There are a number of conditions that can result in a patient having to undergo a hip replacement surgery. Perhaps the most common condition is Osteoarthritis (OA) that is commonly referred to as wear & tear arthritis.

• Osteoarthritis (OA)

It can occur with no previous history of injury to the hip joint. The hip simply wears out with age. Some people are also genetically so pre-disposed that they might have higher chances of developing osteoarthritis.

• Avascular Necrosis:

This is another condition that could lead to a hip replacement surgery. In this condition the femoral head (ball) loses a portion of its blood supply and actually dies. This leads to problems in the proper functioning of the hip joint. Avascular necrosis has been linked to alcoholism, fractures and dislocations of the hip and long term hormonal treatments for other diseases.

• Other Causes:

Hip replacement surgery might also become necessary due to abnormalities of hip joint function resulting from physical damage/stress to the hip or fracture of the hip. Some types of hip conditions that appear in childhood, such as abnormally enlarged hip right from birth called Congenital Dysplasia (CDH) can lead to degeneration many years later necessitating surgery. The mechanical abnormality leads to excessive wear & tear.

There are a number of ways in which the pain in your hip can be relieved. These can include changes in lifestyle or taking pain relieving medications or other conservative methods. Another option is to undergo a surgery to replace your unhealthy hip joint. Replacing the hip joint is usually recommended when the pain becomes so constant that it is problematic to perform your everyday activities and when you and your doctor agree that it is the best course of action.

The aim of a Hip replacement surgery is to:

1. Relieve your pain
2. Correct deformity; for example leg length inequality
3. Restore any loss of function in your hip
4. Improve your quality of life

Hip joint replacement surgery involves replacing the head of the femur (ball) and the acetabulum (socket) with manmade components, called prostheses. The hip prostheses are designed to imitate the human anatomy as closely as possible. Depending on the damage to your hip, your surgeon may decide to give you a total hip replacement or a hip resurfacing procedure.
There are many different designs of hip prosthesis available and your surgeon will choose the one considered most suitable for you. However, the final decision may need to be made during the time of your operation.

Each Hip Prosthesis is made up of several parts:

• The Acetabular Component:

Also called as the artificial cup, it replaces the real acetabulum. The acetabular component can either be made of a metal alloy outer shell with a fitted polyethylene, or it can be made of one polyethylene component. The acetabular cup may have a pure titanium coating which allows a high surface roughness, therefore increasing implant stability compared to the original bone.

• The Femoral Head:

It replaces the femoral ball head. It is made of metal alloy or ceramic and attaches to the Femoral stem. This ball head glides inside the acetabulum cup to provide hip movement.

• Femoral Stem:

Femoral Stem is made up of a metal alloy or medical grade stainless steel, and it is designed to mimic human anatomy. The stems can be coated for younger patients or kept highly polished for use with cement in older patients with deteriorated bone quality.

These are a few things that you should do before your surgery to make your recovery easier and safer:

1. Commit to the success of surgery.
2. Work as a team with your physician, physiotherapist and your family and adopt a positive attitude toward the success of your surgery.
3. Remain as active as possible.

Remaining active while waiting for your surgery is an important key to the success of your surgery. Studies have shown that the stronger and more flexible you are before your operation the quicker you will recover and more flexible you will be after the operation. Gentle exercise such as walking, range of motion exercises and swimming can help you to stay strong and flexible. However, please seek your doctor’s advice before beginning any exercise.

Hip joint replacement surgery is a procedure proven to be safe and effective. As with all surgeries, there are a number of things which the hospital will ask you to do to ensure that the operation is a success. If you have any questions or concerns, ask your doctor or the hospital staff.

• Stop smoking

If you have not already done so, it is suggested that you stop smoking at least four weeks before your surgery. This will help reduce the risk of complications during and after your surgery.

• Make sure all infections are cleared up prior to the surgery

These include: tooth abscesses, bladder infections, infections such as leg ulcers, colds and the flu. This is because infections could spread through your body during the operation. Inform your surgeon immediately if you are suspected or diagnosed with an infection, as they may have to reschedule your surgery.

You should get admitted to hospital in good time before your operation to allow yourself to settle in. You will be examined by your anesthetist, checking your heart and pulse rate. This is an opportunity for you to ask questions and clear all doubts before your operation.
On the day of your operation, it is usual that your doctor will ask you not to drink or eat anything. The area around your hip may be shaved to reduce the risk of infection.
An hour or so before the operation you will be given tablets or an injection to relax you. This is known as ‘Pre-med’. You will then be taken into the operating theatre where you will be given your anesthetic.
The operation usually takes 1-2 hours to complete.

Short Term Recovery

• • Immediately after your operation:

  You will be moved to the recovery room for close monitoring. You will have one or two drips in your arm to put fluid back into your body. When you wake up from surgery, your leg may be swollen and bruised and the muscles may be stiff and sore. Your new joint should not cause you any discomfort, but you may experience some pain from the surgical procedure itself. You will be given pain medications to take regularly while you are recovering.

  • On regaining consciousness:

  When you are fully conscious, breathing well and your blood pressure and pulse are stable, you will be taken back to the ward. You probably won’t feel like eating much at first, but it is important that you drink water or fruit juices. The scar on the side of the hip will eventually fade to a thin white line.

  • First week post the surgery

  During the next few days of the surgery, the drips will be removed. Your physiotherapist will visit you the day after your operation to commence an exercise program to help you get back on your feet. You may feel unstable and in pain at first, but you will be given a frame to help you walk with, then crutches or sticks, which you may need for four to six weeks after, depending on your surgeon’s instructions.

Once you, your surgeon and physiotherapist are happy with your condition and mobility you will be discharged from hospital. The usual hospital stay for hip joint replacement is usually four to seven days.

Long Term Recovery

• Arrange for help:

Upon returning home you will need help for the first few weeks and should make arrangements for someone to shop for you and help around the house.

• Medication:

You will need to continue taking your regular medications as they will aid in faster recovery and avoiding complications.

• Physical therapy:

Continue exercising as directed by your physiotherapist and surgeon. Remaining active and practicing the prescribed exercises are the quickest ways to full recovery. You can expect to regain full use of your leg after surgery. However this will take time. You should be able to return to normal activities again within a few months of the operation. These may include, driving, gardening & playing golf, but check with your doctor first. There will be a continual improvement throughout the first 12 months. Once the operation has fully healed, many people can’t tell they have artificial joint.

Every effort is made to minimize any risk or complications. However, like any other surgery they do occur. Listed below are common signs and symptoms that may indicate a complication with your new joint. Please contact your doctor if you feel that you may have a problem or are experiencing any of these signs and symptoms:

• Fever of 101 degrees Fahrenheit or 38.3 degrees Celsius
• Unusual redness, heat, or oozing at the wound site
• Trouble breathing or shortness of breadth
• Increase in pain that is not relieved by medication
• Increase in swelling of the leg that is not relieved by elevation

• • Myth: Arthritis is part of ageing. We should adapt to the pain and learn to live with it.

Fact:

•  Osteoarthritis is generally detected in people above 55 years of age and Indians preferably choose years of conservative care (physical therapy, drugs, injections) to lessen, but not eliminate, their joint pain. In 2012, more than 1,00,000 total hip replacements were performed in India. If everyday activities are causing pain and interfering with your routine duties, you may benefit from a consultation with an orthopedic surgeon no matter what your age.

• • Myth: Hip replacement is not good for the young.

Fact:

•  Joint replacement is a need and not dependent on age. Total Hip Replacement is considered to be an effective procedure that can help patients resume a more active lifestyle.
  • Myth: Every company provides the same systems.

Fact:

•  Today, joint replacement patients have a choice of implant types as well as a variety of implant shapes and sizes designed to accommodate specific needs and different lifestyles. Your orthopedic surgeon will choose the best system according to your individual need and the clinical history of the implant.
  • Myth: Knee or hip replacement surgery should be the last resort to eliminate chronic pain.

Fact:

•  Many patients who could benefit greatly from a hip replacement are worried that they might not be able to comfortably and confidently return to their normal day-to-day activities. In fact, delaying surgery lowers patients' quality of life not only before the operation, but even for up to two years following the surgery, according to a study in Arthritis & Rheumatism. However, there is a probability that younger patients may need to undergo a second hip replacement later in life.
  • Myth: Joint replacement surgery takes a long time to recover.

Fact:

•  It used to be standard for joint replacement patients to spend a week in the hospital after they got a new hip. Today, patients put weight on their new hip just hours after their surgery and typically go home after 1-2 days. Recovery takes place in stages, with short term recovery taking 4-6 weeks while full recovery (defined as an improvement in function and mobility and a feeling of normalcy) may take up to 6 months. Some patients recover much sooner; others may take longer. There are a number of factors that play a role in a patient's recovery, including attitude, participation in physical therapy and others.
  • Myth: Hip and joint replacement implants are only good for about 10 years.

Fact:

 This used to be true, but not today. Advances in new types of hip implants have revolutionized the longevity of their effectiveness. Today, one can expect a new hip replacement to last more than 20 years.