What is Hip Replacement Surgery?
Hip replacement surgery is a surgical procedure conducted to replace a damaged or worn hip joint with an artificial one. This artificial joint is designed from metal, plastic, or ceramics. The need for this surgery typically arises when there is significant wear or damage to the hip joint.
When a hip joint is healthy, it functions as a ball and socket joint allowing ease of movement in multiple directions. It has a layer of cartilage that ensures the joint can move smoothly. Injury, ageing, or diseases like arthritis can result in the wearing down of this cartilage causing the bones to rub against each other during movement. This results in pain and stiffness, often affecting normal activities.
Hip replacement surgery is a commonly performed procedure that can improve the quality of life of those struggling with persistent hip pain or mobility issues due to a damaged hip joint. The new hip joint serves the purpose of reducing pain, improving the function of the hip and overall movement, and helping the individual return to their day-to-day activities.
Approaches to Hip Replacement Surgery
There are three primary approaches a surgeon might use to perform hip replacement surgery, each referring to the location of the incision made to access the hip joint. The choice of approach is determined by the surgeon’s preference and the specific needs and condition of the patient.
Posterior Approach
For the posterior approach, the surgeon makes the incision at the back (posterior) of the hip. This approach provides an excellent view of the hip joint and is useful for primary and complex hip replacements. It is also one of the most commonly used approaches.
Anterior Approach
In an anterior hip replacement, the surgeon makes the incision at the front (anterior) of the hip. This approach allows the surgeon to work between the muscles without detaching them from the hip or thighbones, keeping the muscles intact.
Lateral or Anterolateral Approach
In this method, the surgeon makes the incision at the side (lateral) of the hip. It offers good exposure to the hip joint and less risk of dislocation than the posterior approach, but there may be a slightly greater risk of limp after surgery since some muscle tissue needs to be cut and repaired.
Each approach has specific advantages and drawbacks, and no one approach is considered comprehensively superior to the others. The decision largely depends on factors such as the surgeon’s training and expertise, the patient’s anatomy, and the specific needs and circumstances of the surgical case.
Common Causes of Hip Pain
Hip pain can be attributed to multiple causes that may affect the joint and the structures surrounding it. Here are some common causes:
- Osteoarthritis: This is the most frequent cause of hip pain, especially in the elderly. Osteoarthritis causes wear-and-tear changes in the joint, causing the cartilage that cushions your hip bones to wear away. The result is pain and stiffness.
- Rheumatoid arthritis: This is an autoimmune disease, where the immune system attacks its own body tissues, causing inflammation of the lining of the joints. Rheumatoid arthritis is known to cause painful swelling leading to bone erosion and deformity.
- Hip Fractures: With age, the bones become brittle and frail often leading to fractures. Given the weight-bearing nature of the hip joint, fractures are frequent and a significant cause of hip pain.
- Bursitis: Bursae are tiny fluid-filled sacs that serve the purpose of cushioning the tendons, ligaments, and muscles around the hip joint. Inflammation of these sacs can result in severe hip pain.
- Tendinitis: This is inflammation or irritation of the tendons caused by repetitive stress from overuse.
- Hip Labral Tear: This is a rip in the ring of cartilage that follows the outside rim of the socket of your hip joint.
Certain infections or cancers also have the propensity to cause hip pain.
Hip pain can sometimes be caused by problems in other parts of the body, such as the lower back or knees, a phenomenon known as referred pain.
Is Hip Replacement Surgery for You?
When Surgery Is Recommended
Hip replacement surgery is typically recommended when hip pain and stiffness limit everyday activities such as walking or bending, and when less invasive treatments have failed to provide relief.
Chronic hip pain during both activity and rest, inadequate pain relief from anti-inflammatory drugs, physical therapy or walking supports are usually strong indicators that a doctor will suggest considering hip replacement surgery.
Candidates for Surgery
Ideal candidates for hip replacement surgery usually demonstrate consistent hip pain that does not subside with medication, experience hip pain during periods of rest, and face difficulties in walking, climbing stairs or rising from a sitting position.
Furthermore, they tend to show limited improvement or negative reactions to non-surgical treatments such as physiotherapy or anti-inflammatory medication. Their daily activities and quality of life are notably compromised due to chronic hip pain and limited mobility caused by the condition of their hip joint.
Different Types of Hip Replacement Surgery
Hip replacement surgeries can mainly be categorised into two types, each serving a distinct purpose and being more appropriate for certain patients based on their specific situation.
- Total Hip Replacement: This is the most common kind of hip replacement surgery. In a Total Hip Replacement, or Total Hip Arthroplasty, the damaged bone and cartilage are taken out and replaced with prosthetic components. The head of the femur (thigh bone) which is damaged is replaced with a metal stem that’s placed into the centre of the femur, topped with a metal or ceramic ball. The damaged cartilage surface of the socket (acetabulum in the pelvis) is also replaced with a metal socket.
- Partial Hip Replacement: In a Partial Hip Replacement, also referred to as Hemiarthroplasty, only the head of the femur (thigh bone) is replaced, not the hip socket. This can be ideal for certain individuals, like elderly patients who have broken their hips and do not have a chronic hip disease.
- Hip Resurfacing: This type of hip surgery is less common and generally used for younger, active patients with strong bone quality. Rather than replacing the entire hip joint as in Total Hip Replacement, Hip Resurfacing simply places a cap (usually metal) over the head of the femur while a metal cup is placed in the acetabulum in the pelvis, similar to Total Hip Replacement.
How to Prepare for Surgery
Preparation for hip replacement surgery can start weeks in advance and involves taking various steps to ensure the best possible outcome from the procedure. Here are points to consider:
- Preoperative Medical Evaluation: Patients usually undergo a thorough physical examination and sometimes a dental check-up to identify any conditions that could interfere with the surgery or its outcome.
- Medication Review: The surgeon or a member of the medical team will assess all the medications and supplements that the patient is currently taking. Some may need to be temporarily discontinued before surgery.
- Home Preparation (Housekeeping): Since mobility will be limited after the procedure, the patient may need to rearrange furniture, secure loose rugs, install safety bars or a raised toilet seat in the bathroom, or consider a temporary stay on the ground floor if they live in a multi-level dwelling.
- Exercise: A physical therapist might suggest exercises to boost the upper body strength for better handling of crutches or a walker after surgery.
- Diet: A healthy diet can support recovery. Sometimes, the surgeon might recommend iron supplements to increase haemoglobin levels in the blood.
Can Hip Replacement Surgery Be an Outpatient Procedure?
Traditionally, hip replacement surgery required a hospital stay ranging from several days to a week or more. Today, advancements in medical methods and technologies have made outpatient hip replacement surgeries possible.
Outpatient surgery, also known as day surgery, implies the patient undergoing surgery can return home the very same day, post the procedure. While this holds promising benefits such as a quicker return to the comforts of home, lesser expense, and a lower risk of hospital-acquired infections, it isn’t an option for everyone.
The suitability of a patient for outpatient hip replacement surgery depends on well-defined medical criteria. Generally, younger patients, those in good overall health, without significant comorbidities, and who have the necessary home support to manage postoperative care are considered ideal candidates.
Nevertheless, the decision rests on the discretion of the medical team taking into account the specific patient’s health status, the complexity of their surgery, and their personal home circumstances.
How Long Does Hip Replacement Surgery Take
The duration of hip replacement surgery typically ranges from one to two hours. The exact time frame is contingent on several factors such as the specific type of hip replacement procedure, the surgeon’s expertise and experience, the patient’s body anatomy and overall health condition, and the complexity of the procedure.
Patients should be aware that additional time is required for steps before and following the surgical procedure itself; this includes the preoperative preparations in the anaesthesia room and the recovery time in the post-anaesthesia care unit or recovery room.
Post-surgery: What to Expect
A return to your everyday routine may take some time post-surgery. There are several stages to the process, which can largely be broken down into the following:
Initial Postoperative Stage
Immediately after the surgery, patients are generally moved to a recovery room where their wakefulness, blood pressure, pulse and pain levels are closely monitored. Once stable, the patient is transferred back to the ward.
Hospital Recovery
Typically, the hospital stay extends from a few days to a week following surgery. This period involves guided physiotherapy, pain management, and learning to use mobility aids like crutches or a walker.
Recovery at Home
The recuperation journey continues at home, usually involving pain management, wound care, a diet for healing, light exercises and physical therapy to restore joint movement, strengthen the hip muscles and improve mobility.
Long-term Recovery
A full recovery might take anywhere from three to six months, sometimes longer. This time frame depends on the patient’s prior health status, age, the specific nature of the surgery, and the patient’s diligence in following the given aftercare and rehab instructions.
Recovery milestones include unrestricted movement without pain, resumption of everyday activities, and ultimate return to work or previous activities.
Possible Complications of Hip Replacement Surgery
As with any major surgical intervention, hip replacement surgery carries potential risks and complications. These do not occur in everyone and are usually treatable when addressed promptly.
Infection
This can occur at the incision site or deep around the implant. Minor infections are generally treated with antibiotics, but major or deep infections may require additional surgery to remove and replace the prosthesis, or prolonged antibiotic therapy.
Blood Clots
There is a risk of blood clots forming in the veins of the leg (deep vein thrombosis) that can travel to the lungs (pulmonary embolism). Medication for blood thinning is generally prescribed to prevent clots.
Dislocation
In rare instances, the ball portion of the implant can become dislocated from the socket. This is more likely shortly after surgery while tissues are healing.
Fracture
The bones could get fractured during surgery or afterwards, if the hip is subjected to trauma. Small cracks are generally left to heal on their own, whereas larger fractures may need surgical correction.
Wear and Loosening
Over time, the components of the hip implant can wear out or loosen from the bone, often requiring a revision surgery.
Change in Leg Length
Some patients may find a slight difference in leg length post-surgery due to the need for a stable and well-positioned joint.
Hip Implant Performance
Some complications can sometimes arise with hip implants. One possible manifestation includes squeaking noises that occur with the movement of the joint; this is often seen in ceramic implants due to the properties of the material. Other issues can involve sensitivity reactions in the body to the metals used in the implant, known as metal hypersensitivity, which can cause inflammation and pain. These are generally avoided when using good quality implants and choosing an experienced orthopedic surgeon.
The Longevity of Hip Implants
Hip implants, much like any other prosthetic device, are subject to wear and tear over time. Modern hip implants are typically engineered to last for many years. On average, hip implants may last between 15 and 20 years, although this can vary widely depending on several factors.
These factors can include the patient’s age, overall health, activity level, weight, and the type of implant used. Improvements in surgical techniques and advancements in the material technology of prosthetics are consistently enhancing the longevity of hip implants.
Success Rates and Outcomes of Hip Replacement Surgery
Hip replacement surgery is a well-established procedure that enhances the lives of thousands of patients worldwide. According to the National Institute for Health and Care Excellence (NICE) in the UK, hip replacement surgery is currently performed approximately 100,000 times a year and is shown to be successful in over 80% of patients within three months post-surgery.
Furthermore, a systemic review published in the Lancet Journal, analysing 150 studies covering more than 300,000 hip replacements across six countries, reported that 58% of hip replacements are expected to last for 25 years in the case of total hip replacements, while it stands at 52% for partial hip replacements.
While these statistics present a favourable outlook, the best results from a hip replacement surgery will come from following aftercare instructions, engaging in physical rehabilitation, leading a healthy lifestyle, maintaining a healthy body weight, and most importantly, choosing the right hip surgeon.
Protecting Your Hip Replacement
Taking good care of the new hip joint contributes significantly to the longevity of the prosthesis and the success of the hip replacement surgery in the long run. Here are some key points to consider:
- Maintain a Healthy Weight: Keeping weight in check reduces stress on the hip joint, helping prolong the durability of the implant.
- Stay Active: Regular low-impact activities like walking and swimming can keep the joint flexible and muscles strong without putting undue pressure on the hip.
- Avoid High-Impact Activities: High-impact sports or heavy lifting can damage the new joint and cause undue wear.
- Follow Physiotherapy Guidelines: Continued practice of strengthening and flexibility exercises as guided by the physiotherapist can help maintain optimum joint function.
- Regular Check-ups: Regular follow-up appointments with the surgeon ensure timely identification and management of any potential issues.
- Dental Procedures: Always inform dentists and doctors about the hip replacement before undergoing any procedure, as preventive antibiotics may be required to reduce the risk of infections spreading to the joint.
Implementing these recommendations can add to the successful outcome and longevity of the hip replacement surgery.
