean you have DVT (deep vein thrombosis) – a blood clot in the leg.

Chest pains or Breathlessness- Although it’s very rare, you could have a blood clot in your lung (pulmonary embolism) which needs urgent treatment.

To reduce your risk of blood clots, you’ll be given blood-thinning medicine and compression stockings. Moving your legs as soon as you can after the operation is one of the best ways to prevent blood clots. Check with a physiotherapist what you should be doing.

Hip Dislocation– In a small number of cases the hip joint can come out of its socket. This is most likely to happen in the first few months after surgery when the hip is still healing.

Altered leg length – The leg that was operated on may be shorter or longer than the other leg. People can adjust to this, but sometimes a raised shoe may be needed.

Infection – Hip replacement surgery is done in an ultra-clean operating theatre and antibiotics are given during the operation. But in less than 1 in every 100 operations, an infection may still happen. Very rarely, the hip replacement may need to be “washed out” or a new replacement may be used.

It’s normal for the wound to be slightly red and warm to touch while healing. However, if you feel unwell, the pain is getting worse or the wound starts to leak fluid, contact the specialist.

Before the Surgery –

After your decision to go in for a joint replacement you should be aware of the basic things to be done before surgery. Such as –

• Suitable prosthesis for you.
• The cost of your prosthesis.
• Total Hospital stay & cost of hospital stay.
• The Blood, Heart and Chest investigations.
• Get these investigations 1 week before the date of surgery & get them checked by a physician.
• It is necessary to confirm that there is no active infection in your body.
• If you have medical insurance, you should contact hospital’s Billing and Insurance Desk at least one week before surgery with your policy documents.
• You should show the drugs which you are already taking. Some types of medicines like steroids & blood thinning medicines are to be stopped 5-7 days prior to surgery.
• For admission in hospital take admission letter from your surgeon.
• You may be advised to get admitted 1-2 days prior to the surgery. Take all investigations report, previous medical records & drugs with you.

RECOVERY –

Recovery times can vary depending on the individual and type of surgery. It’s important to follow the advice the hospital gives you on looking after your hip.

After the operation, you’ll be lying flat on your back and may have a pillow between your legs to keep your hip in the correct position. The nursing staff will monitor your condition and you’ll have a large dressing on your leg to protect the wound.

Physiotherapy is very important after Hip replacement surgery. As part of Enhanced Recovery Pathway (ERAS) – you will be mobilized on the same day after surgery. Initially, you’ll feel discomfort while walking and exercising, and your legs and feet may be swollen.

You may need to do physiotherapy with help of Physiotherapist for 4-6 weeks after surgery. It is also recommended to use walking stick/walker all the time for first 4 weeks and while going outside for first 2 months.

The physiotherapy protocol will be handed over to you and it’s important that the Physiotherapist stick to the given protocol.

You must take regular round the clock painkillers as prescribed by doctor. It will help in you recovery.

Wear your DVT stockings for 6 weeks after surgery.

One needs to be careful not to cross legs while getting in and out of car, climbing stairs, using toilets, and sleeping.

Don’ts after surgery-

1. Don’t cross your legs.
2. Don’t sit on a low chair. Height of your Hip joint should always be higher than height (level) of your knee joint.
3. Don’t sit with legs crossed.
4. Don’t sit on the floor.
5. Don’t use Indian style toilet, use commode.
6. Avoid twisting & bending forwards.