Hip Replacement Surgery
Many patients who reach the stage of requiring a hip replacement usually will have suffered from pain and discomfort in and around the hip joint for quite some time.
Osteoarthritis – which is the most common reason people require hip replacement surgery – usually develops gradually over a number of years with hip discomfort and hip pain noticed at first, which gradually progresses in its severity and frequency.
The pain may be experienced in the groin or around the buttock area or deep within the hip joint itself.
Hip Replacement Surgery Materials And Equipment
Depending on the type of hip replacement you will receive, the equipment and instruments used will differ in terms of their exact specifications, but broadly speaking the materials consist of a stem for the femur, an artificial femoral head that affixes to the stem, an acetabular component which may also require bone screws and the acetabular liner – usually made of a special type of plastic called polyethylene.
Your procedure may or may not require the use of a fluoroscopic imaging unit and will also require special retractors that allow the surgeon to visualize the hip joint as well as trial components of the aforementioned to ensure that the appropriate size component is used at the time of implanting the definitive prosthesis.
The upper part of the femoral stem may be coated with a special porous material to allow bone ingrowth for rigid fixation. The lower end of the femoral stem is usually tapered to fit snuggly in the femoral canal.
The flutes in the lower part of the femoral component helps in letting the blood and the debris out during insertion of the implant. The prosthetic femoral stem may either be press-fitted in the femoral canal or fixed using a bone cement.
The natural head of the femur rotating inside the acetabulum at a special angle. The prosthetic components are placed to match the natural angles of the neck and the head of the femur.
Hip Replacement Surgery Treatment Options
Usually when the patient has reached a stage of requiring hip replacement, they have obtained maximal benefit out of nonsurgical strategies to manage their arthritis which include using gait aids to aid with ambulation, analgesics such as nonsteroidal anti-inflammatory drugs or Tylenol, and courses of physical therapy, massage therapy and even in some cases, injections.
In the event that these strategies are no longer of any benefit to the patient then a hip replacement surgery is usually required.
Many different techniques can be used to perform hip replacement surgery including the use of robotic surgical assistance and different surgical approaches, which will all have different advantages and disadvantages. Your surgeon will discuss these with you in detail and help you reach a decision as to the most appropriate technique for your needs.
Who Is A Good Candidate For Hip Replacement Surgery?
Hip replacement surgery is usually reserved for more elderly patients, although with advances in implant technology and refinements of existing surgical techniques, we are able to offer the surgery in younger patients that absolutely require it.
As previously mentioned, the patient should have maximized their benefit from nonsurgical management strategies before pursuing surgery as a treatment option.
Hip Replacement Surgery Procedure
While every surgeon has slightly different preferences as to how the procedure is performed, broadly speaking the procedure involves gaining surgical access to the hip joint (which can be done via different surgical approaches) and then removing the arthritic femoral head, the arthritis from within the socket, and then replacing both of these with an appropriate size of hip replacement implant, ensuring that the position and orientation of the implant is such that the hip has appropriate stability and the patient’s leg length is as close to the contralateral side as is reasonably achievable.
Following the steps, the surgical exposure is carefully closed to ensure maximal recovery and the surgical wound is dressed and the patient is taken to the recovery room where the recovery process begins.
Hip Replacement Surgery Success Rate
Hip replacement is consistently shown in a broad range of literature to be the most successful procedure across all surgical specialties. Most high quality studies show success rates upward of 95%, with vast majority being in the region of 97 to 98% successful. Ultimately, success is defined by the patient’s pain being improved, their ability to achieve the same level of activity, or an improved level of activity as compared to their presurgery levels, and their overall quality of life.
Hip Replacement Surgery Risks
Although a highly successful surgery, hip replacement is a major surgery, and is associated with a number of risks. These include heart attack, blood clots, stroke, infection, neurovascular injury, dislocation/instability, leg length discrepancy and persistent postoperative pain.
Although many of these can be avoided in the vast majority of patients with existing strategies to minimize these risks, we are unfortunately not able to make the risks of these complications absolutely zero. There are certain patient factors that will increase the risks of developing some of these complications and these include morbid obesity, smoking and poorly controlled diabetes.
Hip Replacement Surgery Recovery And Timeframe
The vast majority of hip replacement patients achieve almost complete recovery by three months post surgery. There is literature to suggest the recovery from a hip replacement is quicker in patients who receive the hip replacement through a direct anterior approach, although ultimately beyond 3 months the success of the procedure is equivalent and has not been demonstrated to be superior thereafter.
The vast majority of the recovery happens in the first 6 weeks, with the first 2 weeks seeing the gradual subsiding of the postsurgical pain; the subsequent month is spent regaining mobility and strength in the muscles surrounding the hip joint.
The patient may require the use of a gait aid during their recovery phase and this is completely normal and entirely acceptable. Returning to work following hip replacement surgery is ultimately determined by the level of strenuous physical activity required in each patient’s job.
Those with a more sedentary occupation can typically return to work within a few weeks, those who are faced with higher physical demands as part of their job will usually take between 6 weeks and 3 months to return to work fully. It should also be mentioned that patients who have the option to modify their duties at work to accommodate limits of their physical activity would be able to return to work sooner than this.
Hip Replacement Surgery Exercises
Although your physical therapist will advise you specifically on the exercises that you are required to do the most in order to achieve the best result in the recovery, these will ultimately be determined by the surgical approach that was used during the surgery.
Typically, strengthening exercises such as straight leg raises, clamshell raises, and even wall squats are typically included in most patients recovery exercise regimen. Gradually improving strengths and numbers of reps in each of these exercises, in addition to any other exercises that your physical therapist has advised you to perform, will give you the best chance at having an uneventful and speedy recovery.
Hip Replacement Surgery Exercises To Avoid
This will also depend on the surgical approach used to replace your hip, and there may be no major restrictions in terms of specific movements immediately following a surgery, however, there may be restrictions on your movement depending on the surgical approach that was used for your surgery.
Your surgeon will advise you of these, and they can include no adduction and external rotation of the operative legs for lateral approach patients, or no abduction and internal rotation of the operative leg in posterior approach patients.
Hip Replacement Surgery Cost
The cost of the surgery will vary significantly depending on the equipment required to complete it. For example, an anterior approach surgery, the use of fluoroscopic imaging guidance is typically required and this does increase the case costings for the case, it may also require special type of table, which may also increase the case costings. Implant cost is also a factor and for the vast majority of patients with arthritis requiring hip replacement surgery, these will be the same.
However, if you have unique anatomy or specific conditions that require special types of implants, these may also increase the cast costings as well. For a full breakdown of the cost of your surgery to your insurance provider and to the patient, please schedule an appointment to discuss your treatment options with one of our specialist orthopedic surgeons who will be happy to provide you with all the information necessary to make an informed decision about the appropriate hip replacement technique and implants for you.