Hip Replacement

Overview

The hip joint is among the most mobile joints of our body. The components that form the hip joint may be damaged over time, or trauma may result in loss of stability in the hip joint.
Total hip replacement or hip arthroplasty is indicated for pain and joint instability that does not respond to medication treatments, physiotherapy, and rehabilitation and is severe enough to affect daily life activities.

The most common causes of pain and instability are osteoarthritis, rheumatoid arthritis, and traumatic injuries. Moreover, the blood supply to the hip joint may reduce due to traumatic and inflammatory events, resulting in necrosis in the ball-like head of the femur (aseptic necrosis).

Why is a Hip Replacement Procedure Done?

Total hip replacement is performed to cure joint disorders that hinder daily life activities (climbing stairs, walking, and getting out of bed) and do not respond to medication treatment and physiotherapy.

There is no absolute age or weight limitation for total hip replacement. The operation decision is based on the severity of pain and the degree of disability rather than the patient's age. Therefore, personalized assessment of each patient or selection of suitable candidates is critical.

Risks

As the case for all surgeries, total hip replacement involves some risks.

Although all possible measures that modern medicine allows are taken to prevent the occurrence of risks, it is by no means likely to warrant that the risks will be eliminated.
These risks may be related to surgery and anesthesia, but some may be faced after the surgery.
Those risks are as follows:

•    Infection
•    Clot formation and migration of the clot to other body parts
•    Laxity of hip prosthesis over time
•    Revision surgery
•    Failure to obtain the desired range of motion

Although rare, these complications may be prolonged, complete recovery might fail, or revision surgery might be required. It would help to inform your orthopedic surgeon about your concerns before the surgery. Your surgeon will explain in detail whether those risks apply to you or, if so, the rate of occurrence.

Preparation

The first phase of preoperative preparation is the same in all Medicana Hospitals. Your orthopedic surgeon makes a total hip replacement decision based on a series of tests and examinations. Your doctor will assess comprehensively to determine whether this surgery helps your complaints. All other treatment options, including but not limited to medications, injections, physiotherapy, and other surgical procedures, are considered.

•    Review of health history
•    A detailed physical examination
•    Necessary laboratory tests and radiology studies
•    Assessment by anesthesiologists and other laboratory tests and radiology studies to minimize anesthesia-related complications

After it is verified that the surgery does not pose a risk, you will be asked to quit smoking if you are a smoker and to stop taking certain medications that increase the risk of bleeding. All other prescribed and over-the-counter medications, herbal products, and supplements will also be questioned, and you will be informed to continue or stop taking them.

A preoperative discussion with your orthopedic surgeon about total hip replacement is vital. All procedure details, potential risks, and healing period are explained. You will also be instructed to stop eating and drinking at a particular time before the surgery. You should strictly follow this instruction to undergo the surgery as scheduled.

Moreover, it is reasonable to plan discharge, post-discharge accommodation, and travel at this phase to manage the postoperative period better.

Surgery and Early Postoperative Period

After you are hospitalized, preparations are completed, and your anesthesiologist will assess you to determine the best anesthesia technique. The orthopedist will first cut the damaged cartilage and bone and prepare them for joint replacement. An artificial (prosthesis) hip joint, made of metal alloy or other suitable materials, is then placed to take over the function of the hip joint. Manufactured joints are attached to existing bones and surrounding tissues using screws, plates, and other fixation materials. The range of motion of the hip joint is checked once more before the surgery is completed. Our physiotherapist will help you learn how to use your new hip joint, but moving your legs after the surgery will not only facilitate wound healing but also contribute to the success of the surgery.

You will be given painkiller (s) after the surgery to manage the postoperative pain. Treatments will be started, and measures will be taken to eliminate risks arising from clot formation. You may also need to use antibiotics to prevent a possible infection. You must follow your doctor's instructions after the surgery to protect and support the outcome of the surgery.

You should see your surgeon for scheduled follow-up visits before you are discharged.

If you experience warmth and redness in your incision line or have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.

Results

You will need inpatient care for several days after the surgery. At this time, your overall health will stabilize, and your joint will be adapted to the post-discharge period by physiotherapy.

Always remember that postoperative pain is a natural component of recovery. Your doctor and nurse will take the necessary measures to manage your pain.
Being able to use your new hip joint requires both patience and strict compliance with the instructions.

Physical therapy, part of postoperative care, will be initiated before you are discharged. However, it would help if you kept doing the exercises at home to speed up the healing process. You may need to use a wheelchair for a few days before full recovery. In addition, in order not to strain your hip joint, you have to comply with some basic rules at home (standing up carefully from a sitting position, not crossing your legs, avoiding abnormal rotational motions in your operated leg, removing objects that can lead to stumbling, use of seat extensions).

If you strictly follow all instructions, you will start doing all routine daily life activities, with no restriction, within several weeks. However, sufficient strengthening and elasticity of muscles might require several months or sometimes up to one year.