Anatomy of hip Joint
Normal hip joint is a ball and socket joint made of femoral head, which is a ball like structure covered with a very thick layer of smooth cartilage. A cup like structure known as Acetabulum in Hip bone also covered with thick layer of cartilage, provides a very smooth surface for gliding of femoral head. Both these structures are encapsulated in a thick tissue known as capsule surrounded with thick and strong muscles which helps in movement of hip joint. The thick Capsule secretes a fluid which provide nutrition this avascular cartilage and also helps in smooth gliding movement between two bearing surfaces.
Hip Hemiarthroplasty or Hemi Hip Replacement is a surgery in which only the femoral head is replaced with new prosthetic metal head. This head is seated on a metallic stem. This stem is fixed in femoral canal. This stem can be either cemented and uncemented one. The head can also be fixed or bipolar depending upon the modularity of implant.
Hip hemi arthroplasty is done in case of fracture neck femur patients whose acetabular cartilage is in good condition. This surgery is generally preferred in elderly and weak patients whose life expectancy is low. This is because, the metallic head erodes cartilage and acetabular bone over the time and and the components get loose, which produces pain and difficult walking.
The expected life of this surgery is from 5 years to 15 years
Total Hip Replacement
A Total Hip Replacement or Total Hip Arthroplasty is a surgery where both the head and the acetabular cup is replaced with artificial prosthetic counterpart. This is done mostly in cases where in the head and cup get arthritic and ultimately gets damaged. The most important reason for this is Avascular necrosis of hip or commonly known as AVN, other cause include old neglected fracture of head or acetabulum, Primary osteoarthritis of Hip etc. The prosthesis consist of 3 component, The Acetabular cup or shell which is implanted in place of degenerated cup with the help of cement or by specially coated material which integrate with bone giving longer life and stability. Degenerated femoral head is replaced either with metallic or ceramic head. These are head are seated on femoral stem which is either cemented or uncemented. Uncemented component are used in strong bones of young individual while cemented component is used majorly in old osteoporotic bones for better hold.
To provide a smooth gliding surface, a Liner is added in between head and cup. It is again made up of either highly cross linked poly or ceramic. Due to it characteristic properties ceramic gives best result, more durability and longer prosthetic life.
The expected life of this surgery is 20 years to 30 years.
Who should be recommended for a Hip Replacement Surgery?
Indication of THR
The most common reason for considering a hip replacement surgery is severe pain debilitating the patient suffering from any one of the following condition of hip causing near complete destruction of hip joint:
Avascular necrosis of hip
Osteoarthritis of hip
Post infective arthritis
Post traumatic arthritis of hip
Childhood conditions like perthes/Legg calves Perthes disease or slipped capital femoral epiphysis (SCFE) leading to osteonecrosis and arthritis of hip.
How can it be diagnosed?
Physical examination-Surgeon will examine the hip and assess the pain, mobility and stability.
Xray- this will confirm the diagnosis and also help to ascertain the stage of ongoing disease.
MRI- in early stages MRI is very useful to confirm the disease and ascertain the stage. Early diagnosis helps in avoiding THR as early intervention and other smaller surgery sometime reverse the process or stops the disease activity
In our institution THR is almost a painless surgery. A special attention is given to keep the pain under control so that the patient can be mobilised early.
During surgery a special mixture of drugs are injected in the tissue surrounding the hip joint for postoperative pain control
An Epidural infusion is started which delivers drugs continuously to spine keeping the pain under control. Also various pain killer injections and patches can be added in patients having severe pain.
Post op protocol
Following Hip Replacement surgery patient is mobilised as early as possible.
Patient is made to stand as soon as the effect of anaesthesia weans off or on very next day of Hip Replacement surgery. Patients are taught exercises for proper pumping of blood in legs which helps in preventing DVT, to strengthen muscle and to achieve early and good range of knee movement.
Our highly skilled Physiotherapist team will visit you post operatively and help you in doing proper exercise.
A step by step protocol is properly designed and individually tailor made for better, early and painless recovery.
I.V. antibiotics are started to cover any possible risk to infection.
Proper precaution and prophylaxis is started in form of blood thinners and is mobilised as early as possible to avoid potential complication Like Deep Vein thrombosis (DVT). All these strategies helps patients to give a successful result of THR.
After successful Hip replacement surgery you need to strictly follow Doctor’s advice and do your exercise regularly. A physiotherapist may help you better in doing your exercise and help you achieve full benefit from your surgery.
Most importantly you have to take care to avoid any fall and any infection anywhere in your body. In case you see symptoms of any infection you must consult your doctor immediately.
What to expect after THR
Patient is made to stand next day after surgery and made to walk on 2nd day. Both his legs are kept apart with pillow in between. He is advice to keep both legs apart while lying and walking for next few months He is taught to climb stair and is discharged with few sets of exercises from hospital after 3-5 days of surgery.
Stitches will be removed on day 14 after surgery.
Patient is encouraged to do regular exercises with the help of physiotherapist to achieve early strength and good movement so that he can start his regular activities as soon as possible. Full recovery may take from 2 months to 4 months after which patient will be able to walk for long distance and climb stair freely. THR patients are not allowed to sit on ground or to use Indian toilet or squat as there are high chances of dislocation. Once hip gets dislocated it is relocated under anaesthesia and kept in traction for some time. If there are multiple such episode of recurrent dislocation of hip then Revision Total hip surgery might be required.
Life of Total Knee Replacement Surgery
Usually your surgery may last anywhere from 15 years to 25 years or may be long.
After successful implantation and with regular physiotherapy you will experience near normal functioning Hip joint and this hip can even last for life in most individuals.