When is hip replacement recommended?
Hip replacement surgery is recommended for patients who are experiencing:
- Hip pain that limits daily activities like walking
- Persistent hip pain even while resting
- Stiffness in the hip that limits movements
- Insufficient pain relief from physical therapy, anti-inflammatory drugs or walking supports
Although most patients who undergo total hip arthroplasty in Singapore are aged between 50 to 80, there is no absolute age restriction for this procedure. The surgeon will evaluate several considerations before deciding whether it is suitable for you.
The considerations include:
- Medical history – your orthopaedic surgeon will gather information about your general health and ask questions related to your hip pain.
- Physical examination – your orthopaedic surgeon will access your hip mobility, strength, and alignment.
- X-rays – imaging helps your orthopaedic surgeon determine the extent of damage in your hip.
- CT/MRI scan – may be needed to determine the condition of your bone and the soft tissues surrounding your hip.
Surgical procedure
A hip replacement consists of two important steps – choosing the implant components and the actual procedure.
Implant components
There are many designs and materials used in artificial hip joints but all of them consist of the two same basic components: the ball and the socket. The ball is usually made of highly polished strong metal or ceramic material while the socket is made of durable plastic, ceramic or metal.
The components may be “pressed” into the bone to allow your bone to grow onto the components or cemented into place. This decision depends on the quality and strength of your bone.
Procedure
Your orthopaedic surgeon will remove the damaged femoral head and replace it with a metal stem in a total hip arthroplasty. A metal or ceramic ball is then placed on the upper portion of the stem to replace the damaged femoral head that was removed.
The damaged cartilage surface of the socket, also known as the acetabulum, gets removed and replaced with a metal socket. Screws or cement are used to hold the socket in place, followed by inserting a plastic, ceramic or metal spacer between the ball and socket for smooth gliding.
Advances in total hip arthroplasty in Singapore have resulted in increased longevity of hip replacements, allowing patients to greatly improve their quality of life. These include better surgical techniques for accurate positioning of the hip components and bearing surfaces and designs that improve the stability and range of motion of the replaced hip, with reduced wear rates of the implants.
HIP REPLACEMENT
Commonly Asked Questions
Planning for the surgery
Your orthopaedic surgeon may recommend consulting your primary doctor or anaesthetist to check your general medical condition and do blood tests, a chest X-ray, and an electrocardiogram to assess your fitness for surgery.
You will be admitted to the hospital on the day of your surgery and go home within the next one to two days. Physical therapy will be started, and you can expect to be allowed to walk starting on the same or next day.
It is best to consult your orthopaedic surgeon for specific instructions. You may have to stop taking traditional medicine, blood thinning medications and control your general medical conditions before the surgery. You should try to lose some weight to minimise the stress on your new hip and do some home planning such as care arrangements, installing handrails in the shower for support to facilitate your return from hospital.
The most common types of anaesthesia for hip replacement surgery are general anaesthesia where you go to sleep or regional (spinal) anaesthesia where your body is numb from the waist down.
A hip replacement will typically take between one to three hours, depending on severity of the disease.
Complications
The risk of complications in hip replacement surgery is low, with serious complications occurring in less than 2% of patients. Complications such as infection, blood clots in the veins, nerve and vessel injury, fractures, mild leg-length inequality, dislocation and loosening may occur although they are uncommon.
Recovery
Feeling some pain is part and parcel of the healing process after surgery. Rest assured that your doctor will prescribe medications for short-term pain relief.
Paracetamol, non-steroidal anti-inflammatory drugs, and opioids are common temporary pain relief medications that will be prescribed. Your doctor might also recommend aspirin or other blood thinning medication to reduce the risk of blood clots in the veins.
Your orthopaedic surgeon may prescribe inflatable leg coverings and blood thinners to reduce the risk of blood clots in the veins. Foot and ankle movement is encouraged to increase blood flow in your leg muscles. Avoid getting your wound wet and go for dressing changes according to the instructions given by your orthopaedic surgeon to reduce the risk of wound infection. You should have a balanced diet to promote proper tissue healing and restore muscle strength.
Physical therapy is started inpatient and continued outpatient to train you to walk properly and strengthen your muscles. You may initially need a walking aid until your limping stops, after which you are encouraged to walk independently. Doing simple exercises is critical during the recovery process and you should be able to resume light activities in three to six weeks.
Your orthopaedic or rehabilitation specialist will advise you on special precautions; to avoid certain postures that may predispose to hip instability, and to avoid falls and injuries. You should participate in light exercises and see your orthopaedic surgeon for routine follow-up checks and X-rays.
