Total Hip Replacement

1 What is a Total Hip Replacement?

A total hip replacement is a surgical procedure during which the diseased cartilage and bone of the hip joint are surgically replaced with artificial materials.

The surgery is recommended to patients with progressively worsening severe arthritis in the hip joint, most commonly degenerative arthritis (osteoarthritis) of the hip joint due to aging, congenital abnormality of the hip joint, or prior trauma to the hip joint, and to patients with bony fractures of the hip joint, rheumatoid arthritis, and death (aseptic necrosis) of the hip bone caused by fracture of the hip, drugs (such as prednisone and prednisolone), alcoholism, and diseases (such assystemic lupus erythematosus).

Patients with these kinds of diseases have progressively intense chronic pain together with impairment of daily function including walking, climbing stairs, and even arising from a sitting position and when anti-inflammatory and/or pain medications are no longer adequate, a total hip replacement should be considered.

Before surgery, patients often donate their own blood to be banked for transfusion during the surgery if it will be necessary. Also, preoperative evaluations will be done which include complete blood counts, chest X-ray, EKG, urinalysis and physical exam.

The patient’s physician will decide which other tests are necessary based on the patient’s age and medical condition. They will also give a patient instruction which medication he/she must or must not take prior to surgery (usually aspirin and anti-inflammatory medications because they can affect platelet and blood clotting).

A surgery takes approximately two to four hours. After the procedure, patients must notify medical staff if they feel unusual symptoms of tingling of numbness because the lower extremities will be closely observed for both adequate sensation and circulation.

Patients will receive medications to thin the blood and wear elastic hose (TEDs) and compression stocking to prevent blood clots and to force blood circulation in the legs, tubes which drain fluid from the surgical wound, catheters in the bladder to allow normal passage of urine and commonly a patient-controlled-analgesia (PCA) pump to administer his/her own dose of pain-control medication on demand. The sutures, which are usually staples, are removed several weeks after the operation.

Physical therapy is very important after total hip joint replacement and it should be started immediately after surgery. It helps prevent contractures and strengthen muscles around the hip joint.

After the first day, patients will usually start with sitting in a chair and eventually continue with stepping, walking and climbing in beginning with supportive devices like walker or crutches. Patients usually continue with outpatient physical therapy for a period of time.

Also, patients are instructed:

  • Not to cross the leg over the other leg while they are sitting
  • To avoid heavy lifting or other unusual activities at home
  • To lie down on the nonoperated side with a pillow between legs
  • To look for signs of infection, including swelling, warmth, redness, or increased pain in or around the surgical site and immediately notify the doctor's office immediately if these changes are noted.

Hip joint replacement surgery is one of the most successful joint surgeries performed today and if the candidate was appropriate and after surgery educate, the procedure lasts at least 15 years in nearly 95% of patients.

The risks of total hip replacement include blood clots which can cause a pulmonary embolism and respiratory failure and shock but it can be prevented.

Other problems which can occur are:

  • Usual risks of anesthesia (heart arrhythmias, liver toxicity, and pneumonia)
  • Difficulty with urination
  • Local skin or joint infection
  • Fracture of the bone during and after surgery
  • Scarring and limitation of motion of the hip
  • Loosening of the prosthesis which eventually leads to prosthesis failure
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