Anatomy

The hip is one of the body’s largest weight-bearing joints. It consists of two main parts: a ball (femoral head) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.

The most common cause of hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

Symptoms of OA Hip

• Pain in hip and groin area on walking and after prolonged period of rest.
• Difficulty in standing from sitting.
• Difficulty in turning side
• Clicking or grinding sensation in hip

On examination

• Tenderness in the hip area,
• Loss of movement as compared to other side
• Shortening of the limb

X-rays shows typical loss of joint space and osteophytes (new bone formation)

The treatment for an arthritic hip initially conservative RICE if no relief surgical intervention (THR Required)

Whether to have hip replacement surgery should be a cooperative decision made by you, your family & your orthopaedic surgeon at A+ clinic.

Although many patients who undergo hip replacement surgery are 60 to 80 years of age, orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability, and general health status not solely on age.

Hip replacement surgery may benefit you if

• Hip pain limits your everyday activities such as walking or bending.
• Hip pain continues while resting, either day or night.
• Stiffness in a hip limits your ability to move or lift your leg.
• You have little pain relief from anti-inflammatory drugs or glucosamine sulfate
• Other treatments such as physical therapy or the use of a gait aid such as a cane do not relieve hip pain.

SURGERY

A complete assessment of your body along with functioning of all vital organs like heart, lungs , liver and kidney along with anaesthetic check up is done to ensure the proper optimisation of all body organs is achieved.

The surgical procedure takes a few hours. The orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic joint surfaces to restore the alignment and function of your hip.

Depending the age of Patient the choice of prosthesis is made

TWO TYPES OF HIP REPLACEMENT

• A cemented prosthesis – used in elderly patient to promote early ambulation. Here a cement is used to hold the implant in the bone and gives immediate mobility
• Un cemented – is used in a younger population because of its durability. Here a an-cemented implant with Hydroxy or Porus coated implant is press fitted to the bones. This implant takes few weeks to integrate with the parent bone hence immediate mobilisation is not allowed for 6 weeks. Patient weight bearing with the help of walker started after 6 weeks

Post operative

First day is complete rest with good PCA- patient controlled analgesia. After check x-ray, the second post operative day you are able to sit bedside and may be stand also if feeling up to it. Third post operative day walking with help of walker is initiated and generally discharged home by 5-6th day.

Walking and light activity are important to your recovery so are begin a day after your surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.

Recovery

The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon’s instructions regarding home care during the first few weeks after surgery. There are modifications done at home to keep the bed and chair high so that you don’t have to sit on low surface and hence avoid unnecessary stress on new hip.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.

Avoid getting the wound wet until it has thoroughly sealed and dried. A bandage may be placed over the wound.

Special Precautions:

• Do not cross your legs.
• Do not bend your hips more than a right angle (90°).
• Do not turn your feet excessively inward or outward.
• Use a pillow between your legs at night when sleeping until you are advised by your orthopaedic surgeon that you can remove it.

What changes at home will help a patient with THR

The following is a list of home modifications that will make your return home easier during your recovery:

• Securely fastened safety bars or handrails in your shower or bath
• Secure handrails along all stairways
• A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
• A raised toilet seat
• A stable shower bench or chair for bathing
• A long-handled sponge and shower hose
• A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
• A reacher that will allow you to grab objects without excessive bending of your hips
• Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
• Removal of all loose carpets and electrical cords from the areas where you walk in your home

What to Expect From Hip Replacement Surgery

• An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do.
• Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. However, hip replacement surgery will not enable you to do more than you could before your hip problem developed.
• Following surgery, you will be advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life. You may be asked to avoid specific positions of the joint that could lead to dislocation.
• Even with normal use and activities, an artificial joint (prosthesis) develops some wear over time. If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.
• If looked after properly and all the instructions of your surgeon and therapist are followed your new hip is likely to bring a very good relief to your symptoms and is likely to last you for life time.
• Very reliable and predictable surgery for osteoarthritis of Hip.