The hip is one of the body's largest joints. This is a ball and socket form. The socket is formed by the acetabulum, which is part of the pelvic bone. The ball is the femoral head, which is the upper end of the femur (thigh bone). The bony surface of the ball and socket is covered with articular cartilage which is a smooth tissue that protects the ends of the bones and allows them to move easily. This hip joint can be damaged by various diseases such as osteoarthritis, rheumatoid arthritis, trauma, osteonecrosis, and congenital disorders since childhood.
The Total Hip Replacement ( THR ) surgical procedure is an operation to replace a damaged hip joint caused by a disease that affects the hip joint. Mostly, this procedure is performed for degenerative arthritis or osteoarthritis associated with aging, trauma, and inherited disorders. In addition, this procedure is also recommended for patients with similar diseases, such as rheumatoid arthritis, osteonecrosis, and fractures that cause arthritis in the hip joint.
In Total Hip Replacement (THR) surgery, the damaged bone and cartilage are removed and replaced with a prosthetic component. The damaged femoral head is removed and replaced with a metal rod that is placed in the hollow center of the femur. The femoral shaft can be cemented or "press fit" into the bone. A metal or ceramic ball is placed at the top of the rod. This ball replaces a damaged femoral head that has been removed. The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. A plastic, ceramic, or metal spacer is inserted between the new ball and socket to allow for a smooth sliding surface.
When Should the Hip Replacement Surgery Procedure Be Done?
An orthopedic surgeon will advise patients to undergo a total hip replacement procedure if the pain experienced in the hip is chronic and progressive and leads to a decrease in normal bodily functions, such as:
- Pain in the hip that limits the ability to perform daily activities such as walking
- Hip pain that persists even after taking pain medication, physiotherapy, and using assistive devices
- Hip pain that disrupts sleep patterns and persists when resting both day and night
- Hip pain that gets worse when walking and climbing stairs
- Stiffness in the hip joint makes it difficult to move or lift the leg.
Hip Replacement Surgery Procedure.
Before starting the procedure, the doctor concerned will carry out a general physical examination, blood tests, X-rays, and MRI. After the joints and muscles are declared suitable for the procedure, the operation will be carried out. The procedure will take 1 - 2 hours and requires general anesthesia with an 8 - 10 inch incision on either side of the hip to expose the hip joint. Then, the damaged ball and socket joint will be removed by a doctor and replaced with an artificial joint made of metal, plastic, ceramic, or a combination of these three materials using bone cement.
What Are the Risks of a Hip Replacement Surgery Procedure?
Even though it is one of the types of surgery with a high success rate, hip replacement surgery also has several risks of complications, including:
- Infection.
Infection can occur at the surface of the wound or deep around the prosthesis. This may occur within days or weeks after surgery. It might even happen years later. Mild infections in wounds are generally treated with antibiotics. Large or deep infections may require more surgery and removal of the prosthesis. Any infection in the patient's body can spread to the patient's joint replacement. - blood clots
Blood clots in the veins of the legs or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they break loose and travel to the patient's lungs. The orthopedic surgeon will carry out a preventive program which may include blood thinning medication, physiotherapy, and early mobilization. - Leg length difference.
Sometimes after a hip replacement, one leg may feel longer or shorter than the other. The orthopedic surgeon will make every effort to equalize the length of the patient's legs, but may slightly lengthen or shorten the patient's legs to maximize stability and hip biomechanics. - Dislocation.
This occurs when the ball leaves the socket. The risk of dislocation is greatest in the first few months after surgery while the tissue is healing. Dislocations are rare. If the ball does pop out of the socket, the closed reduction can usually put it back in place without the need for further surgery. In situations where the hip continues to dislocate, further surgery may be required. - The prosthesis wears out.
Over the years, the hip prosthesis may wear out or loosen. This is most often caused by daily activities. It can also result from a biological thinning of the bones called osteolysis. If loosening is painful, a second surgery called revision may be needed. - Other complications.
Nerve and blood vessel injuries, bleeding, fractures, and stiffness may occur. A small number of patients may continue to experience pain after surgery.
To find out more about Total Hip Replacement ( THR ) Procedures, you can consult with a Hip and Knee Consultant Orthopedic Specialist Doctor at EMC Sentul Hospital
The article was written by dr. Rommy Darmawansa, M.Kes, Sp.OT (K) Hip & Knee (Orthopedics and Traumatology Specialist, Hip & Knee Consultant at EMC Sentul Hospital).