Total Hip Replacement (THR) Surgery

Complete hip replacement refers to a surgical procedure where your normal hip joint is replaced with an artificial joint to help you function normally. It is one of the most successful surgeries in all medicine and has become quicker, easier, and more effective with advances in technology. Lakhs of hip replacements are carried out every year worldwide. Complete hip operation, also known as hip arthroplasty, involves the replacement of the damaged bone and cartilage with prosthetic components.

The human body has the hip as one of its largest joints. Popularly known as a ball-and-socket joint, the hip joint is in the form of a ball fitted into a socket, where the ‘ball’ moves or glides whenever the person attempts to move their hip. The anatomy of the hip can be better explained as follows:

• The hip, i.e. the ball-and-socket joint, consists of the femoral head as the ball and the acetabulum as the socket. While the femoral head is the upper end of the thighbone or femur, the acetabulum is a part of your pelvis bone.
• The bones are surfaced with articular cartilage, which refers to a smooth tissue allowing for easy movement of the ends of the bones.
• This cartilage needs to be lubricated from time to time to allow smooth movement. For this, the hip joint is surrounded by a thin tissue (called synovial membrane) that makes a fluid that works to eliminate all friction during movement.
• Lastly, there are ligaments that connect the ball to the socket. The ligaments are bands of tissues (called the hip capsule) and provide stability to your overall hip joint.

Conditions that lead to chronic hip pain and disability, and a need for full hip replacement surgery are as follows:

• Osteoarthritis: Osteoarthritis is age-related; when the cartilage wears away with age, the bones start rubbing against each other, which causes hip stiffness and pain. It can also occur in people with a family history of arthritis.
• Rheumatoid arthritis: It is an autoimmune disorder, where the synovial membrane gets inflamed. This damages the cartilage, resulting in pain and stiffness.
• Posttraumatic arthritis: Trauma such as a serious hip injury or fracture can damage the cartilage and lead to a need for surgery.
• Osteonecrosis (or avascular necrosis): It’s a condition where an injury (a dislocation or a fracture) limits blood supply to the femoral head, causing the bone surface to collapse and ultimately resulting in arthritis.
• Childhood hip disease: Sometimes, infants and children also develop hip problems, which even after treatment, cause arthritis later. This usually happens when the hip doesn’t grow normally and when the joint surfaces are affected.

THR or full hip operation may be suggested, when:

• Hip pain persists despite medications and physical therapy
• Pain worsens even during walking on your own or with crutches/cane/walker (walking supports)
• Hip pain interferes with your sleep
• It affects your ability to take stairs or come down them
• When hip pain makes it tough for you to get up from a seated position

THR has no age or weight restrictions, although it is mostly done on patients aged 50 to 80.

A hip operation can be of the following three types:

• Total hip replacement (THR): This is the most common type of hip replacement surgery and the one we are discussing in detail.
• Partial hip replacement (Hemiarthroplasty): In this type, only one part of the hip joint is replaced, contrary to the total hip replacement surgery procedure where both parts (ball as well as a socket) are replaced. Hemiarthroplasty is often required when old men and women fracture their hips.
• Hip resurfacing: This is more common in younger people. It involves resurfacing of the head (ball) and the socket.

Furthermore, hip replacement can be done traditionally as well as in a minimally invasive manner. Moreover, the surgeon may access the hip joint from different angles, based on which the hip replacement can be anterior, posterior, or lateral.

You should follow your doctor’s instructions, clear all your doubts with him/her, and end tobacco usage if any. Also, choosing to undergo this surgery is in itself a big question and you should make sure that you speak everything with your family and doctor, and carry realistic expectations.

Here are some of the ways you can be best prepared for a whole hip replacement:

• Medical evaluation: A complete physical checkup is done to make sure you are healthy for the surgery. Patients with chronic medical conditions like heart disease may also be evaluated by a cardiologist.
• Tests: X-rays, MRI scans, blood and urine samples, and EKGs (electrocardiograms) may be required.
• Preparing the skin: Your skin should be free of any irritations and infections. If it’s not so, speak to your doctor beforehand.
• Medications: You need to know right from the beginning, as to which medicines you can continue or add and which ones to avoid.
• Weight loss: For those who are overweight, shedding some weight helps reduce stress on the hip post-surgery and reduces surgery-related risks.
• Dental evaluation: In case you are planning to have a major dental procedure as well, have it before THR. This is to prevent infections.
• Urinary evaluation: Those with past or recent urinary infections should get a urinary evaluation done. Men with prostate disease should also complete their required treatment before THR.
• Social planning: Make sure that you have a helping hand there for the recovery period. You will need help with the daily tasks, to go for routine checkups, and for emotional support.
  • Home planning: You can prepare your home accordingly before the surgery. This involves securely fastening handrails in your shower and along the stairways, and making sure there is a raised toilet seat, a stable chair, and so on.

The total hip transplant procedure is 1-2 hours long and is carried out in the following manner:

• You are administered anesthesia which is usually general anesthesia. It can also be spinal, epidural, or regional nerve block anesthesia.
• An incision is made over the hip through the tissue layers.
• The diseased/damaged bone and cartilage are removed while the healthy parts are left intact.
• The replacement socket is implanted into the pelvic bone.
• A metal stem is inserted into the top of the thighbone (femur) and finally topped with a replacement ball.

In other words, the damaged femoral head (ball) is removed and replaced with a metal stem, which is inserted into the hollow center of the femur and topped with a metal/ceramic ball. The acetabulum is also removed and then replaced with a metal socket. The surgeon may use screws or cement at times to make the adjustment. Between the new ball and socket, a plastic, metal, or ceramic spacer is inserted to allow a smooth gliding surface.

Finally, you are moved to the recovery room. You are taken to the hospital room or discharged after you wake up from the effect of anesthesia.

The implants used in THR are the following three:

• Stem: Usually made of metal (cobalt-chrome or titanium), which is inserted into the femur (thighbone).
• Ball: Made of polished metal or ceramic, fitted on the top of the stem.
• Socket: Made as a combination of a plastic liner and cobalt-chrome/titanium backing.

Many varying types of designs and materials are used nowadays and your surgeon helps you understand which type will best meet your needs. Your surgeon may ‘press fit’ the prosthetic components into the bone, or cement them into place. S/he may also use a combination of the two options, where the stem used is cemented while the socket is non-cemented. The decision depends on various factors including the strength of your bone.

Recovery is very crucial to the success of the THR procedure. So you need to be very careful during this phase and follow all given instructions properly.

• Pain management: You’ll be prescribed medications to overcome pain after surgery.
• Wound care: There can be stitches, staples, or sutures closing the wound. Avoid getting the region wet until it is completely sealed and dried. The stitches or staples will be removed around 2 weeks post-surgery.
• Diet: Drink plenty of fluids and maintain a balanced diet, often added with an iron supplement for proper healing.
• Activity: Exercise is critical to recovery post-THR. Normal light activities can be resumed within 3-6 weeks. You may be asked to follow a program whereby you slowly increase mobility, resume activities like sitting, climbing stairs, and standing, and carry out specific exercises to strengthen the hip and restore movement.

Know that you may experience numbness in the affected area and feel some stiffness, but these tend to go away with time. Attend all follow-ups and avoid any falls and injuries to prevent the need for another surgery.

The following table identifies the similarities and differences between the two types of hip replacement:

Hip Surgery can be a daunting aspect, and feeling anxious is normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!