Types of Hip Replacement Procedures
Hip arthroplasty, popularly known as hip replacement, is a surgical procedure performed to repair damage to the hip and associated structures. The surgery involves the removal of damaged sections of the hip joint (the head of the femur or thigh bone, also known as the ball and its socket. This is a part of the pelvis or the hip bone). The surgery also involves the subsequent replacement with parts made of metal, ceramic, or very hard plastic. These prosthetics help reduce pain and improve function Read More
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Types of Hip Replacement Procedures
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Hip arthroplasty, popularly known as hip replacement, is a surgical procedure performed to repair damage to the hip and associated structures. The surgery involves the removal of damaged sections of the hip joint (the head of the femur or thigh bone, also known as the ball and its socket. This is a part of the pelvis or the hip bone). The surgery also involves the subsequent replacement with parts made of metal, ceramic, or very hard plastic. These prosthetics help reduce pain and improve function.
Indications for Hip Replacement Procedures
The doctors recommend hip replacement surgery when the nonsurgical management options for hip pain have not been effective and pain interferes with daily activities. Certain conditions can lead to the necessity of hip replacement. They include the following:
- Osteoarthritis: This is the most common cause of hip damage which requires a hip replacement. It occurs as a result of the wear-and-tear of the cartilage responsible for the smooth movement of the hip joint.
- Rheumatoid arthritis: An immune-mediated arthritis, rheumatoid arthritis results in an inflammation that can erode cartilage and the underlying bone, thus causing damage.
- Osteonecrosis. Also called avascular necrosis occurs from a lack of blood supply to the ball portion of the hip joint.
- Hip injury: Injuries of the hip, such as fractures can also require a hip replacement.
- Bone dysplasia: Disorders of the bone that could be congenital or acquired could result in bone deformation.
- Tumour in the hip joint
Types of Hip Replacement Procedures
Hip arthroplasty can be Total or Partial depending on the parts that need replacement. There is also hip resurfacing.
Total Hip Replacement/ Arthroplasty involves the replacement of both the ball and the socket. It is the most common type of hip replacement surgery.
A Partial Hip Replacement, however, involves the replacement of either the ball or the socket of the hip joint. It is also known as hemiarthroplasty and is common in older patients.
Hip resurfacing of the femoral head and socket involves the removal of injured surfaces of the hip bones and replacing them with a metal surface. It is most common in younger and active patients. However, due to concerns about soft tissue injury by the metal surface, this procedure is less popular.
Parts of a Hip Prosthesis/ Replacement Implant
The hip prosthesis consists of the following:
- A ceramic ball with a metal stem which is inserted into the thigh bone for stability. The ceramic ball was formerly made of metal, but current standards involve a ceramic ball.
- A metal cup usually made from titanium and lined with an inner plastic layer. This is attached to the socket part of the hip joint and allows the free movement of the prosthesis joint.
Types of Socket Implant Attachment
The socket implants may be cemented or uncemented. The cemented prosthesis attaches directly to the bone, while the uncemented one is attached to a porous surface giving room for bone growth around it over time. Both approaches are effective and have been used successfully. Newer and more effective techniques are available, and surgeons may combine both methods in a joint.
The surgeon may take a minimally invasive hip replacement approach or a traditional hip replacement approach. Access to the hip can be done via different approaches. It could be from the front (anterior approach), the side (lateral approach), or the back (posterior approach).
The minimally invasive hip replacement, as the name implies, aims to reduce the effects of the surgery on surrounding healthy tissues. It ensures quicker recovery, less pain, and lower complications. However, it is not suitable for all patients. Factors such as age, weight, type and nature of the implant, and fitness are considered.
A traditional hip replacement involves a single, large lateral or posterior incision that helps the surgeon gain access to the hip. Recovery time is much longer because trauma to surrounding tissues is inevitable.
The main procedure involves making an incision over the hip and tissue layers. Damaged bones and surrounding tissues are removed, and the implants are placed. Postoperative recovery and evaluation are done, and the patient is discharged. This could be on the same day depending on the surgical approach employed.
Physical therapy and some lifestyle changes are necessary during the recovery process. Full recovery from a hip replacement may occur from three to twelve months post-surgery. It is worthy of note that high activity may affect the healing process.
Complications associated with the hip replacement procedure
Several risk factors are taken into place following hip replacement surgery. These may include:
- Blood clots: Formation of blood clots or DVT (Deep Vein Thrombosis) is a dangerous side effect of hip arthroplasty. Several preventive options are available such as the use of blood thinning medications, resting of the legs, etc.
- Infection: infections may occur if the surgery was done in septic conditions. It may also be due to complications arising from post-surgical management. Antibiotics may be used in mild infections whereas severe infections may result in surgery.
- Fracture: This can occur both during and after the surgical procedure. Care should therefore be taken by the patient in ensuring strict adherence to the doctor’s recommendations.
- Dislocation: Due to several factors, a dislocation of the newly replaced joint may occur thus, this may require further stabilization.
- Change in leg length: Muscle contractions after hip replacement surgeries may lead to a discrepancy in the limb length. Surgeons take precautions during the surgery to prevent this. However, postoperative physiotherapy can help in the management and correction of differences in length.
- Loosening: There have been records of loosening or wearing out of the prosthesis which occurs when the implants are not well fixed to the bone. This is quite rare with newer implants but can be resolved through surgery.
- Nerve damage: Although a rare complication, damage to the nerves may occur during or after surgery. Signs of nerve damage may include numbness, weakness, and pain.
Other risks associated with hip replacement surgeries include bleeding, continued pain, or stiffness of the limb or joint.
Most hip prostheses can serve for up to 15 years before a replacement is needed. It is a relatively safe surgery and has revolutionized the management of arthritis and other hip diseases over the years. It is necessary to consult a medical professional for advice on management options, and any signs noticed post-operatively should be reported in due time.