Hip Replacement
Overview
The hip joint is among our most mobile joints of our body. The components that form the hip joint may be damaged over time, or a trauma may result in loss of stability in the hip joint.
Total hip replacement or total hip arthroplasty is indicated for pain and joint instability that do not respond to medication treatments and physiotherapy and rehabilitation and are severe enough to affects daily life activities.
The most common causes of pain and instability are osteoarthritis, rheumatoid arthritis and traumatic injuries. Moreover, 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 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 the 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 patient's age. Therefore, personalized assessment of each patient or selection of good candidates is extremely important.
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 occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.
These risks may be related to surgery and anesthesia, but there are also some risks that 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 desired range of motion
When these complications occur, albeit rare, recovery time may prolong, complete recovery might fail or revision surgery might be required. You should 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 same in all Medicana Hospitals. Decision of total hip replacement is made by your orthopedic surgeon based on a series of tests and examinations. Your doctor will make a comprehensive assessment to determine whether this surgery helps your complaints or not. All other treatment options, including but not limited to medications, injections, physiotherapy and other surgical procedures, are taken into consideration.
• Review of health history
• A detailed physical examination
• Necessary laboratory tests and radiology studies
• Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications
After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase 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 very important. All details of the procedure, potential risks and healing period are explained. You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.
Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage 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. Orthopedist will first cut the damaged cartilage and bone and prepare them for joint replacement. Artificial (prosthesis) hip joint, which is made of metal alloy or other suitable materials, is then placed so as to take over the function of the hip joint. Artificial 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 to learn how to use your new hip joint, but moving your legs after the surgery will not only facilitate wound healing, but it will also contribute to the success of the surgery.
You will be given pain killer(s) after the surgery in order to manage the postoperative pain.
Treatments will be started and measures will be taken to eliminate risks arising out of clot formation.You may also need to use antibiotics to prevent a possible infection.It is very important that you follow all instructions of your doctor after the surgery to protect and support the outcome of the surgery.
You should see your surgeon for follow-up visits that are scheduled before you are discharged.
If you experience warmth and redness in your incision line, or if you 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 interval, both your overall health will be stabilized and your joint will be adapted to post-discharge period by physiotherapy procedures.
Always remind that postoperative pain is a natural component of the recovery. Your doctor and nurse will take necessary measures to manage your pain.
Being able to use your new hip joint requires both patience and strict compliance to the instructions.
Physical therapy, which is a part of post-operative care, will be initiated before you are discharged. However, in order to speed up the healing process, you will need to keep doing the exercises at home. 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 to some basic rules at your home (standing up carefully from 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 probably 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.
