Total Hip Replacement: Symptoms, Benefits, Recovery, Cost
Total Hip Replacement: Symptoms, Benefits, Recovery, Cost
Hip replacement surgery is considered under the following conditions:
• Hip pain interfering with daily activities
• Ineffective non-surgical treatments and over-the-counter medicines
• Stiffness in the hip region
• Pain resulting in discomfort wherein the patient cannot get up from a seated position
• Persistent and recurrent pain overtime
• Hip aches after gaming and exercising
The most common causes that require hip replacement surgery are as follows:
• Osteoarthritis: This is a degenerative disease resulting from the damage in the bone tissue in the hip region causing inflammation, pain, and stiffness.
• Rheumatoid arthritis: It is an autoimmune disorder that causes inflammation in the hip joint resulting in severe pain, swelling, and stiffness.
• Traumatic arthritis: It is a type of osteoarthritis that arises as a result of specific injury or damage to a joint due to accidents.
• Osteonecrosis: It is the death of bone tissues when the supply of blood is interrupted to the femoral head of the hip joint that could be a result of dislocation or fracture resulting in deformity.
• Childhood hip disease: This is a result of abnormal hip growth affecting joint surfaces that in later stages may lead to arthritis.
There are majorly three types of hip replacement procedures that are followed worldwide. It includes-
• Total Hip Replacement: It is the most common type of hip surgery that uses metallic/ ceramic implants to replace and restore the normal structure of the hip. In this surgery, a prosthetic metal stem is infused into the femur/ thighbone for support, and the head of the thighbone is replaced with an artificial cup and the entire structure is stabilized by using bone cementing material.
• Partial Hip Replacement: In partial hip replacement surgery, the femoral head is removed and replaced with a metallic or ceramic ball. The socket of the ball and socket joint is not replaced in this surgery. This kind of surgery is carried out to repair specialized types of injury, fractures, and impairments.
Hip Resurfacing: This procedure is usually carried out to ease hip pain from cartilage loss. It includes scraping off the damaged bone tissue and substituting and resurfacing it with a smooth metal covering. The implants act as a substitute for damaged tissue and allow for the movement of synovial fluid.
Hip replacement surgeries are generally carried out to relieve people from hip pain that arises as a result of an accident, injury, autoimmune conditions like rheumatoid arthritis, and degenerative diseases. They are several ways for performing this surgery. It includes:
Total Hip Replacement
Partial Hip Replacement
Double Hip Replacement
Revision Hip replacement surgery
Robotic Hip replacement Surgery
Depending upon the severity of damage, injury, or deformity, the course of action is decided by the surgeons. Two types of treatment modalities are usually followed:
Hip Replacement Non-Surgical Treatment
If the patient is in the initial stages of hip arthritis, doctors usually recommend a combination of over-the-counter pain relievers like acetaminophen and anti-inflammatory drugs. Nutritional supplements containing glucosamine and chondroitin might also add to some relief. In addition to this, short term physiotherapy might serve a benefit in reducing pain and improving strength.
Hip Replacement Surgical Treatment
Surgical treatment is usually carried out if the patient is in the later stages of hip arthritis and over the counter medications are no longer helpful in containing the pain. In this procedure, firstly, the damaged bone/ tissue/ cartilage in the ball and socket joint of the hip is removed by scraping away the affected areas, and around the surface is created for inserting the hip implant.
The socket of the pelvis is known as the acetabulum. The metallic implant that is placed into this socket is known as the acetabular component. It is fitted securely in the pelvis region by creating a socket. Since the implant bears an irregular and uneven surface, it facilitates bone growth over it in the later stages of the surgery.
After fixing the socket of the ball and socket joint, now the ball of the hip joint is addressed. It is stabilized by inserting an implant downwards the hollow center of the femur. It is known as the femur stem. Specialized tools are used to form the center of the femur so that it can accommodate and hold the femoral stem tightly and firmly. Bone cement helps in the stabilization of the entire structure. Before inserting the metal stem, liquified bone cement is introduced first. It takes a few minutes for the cementing material to settle and dry and once it gets dry, it is capable of holding the implant within the bone.
When any kind of cementing material is not used for fixation, then it is known as “press-fit” wherein the metal implant is forcefully jammed into the bone socket. Since the implant has a rough surface, it facilitates bone growth over it in the later stages.
With the stem inserted centrally downwards of the femur, the ball portion of the hip joint can be fitted tightly on the stem thereby forming the new hip joint.
Once the surgeon has given a green signal, preparations for this surgery starts wherein the patients are advised to do the following things:
• A complete physical exam- It is important for the patients who are considering a total hip replacement surgery to undergo a general physical examination so that overall health can be evaluated and any medical condition that can interfere with the surgery and recovery can be identified and addressed.
• Avoiding certain medications- Patients’ surgeon can ask him/her regarding certain medications that should not be taken before surgery. These medications might include supplements, prescription drugs, etc.
• Routine laboratory tests- Lab tests such as blood and urine test along with X-ray and ECG exams may be asked by the healthcare provider to assess and confirm that the patient is fit for the procedure.
• Exercising- Regular exercising under the guidance of a physician is required for best body conditioning and muscle development to help and promote a speedy recovery. Strengthening the muscles is imperative for enhancing the leg strength that can support the new joint post-surgery.
• Pre-procedure consultation: In this visit, the patient must discuss personal care plan, diet, anesthesia, pain control, anticoagulants or other blood-thinning agents, etc. The patient must bring to the attention of the healthcare provider if he/she is sensitive or allergic to any dye, medications, latex, anesthesia, implant, etc.
• Evaluation of home care needs –Patients considering hip replacement surgery must ensure that they have all made all the necessary arrangements for post-op care as they will be needing help and support for the first few weeks for meals and transportation.
• No smoking- It is usually asked for minimizing the post-surgical lung ailments and facilitating the healing process.
• Weight loss- Patients falling under the obese category should consider weight loss to minimize pressure on the surgically formed joint.
• Post- Surgery Care at Hospital
When the surgery is done, the patient is taken to the recovery room for observation. His vital signs are checked over periodic intervals and once they are stable, the patient is taken to the general suite. For facilitating the movement of a new joint, a physical therapist is appointed as a part of the exercise and rehabilitation program. Pain killers are given for pain management so
that the patient can actively participate in the exercise. When the patient gets stable in moving the new joint, discharge is scheduled and a discharge plan is given to the patient. They can be discharged home where all the facilities for physiotherapy are available or they are discharged to a rehab center. All the necessary arrangements for the continuation of physical therapy are made so that the patient can attain the required muscle strength and improve range of mobility.
• Home Care
When the patient is at-home care, it is important to keep the surgical zone clean and untouched for preventing sepsis or infection. Specific bathing instructions will be provided by the healthcare provider. The stitches and the staples should be handled with the utmost care until they are removed during the follow-up visit. It is important to only take medicines prescribed by the care provider for pain management as pain medications like aspirin might increase the chances of bleeding.
Recovery after Hip Replacement Surgery
The recovery period and the success of the surgery will greatly depend on the patient’s compliance with his/her orthopedic surgeon’s instructions. The following areas must be given utmost care during this period:
• Pain Management: A combination of different pain medications is prescribed for short term pain relief. It includes nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and local anesthetics. If the pain continues, the patient should consult his/her surgeon.
• Wound Care: It is important to avoid getting the wound wet to prevent sepsis and post-surgical infections until the wound is sealed and dried. Bandages can be used to prevent irritation from clothes. The stitches and staples are usually removed after two weeks of surgery.
• Diet: Patients might experience loss of appetite for a few weeks post-surgery. A balanced diet coupled with iron supplements can aid in promoting proper tissue healing and restore muscle strength. Patients must ensure drink plenty of fluids to support rapid healing.
• Activity: Exercise and physiotherapy are the most critical components of home care especially during the first few weeks of surgery. Patients must follow their activity plan during these weeks to fasten recovery and to regain joint mobility. The activity plan must include the following:
A walking plan for increasing mobility
Resuming normal household activities without putting any stress on hips/ hip joints
Specific exercises prescribed by the physiotherapist for strengthening muscles and restoring movement.