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BLK Centre for Orthopaedics, Joint Reconstruction & Spine Surgery >> Treatment Offered >> Hip Replacement

Hip Replacement

What is a hip joint?

Hip is a ball-and-socket joint where thigh bone (femur) meets hip bone (pelvis). A healthy hip has layers of smooth cartilage that covers the ball-shaped end of the femur and socket part of the pelvis. Cartilage acts as a cushion and allows the ball of the femur to glide easily on the socket of the pelvis. Muscles around the joint support your weight and help move the joint smoothly so that you can walk without pain.

 

What is a degenerated hip joint?

When smooth cartilage layers around the ball of the femur and the pelvic socket wears down, the condition is called degeneration. It can happen because of arthritis, injury or as a side effect from medicines, such as steroids. When the joint wears down, smooth surfaces become rough. Instead of gliding smoothly with leg movement, the ball grinds in the socket causing pain and stiffness.

 

How is hip pain treated?

In early stage of hip arthritis, pain can be controlled with weight reduction, physiotherapy and mild medication.

During the last stage of arthritis, when degeneration or arthritis worsens, there’s a severe decrease in the joint space and significant increase in amount of pain while walking, getting up from chair, and sometimes even while resting. In such a scenario, surgery may be required to replace the hip

 

What is total hip replacement?

Total hip replacement is an operation that replaces the worn out or damaged hip joint. It involves replacement of both the joint socket and the head of thigh bone with a hip prosthesis (artificial joint), which is made of metal, plastic, ceramic or a combination of these materials.

 

What are the benefits of surgery?

Provided the patient follows post-operative precautions and works hard on his or her mobility after hip replacement operation, a significant improvement can be expected in quality of life. There is greater mobility and appreciable reduction in pain.

 

Prerequisites before surgery?

  • Patient and surgeon should make sure that patient doesn’t have any source of infection in the body, such as skin boils, dental, urine and chest infection
  • If patient is taking blood-thinning medicines, the doctor should be informed. These medicines may have to be stopped a few days before surgery
  • If patient has any other medical issues such as diabetes, hypertension, asthma, hypothyroidism, etc., ensure that the doctor takes appropriate measures to control the same before surgery

 

What is the surgery process?

  • Patient is admitted one day prior to surgery
  • Relevant investigations are done
  • Patient is seen by a member of the anaesthesia team
  • Patient discusses choice of anaesthesia with anaesthetist – epidural or general
  • Hip replacement is usually done under epidural anaesthesia (injection on the back to make the legs numb). This avoids certain problems associated with general anaesthesia
  • Patient should mention if there are other medical issues such as diabetics, hypertension, asthma, etc. so that a physician can be consulted
  • Patient shouldn’t eat or drink anything after midnight. Eight hours of fasting is necessary before surgery
  • Shower should be taken in the morning and legs cleaned with soap and water. Legs are not shaved in the room. If required, it is done in the operation theatre
  • Couple of tablets may be given in the morning – if required, they’re to be taken with a small sip of water
  • Patient is shifted to preoperative area about an hour before being taken to the operation theatre
  • After the operation patient is kept in recovery ward for 4-6 hours and then sent back to the room or ICU as necessary
  • Following surgery, a bulky dressing is made around the hip, with a small tube (drain) to collect any blood oozing out of the operated area
  • The drain will be removed 24-48 hours after surgery

 

What is the recovery process?

These exercises help to keep the chest as clear as possible. Three or four deep breaths are to be taken (not more as it may make the patient feel light headed). It is recommended to breathe in deeply, and after the last breath, try to puff the air out.

Circulation exercise

Patient should start moving foot and ankle up and down as many times as possible to regain power in the legs. This should be carried out throughout the hospital stay. It helps pump the blood up and prevent complications like thrombosis (blood clot in the veins)

Lower limb exercises to improve circulation and muscle strength

  • With legs straight, ankles are pulled forward and then the back of the knees are pressed into the bed. Knees are held tight for five seconds and then released gently. To be repeated 10 times every hour
  • The bottom muscles are clenched together, held for five seconds then released gently. To be repeated 10 times every hour
  • The physiotherapist would advise on gentle knee bending exercise of the operated leg and how much should the knee be bent

Walking

  • Patient is made to stand with the help of a walking frame 24-48 hours after surgery and is encouraged to start walking. This can help in preventing complications like thrombosis

Pain relief

  • Adequate treatment is given for pain relief. This may be in the form of epidural pump, patient control analgesia (PCA) and a cocktail of certain drugs. Patient should inform when in pain. The BLK Pain Management Team is there to offer assistance at any given time

DVT prevention

  • Adequate measures are taken for prevention of thrombosis, such as DVT pump (pressure cuff around the calf), certain drugs and early mobility

Discharge from hospital

  • Patient may be ready for discharge from the hospital 4-5 days after surgery in case of single hip replacement and 7-8 days if both hips are operated

 

What precautions should be taken after surgery?

  • Temperature should be monitored. Doctor to be informed if it goes above 100.5 degrees Fahrenheit
  • Doctor to be informed if there’s excessive pain
  • Doctor to be informed if there’s excessive swelling, redness around the operated area or discharge from the wound
  • Use of walking aid is recommended until advised otherwise
  • Low chairs or commodes should not be used
  • After hip replacement, the surrounding muscles and tissue take some time to heal. After this, patient may be able to resume normal activities.

 

It is important that following movements are avoided for the first 12 weeks to reduce the risk of hip dislocation:

  • Bending the hip beyond an ‘L’ shape
  • Crossing the leg or moving the operated leg across the midline of the body
  • Twisting the operated leg

These precautions should be taken even in long run.

 

Long-term precautions

  • Antibiotic cover should be taken while undergoing any dental / surgical procedures. Doctor should be kept informed
  • High impact exercise such as jumping, running should be avoided
  • Doctor to be informed if there’s pain, swelling or instability

Care at home

  • The toilet seat at home should have a high commode attachment or a high commode chair should be used
  • Physiotherapy should be done regularly to facilitate walking and strengthening of muscles
  • Patient should be mobilized as much as comfortably possible

 

Putting hip precautions into practice

Sitting

Patient should use a chair with arms and avoid sitting on a low chair. To get out of a chair, push the body to the front edge, place the operated leg slightly forward and push up on the arms of the chair, taking most of the body weight on the non-operated leg. Regain balance and then get the crutches / walking aid. Reverse the procedure to sit down. The same method to be used while getting on / off the toilet seat

Getting in / out of bed

It is advisable to continue sleeping on the back for first six weeks following surgery. A pillow between the legs will help. If possible get off the bed on the same side as the operated hip. When getting on / off the bed, avoid twisting the hip. Try to keep the toes pointing to the ceiling while moving the operated leg across the bed. Push up from the bed with the hands, taking the weight on the non-operated leg

Stairs

Once the patient is walking well, he or she will be taught how to manage stairs or a step

Take one step at a time

Going upstairs: use the banister on one side and the crutch / stick on the other side leading with the non-operated leg, place the foot on the step and then let the operated leg follow

Going downstairs: use the banister on one side and the crutch / stick on the other side. Place the crutch / stick first on the step, then put the operated leg onto the step and then let the non-operated leg follow onto the same step

Remember: “good leg up, bad leg down, i.e. non-operated leg first while going up and operated leg first while coming down”.

 

What are the risks / complications of the procedure?

All types of surgical procedures and anaesthetics carry some risks, particularly if there are other medical problems such as the patient being overweight etc. Our healthcare team has been trained to make sure that these are minimized and the treatment is carried out safely. There are some specific risks related to hip surgery that patients need to be aware of. However, chances of immediate complications are less than 2 %

Infection: Sometimes despite strict precautions, infection can occur. Superficial infection may occur at the wound site

Deep infection: May occur early post operation or much later. Therefore, it is recommended to promptly treat infection that may develop in any part of the body

Deep Vein Thrombosis (DVT): Despite taking precautions to prevent blood clot (thrombosis) formation in the veins of the leg post surgery, it still remains a common risk after hip replacement surgery. Rarely, these clots can dislodge and travel through the heart to the lungs. This is known as pulmonary embolism which can cause serious complications in rare cases.

Loosening of the prosthesis (new joint): This is a risk common to all artificial joints. It is caused by weakening of the bond between the new joint and the bone. Although it is expected that the new hip will last for many years, it can become loose earlier than anticipated, particularly if the patient is grossly overweight, damages the joint by falling on it, or returns to a hectic work schedule in a hurry. If the joint becomes loose then it’s usually possible to replace it with another one - although this is a more complicated operation with greater risks involved. With newer implants, it is common to see hip replacements last more than 15 years

Persistent pain: The operation may not relieve the patient of all pain, and he or she may continue to experience some mild discomfort. Complex regional pain syndrome, while uncommon, may be the cause of pain, swelling, stiffness and skin changes

Other recognized risks of hip surgery include bone fracture, bruising, urinary retention and risks associated with anaesthesia and blood transfusion

 

How soon does a patient recover from surgery?

  • After single hip replacement, patient can stand with assistance of physiotherapist 1-2 days after surgery and start moving with the help of a walking aid
  • Patient can use toilet seat (raised) 3-4 days after surgery
  • By the time patient gets home, he or she should be able to go to toilet independently with the help of a walking aid
  • Patient will need to use crutches or walking frame for 2-4 weeks
  • It will take 8-12 weeks to achieve full benefits of surgery
  • In case both hip replacements were done together, the recovery process is a little slower but same principles would apply in this condition as well

 

Frequently asked questions

Q. Do I need hip replacement?

A. It depends on the extent of pain and difficulty in walking. Advice is given after analyzing X-ray findings. It is you who’s suffering from pain and you are as much a part of decision making as your doctor.

 

Q. Can I get both hips operated at the same time?

A. It depends on how badly both hips are affected. If a patient is young, with good medical status, then both hips can be replaced in one sitting. In case of the elderly, hips are replaced one at a time.

 

Q. Is hip replacement painful?

A. There are modern methods available for pain relief, such as continuous epidural anaesthesia, patient controlled anaesthesia (PCA) and a cocktail of certain drugs that can control pain very effectively

 

Q. Can I sit cross-legged on the floor?

A. Although a patient may have sufficient mobility for sitting cross-legged, it is generally not recommended as sometimes the hip can dislocate. Also, it puts abnormal stress on the bonding of bone implant.

 

Q. Do I need physiotherapy?

A. Physiotherapy is important in achieving early mobility and good hip movement. Physiotherapy starts immediately after surgery. You may need physiotherapy for 4-6 weeks. This can be organized at your home or a nearby clinic.

 

Q. For how long should a commode or raised toilet seat be used?

A. It is a good to use a raised toilet seat for at least 3 months and even longer.

 

Q. How frequently do I need to visit the hospital?

A. You are required to visit the hospital 10 days after surgery for stitch removal. After that you may be asked to return in 2-4 weeks to monitor your progress. Subsequent visits are required only after 3 months and 1 year of surgery - unless medical condition dictates otherwise.

 

Q. Is hip replacement detected by a metal detector?

A. Yes. You should collect a credit card shaped certificate from the orthopaedic office certifying that you’ve had hip joint replacement. This can be shown to the security staff.

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