Total Hip Replacement

What is Total Hip Replacement?

Total hip replacement, also known as total hip arthroplasty, is a surgical procedure where damaged bone and cartilage in the hip joint are removed and replaced with prosthetic components. This procedure is primarily conducted to alleviate pain and improve function in the hip that has been impaired by damage or disease.

The hip joint is a ball-and-socket synovial joint, connecting the pelvis to the lower limb. This structure allows for weight-bearing and stability. In cases where the hip joint is severely damaged, movement can become restricted and painful. This may warrant a total hip replacement.

Indications for Total Hip Replacement

Total hip replacement surgery is recommended when other treatments have not provided adequate pain relief and when the condition seriously hinders daily activities. The primary indications include:

Specific Hip Conditions

Common conditions leading to total hip replacement include:

• Osteoarthritis: Age-related wear and tear causing joint pain and stiffness.
• Rheumatoid arthritis: An autoimmune disease leading to joint inflammation and damage.
• Avascular Necrosis: Loss of blood supply to the femoral head, leading to bone collapse.
• Hip Fracture: Severe injury leading to immediate or eventual joint damage.
• Tumour in the Hip Joint: Neoplastic growths causing joint destruction or pain.

Persistent Hip Pain Due to Underlying Conditions

The primary indication for total hip replacement is continuous hip pain that limits everyday activities such as walking or bending and persists even while resting. This level of pain usually suggests severe deterioration of the hip joint.

Hip Stiffness

Restricted movement, particularly difficulty in lifting the leg due to hip stiffness, is an indicator of surgery. This stiffness often severely impacts the ability to perform routine tasks.

Inadequate Response to Other Treatments

When symptoms of hip pain and disability do not improve with anti-inflammatory medications, physical therapy, or walking support, total hip replacement may be considered.

Total Hip Replacement Procedure

The total hip replacement procedure involves several steps to replace the damaged hip joint with prosthetic components.

1. Incision: Surgery begins with an incision over the hip to expose the hip joint.
2. Removal of Damaged Components: The damaged femoral head is removed. The acetabulum (socket) is then prepared by removing the damaged cartilage surface.
3. Insertion of Prosthetic Components: A metal or ceramic ball is placed on a stem that is inserted into the femur. The acetabular component is inserted into the socket, sometimes reinforced with screws. A liner made of plastic, metal, or ceramic is then placed inside the acetabular component to create a smooth gliding surface.
4. Repositioning of the Hip: The new femoral head component is placed on the femoral stem, and the hip is relocated into position.
5. Closure: Muscles and soft tissues around the hip joint are stitched back together.

The surgery usually takes between 1 to 2 hours. The choice of prosthetic components and the specific techniques used can vary based on individual patient needs.

Recovery and Rehabilitation

Recovery and rehabilitation after total hip replacement may include:

• Physical Therapy
  A set of exercises, supervised by a hip specialist, is initiated early post-surgery to strengthen muscles and improve hip movement. This regimen includes exercises to improve range of motion and muscle strengthening, starting with simple movements and gradually advancing to more complex activities.
• Use of Walking Aids
  Initially, patients use walking aids such as walkers, crutches, or canes to aid mobility. As strength and balance improve, these aids are gradually phased out.
• Pain Management
  Postoperative pain can be managed through medications prescribed by the surgeon. This may include a combination of opioids, NSAIDs, and local anaesthetics, with careful consideration given to minimising opioid use.
• Activity Modification
  Patients should gradually increase their level of activity, starting with walking and light household tasks. High-impact activities are generally discouraged to prolong the life of the hip implant.
• Maintaining a Balanced Diet
  A balanced diet, sometimes supplemented with iron, can aid in tissue healing and muscle strength recovery. Hydration is also emphasised.

Benefits of Total Hip Replacement

Total hip replacement surgery offers numerous benefits, particularly for individuals who have not found relief through other treatments.

Pain Relief

One of the main benefits of this surgery is its potential to reduce hip pain. By replacing the damaged joint surfaces, patients typically experience a decrease in pain levels.

Improved Mobility

Total hip replacement often results in enhanced mobility. Patients generally find it easier to perform everyday activities like walking, climbing stairs, and getting in and out of chairs, which were painful or difficult before surgery.

Increased Activity Level

Many patients with reduced pain and improved joint function after surgery typically find it easier to increase their overall activity levels. They can engage in a variety of low-impact activities such as swimming, biking, and golf.

Durability of Implants

While the longevity of the implants can vary, most patients can expect their hip replacement to last for many years, depending on factors like activity level and body weight.

Risks and Complications

Like all surgical procedures, total hip replacement comes with potential risks and complications.

• Infection: Infections can occur at the wound site or deeper around the prosthesis. Minor infections are generally treatable with antibiotics, while major infections may require further surgery.
• Blood Clots: Another potential complication is the formation of blood clots in the legs or pelvis. These can be life-threatening if they travel to the lungs. Preventative measures include blood thinning medications and early mobilisation.
• Dislocation of the New Hip Joint: The new hip joint may dislocate, where the ball comes out of the socket. This risk is highest in the first few months post-surgery.
• Loosening and Wear of the Hip Prosthesis: Over time, the hip prosthesis may loosen or wear out, more rapidly in cases of high activity or overweight. If loosening is painful, a revision surgery may be necessary.
• Leg Length Inequality: Post-surgery, one leg may feel longer or shorter than the other. This is often addressed during surgery, but minor differences may remain.
• Nerve and Blood Vessel Damage: Though rare, there is a risk of damage to nerves or blood vessels surrounding the hip joint during surgery.
• Fractures: There is a small risk of fractures in the femur or pelvis during or after surgery.
• Osteolysis: Long-term use of the hip replacement can lead to osteolysis, where the bone around the implant begins to thin.