Total hip replacement is considered one of the most successful operations ever invented. It was called the “Operation of the Century” by the Lancet due to the tremendous pain relief it affords, it’s safety and reproducibility, as well as the incredible functional improvements patients enjoy. Total hip replacement is now performed over 300,000 times annually in the US. It offers almost total relief to patients suffering from a number of arthritis, fracture or avascular necrosis.
Your total hip replacement begins with a consultation and examination. Dr. Melvin will perform a thorough history and physical exam, and review all imaging. This will allow him to fully understand your diagnosis, overall health as well as your social and support situation. If total hip replacement is determined to be the most appropriate treatment, a detailed plan for the full surgical episode, from pre-surgery preparation through the recovery, will be discussed.
Introduction
The total hip replacement procedure involves removing the damaged cartilage and bone and replacing them with artificial components. The hip joint is one of the body's largest weight-bearing joints, located between the thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is normally covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint.
A number of diseases and conditions can cause damage to the articular cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.
Disease Overview
Arthritis is inflammation of the joints resulting in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability. The three most common types of arthritis that affect the hip are:
- Osteoarthritis: It is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage wears down, the bone ends rub against each other and cause pain in the hip.
- Rheumatoid arthritis: This is an autoimmune disease in which the tissue lining the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). This leads to loss of cartilage causing pain and stiffness.
- Traumatic arthritis: This is a type of arthritis resulting from a hip injury or fracture. Such injuries can damage the cartilage and cause hip pain and stiffness over a period of time.
Symptoms
The most common symptom of hip arthritis is groin pain that may radiate to the buttock or thigh resulting in stiffness and limited range of motion. Vigorous activity can increase the pain and stiffness which may cause limping while walking.
Diagnosis
Diagnosis is made by evaluating medical history, physical examination and X-rays.
Surgical Procedure
Total hip replacement may be recommended, if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms. The surgery is performed under spinal or general anesthesia. During the procedure, a surgical cut is made over the hip to expose the hip joint. The femoral head is then dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone is removed using a reamer. The acetabular component is inserted into the socket, where the bone will ultimately grow onto the component. A liner made of plastic or ceramic is placed inside the acetabular component. The femur or thigh bone is then prepared by removing the arthritic bone using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. The hip capsule is then repaired around the new joint and the incision is closed.
Recovery
There are several aspects to a healthy, safe and rapid recovery following total hip replacement
- Minimize narcotic pain medication to limit side-effects
- Maintain a healthy diet and adequate nutrition.
- Incision care - Dr. Melvin will educate you on proper incision care for the best possible recovery. Typically, a water-proof bandage will be placed over the incision and may stay in place until follow-up if it remains well sealed to the skin.
- Physical activity is important. You should perform home exercises and walk daily. Your body will need to adapt to your new prosthetic over time, so continued motion is an important factor. Physical therapy may also be prescribed.
- Follow-up appointments will be scheduled with Dr. Melvin. This will allow him to monitor the new hip and ensure that your recovery is proceeding well.
Risks
As with any major surgical procedure, there are certain potential risks and complications involved with anterior total hip replacement surgery. The possible complications after total hip replacement can include:
- Infection
- Dislocation
- Fracture of the femur or pelvis
- Injury to nerves or blood vessels
- Formation of blood clots in the leg veins
- Leg length inequality
- Hip prosthesis may wear out
- Failure to relieve pain
- Scar formation
- Constipation
- Anemia
- Heart attack, stroke, blood clot, death.
New Hips & Hurricanes
LAST FALL WAS QUITE EVENTFUL for John Boyd, 73, of St. Croix, U.S. Virgin Islands. In August, he finally received long-awaited surgery to replace both hips—during one single operation at Sibley. In September, while he was completing rehabilitation at the hospital, two Category 5 hurricanes just weeks apart pummeled St. Croix and his home.
