Q: What is a total hip replacement?
A: This is a surgical procedure where the diseased parts of the hip joint are removed and replaced with an artificial socket ball and stem.
Q: Who will benefit from a total hip replacement?
A: A total hip replacement is a quality of life improving operation. It is usually indicated for patients where pain cannot be managed satisfactory with painkillers, walking aids and activity modification.
Q: Does age determine whether one is a candidate for a total hip replacement?
A: Traditionally, a hip replacement was only offered to older patients because of problems with the durability of the artificial hip joint. Recent advances such as hip resurfacing, new plastics, ceramics and metals have significantly improved the longevity of a hip replacement. A total hip replacement is now offered to almost any patient if their symptoms are severe enough.
Q: Are there any surgical alternatives to a total hip replacement?
A: In selected and very young patients, a hip fusion (stiffening of the joint) can be considered. However, the advent of new technologies has made this a very rare operation nowadays.
Q: How is the decision made to undergo a total hip replacement?
A: The joint replacement specialist will assess the patient and use x-rays to assess the severity of the arthritis. The most important factor in the decision making process is the amount of pain a patient experiences. The specialist will offer the patient surgery but the decision to proceed, lies with the patient.
Q: What types of hip replacement are available?
- Cemented Hip Replacement: The artificial hip joint is fixed with cement to the bone
- Cementless Hip Replacement: Here the patient’s own bone grows onto the prosthesis and provides long-term fixation.
Q: What are the moving parts of a hip replacement made of?
- Metal head and plastic cup
- Ceramic head and ceramic cup
- Metal head and metal cup
- Ceramic head and plastic cup
The orthopaedic specialist will advise the patient on the specific advantages and disadvantages of each type and select the most appropriate one together with the patient.
Q: How is the operation performed?
A: In most cases a spinal or epidural anaesthetic combined with sedation is used. The operation is performed with the patient on the side. The surgeon makes a 10-15 cm long cut over the bony prominence of the hip joint. The muscles are then moved away to access the bones of the hip. The top of the thigh bone is cut off and a metal or plastic cup fixed to the pelvis. A metal stem is inserted into the thigh bone and a new ball attached to it. The wound is then closed.
Q: What happens after the operation?
A: Some patients get up on the same day of the operation but most on the day after surgery. Adequate pain control is the most important aim after the operation as it allows the patient to exercise and walk and therefore accelerate the recovery. Most patients leave the hospital three to four days after surgery.
Q: How long is the recovery?
A: Most patients feel fine after six weeks and do not use any walking aids. At that time patients can resume all normal activities including driving. Short –haul flights are also permitted at that stage.
Q: What types of sports are allowed after a hip replacement?
A: All low impact activities such as swimming, cycling and hiking are possible. Higher impact activities such as running and tennis should be discussed with the surgeon before the operation as special types of hip replacements can be chosen for these activities.
Q: How long does a hip replacement last?
A: This depends on the age and activity level of the patients but most hip replacements can last up to 15-20 years.
Q: What are the main complications after a hip replacement?
Medical complications:
- heart attack, stroke, blood clots, kidney and lung problems
Surgical complication:
- Infection: 1%
- Dislocation: 2-3%. This happens when the new ball jumps out of the socket. The surgeon can reduce the risk by using a large ball hip replacement.
- Leg length discrepancy: 5%. The surgeon plans every operation to ensure equal leg length after the operation. However, it is not always possible due to various factors. The surgeon will discuss this before the operation.
- Nerve injuries: 1%. The surgeon makes every effort to avoid damaging any of the large nerves near the hip joint. In rare circumstances they can be permanently injured.
- Fractures: The bones around the new hip joint can break either during the operation or at any time afterwards. This might require another operation
|
