To help you fully understand the process of Total Hip Replacement, it may be useful to have an understanding of what a hip is and how it works.
What we call a ''hip'' is actually a ball and socket-type joint, which unites two separate bones - the thigh bone, or femur, and the pelvis. The pelvis has two cup-shaped depressions called the acetabula or sockets. The head of the femur or ball fits into the acetabulum, forming a joint which allows the leg to move forward, backward and sideways in a wide range. The acetabulum is lined with cartilage, which cushions the bones and allows the joint to rotate smoothly and with minimal friction. An envelope of tough ligaments connect the pelvis and femur, covering the joint and stabilizing it. The cartilage also makes the joint strong enough to support the weight of the upper body, and resilient enough to absorb the impact of exercise and activity.
A healthy hip will allow the leg to move freely within its range of motion, while supporting the upper body and absorbing the impact that accompanies activities like running and jumping.
Non Surgical Alternatives to Hip Surgery:
The artificial socket is commonly made of metal with a high density plastic liner, and the artificial ball is made out of metal or ceramic.
In total hip replacement surgery, the prosthesis or implant, is made up of three components. The femoral stem is made out of a metal, such as titanium, and is implanted down the shaft of the thigh bone or femur. The ball, or femoral head, is attached to the stem and is designed to replace the arthritic femoral head. The third part, the acetabular component, is a metal shell with a plastic inner socket liner.
These components are implanted into the pelvis and thigh bone, and are designed to closely approximate the mobility of the natural hip joint.
Some questions you are probably thinking about are: what kind of implant device you will be receiving, what is it made of, and why is your surgeon using a particular kind of device? If you haven’t discussed this with your surgeon, you should, because not all hip implant devices are made of the same material.
Due to significant advancements in technology, there is a new material for hip implant devices called OXINIUM* Oxidized Zirconium that is a superior metal for use in hip implants. This is due to its hardness, smoothness and resistance to scratching and abrasion. It also exhibits superior performance characteristics over the alternative material options of cobalt chrome and ceramic. Ask your orthopaedic surgeon about OXINIUM and if it is the right implant option for you.
The hip implant is comprised of four parts that work together to restore the original function of your ball-and-socket joint:
Hip implants are not one-size-fits-all, therefore your orthopaedic surgeon will choose the right hip implant for your body. Your surgeon will determine which design options will work best together to restore accurate leg length, while minimizing risks of dislocation and premature implant wear.
Before you are taken to the operating room, your anesthesiologist will talk with you about the medications used during the procedure and will administer medication to help you relax.
Next, the surgeon will make an incision in your leg to access the hip joint. Your surgeon will select the appropriate incision length and approach that is best for your case. After the incision is made and exposure is adequate, the ligaments and muscles are separated to allow access to the bones of the hip joint.
The femoral head is then dislocated from the hip joint and removed at the level of the femoral neck. After the femoral head is removed, the cartilage of the acetabulum is removed using a special reamer that forms a hemispherical shape. The remaining shape will allow for a proper fit of the metal shell. A trial component is placed in the reamed area to determine the proper size and fit. Once your surgeon is satisfied with the size and positioning of the trials, he will implant the metal shell.
The next step involves preparing the femoral canal to accept the femoral stem implant. Special instruments are used to hollow out the femur to match the shape of the metal stem of the femoral component. Trial components of the femoral stem, femoral head and acetabular shell are temporarily implanted to ensure the proper size and fit of the final implants.
At this stage, the surgeon will move your hip in all directions to make sure the trial components are implanted appropriately. Once he is satisfied with the placement of the implant trials, he will insert the final components. For some patients, a special type of acrylic cement, which is well-tolerated by the body, is used to fix the components to the underlying bone.
For other patients, the implants are fixed to the bones without cement. In these cases, the implants are coated with a special porous surface that allows the living bone tissue to adhere to the implant. Finally, the wound is closed, an external dressing is applied to the incision, and you will be taken to the recovery room.In the recovery room, the staff will monitor your vital signs until you are transferred to your hospital room.
When you and your orthopaedic surgeon decide that total hip replacement is right for you, here is an idea of what you may expect during the days and weeks leading up to surgery, as well as the day of surgery.
You and your orthopaedic surgeon may participate in an initial surgical consultation. This appointment may include preoperative X-rays, a complete medical and surgical history, physical examination, and comprehensive list of medications and allergies. During this visit, your orthopaedic surgeon will likely review the procedure and answer any questions you may have.
Your orthopaedic surgeon may require that you have a complete physical examination by your internist or family physician as you will need to be cleared medically by your physician before undergoing this extensive procedure. And you may be instructed by your internist on whether you need to donate blood prior to surgery in the event that you will need a blood transfusion post-operatively. Also, your orthopaedic surgeon may ask you to consult a physical therapist to discuss the recovery period, rehabilitation program, and important precautions, as well as instruct you in exercises that you can begin prior to surgery that will make the recovery much easier.
Your physician and hospital may also require that you visit the admissions department prior to surgery to pre-certify the procedure with your insurance company. Finally, maintaining good physical health prior to surgery will also improve the recovery period and overall post-operative outcome.
You may want to bring the following items to the hospital for your hip replacement surgery:
You should follow your regular diet on the day before your surgery. DO NOT EAT OR DRINK AFTER MIDNIGHT. Follow your doctor's instructions regarding use of medication in the days leading to surgery. Finally, try to get a long, restful night's sleep.
On the morning of the surgery, you will be admitted to the hospital and taken to the appropriate pre-surgical area. The nurse will spend a few minutes preparing you for surgery by taking your vital signs, starting IV fluids, and administering medications as needed. You will be asked to empty your bladder just prior to surgery, and to remove all jewelry, contacts, dentures, etc. You will change into a hospital gown, be placed on a stretcher, and transported to the operating room.
The anesthesiologist will meet you and review the medications and procedures used during the surgical case.
After the surgical case is completed, you will be taken to the recovery room for a period of close observation. Your blood pressure, heart rate, respiration, and body temperature will be closely monitored by the recovery room staff. Special attention will be given to your circulation and sensation in the feet and legs. When you awaken and your condition is stabilized, you will be transferred to your room.
Although the protocols may vary from hospital to hospital, you may awaken to some or all of the following:
Hip replacement surgery is a very complex procedure. However, the outcomes following hip replacement are usually very successful. One of the important critical success factors for a successful outcome is following the physical rehabilitation process. In order to help achieve the goals for a successful total hip replacement, you must actively participate in the rehab process and work diligently on your own, as well as the physical therapists, to achieve optimal results.
Your recovery program usually begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement needed during the first few days after surgery. You may be given a device called an incentive spirometer that you inhale and exhale into. It measures your lung capacity and assists you in taking deep breaths. These exercises reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs.
The physical therapist will begin as early as 1-2 days after surgery. They will teach you some simple exercises to be done in bed that will strengthen the muscles in the hip and lower extremity. These exercises may include:
Your physical therapist will also teach you proper techniques to perform such simple tasks as:
Although these are simple activities, you must learn to do them safely so that the hip does not dislocate or suffer other injury. Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and your therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance for accident or injury.
The occupational therapist will also visit with you to teach you how to perform activities of daily living safely. They will provide you with a list of hip precautions which are designed to protect your new hip during the first 8-12 weeks following surgery.
Also, the occupational therapist will instruct you in the proper use of various long-handled devices for activities of daily living. These devices may include the following:
Following surgery, a physical therapist may help you with your rehabilitation protocol. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regularly basis to further strengthen your hip muscles.
An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to mange.
Here is a list of potential exercises that you may be asked to perform. If an exercise is causing pain that is lasting, reduce the number of repetitions. If the pain continues, contact your physical therapist or physician.
While at home, you will continue to walk with the assistive device unless directed by your surgeon to discontinue use. You must also remember to strictly follow the hip precautions and weight bearing instructions during the first few months following surgery. It is recommended that you not drive unless you have been approved by your doctor.
Once you have completed your rehabilitation program, you can expect to be able to perform most activities of daily living with little to no pain or assistance. Patients following total hip replacement routinely are able to walk, dress, bathe, drive, garden, cook, and return to work. Although final outcomes may vary from patient to patient, total hip replacement surgery is one of the most successful procedures in modern medicine and most patients return to a full and active life.
Once you have completed the post-operative rehabilitation process, you should have near normal range of movement and adequate strength in your hip to perform most activities of daily living.
Because total hip arthroplasty is one of the most successful procedures in modern medicine, you can expect to return to a high level of function. However, special precautions should be taken by people with hip replacements. You should avoid high impact activities as running, vigorous walking, downhill skiing, or other high impact activities. Be careful when lifting heavy objects.
Patients having total hip replacement surgery have successfully returned to such activities as walking, driving, swimming, golf, doubles tennis, stationary cycling, and gardening.
Remember to listen to what your body tells you. If you begin to have pain or swelling for over 24 to 48 hours contact your surgeon for advice.
One of the most common problems following total hip replacement is hip dislocation or subluxation. Because the prosthetic ball and socket are smaller than the natural anatomy, the ball can become dislodged from the socket if the hip is placed in certain positions. The following precautions must be taken to prevent hip dislocation:
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