- Types of hip replacement procedures
- What to expect from hip replacement surgery
- Hip replacement procedure
- Care after surgery
Types of Hip Replacement
1 Uncemented Total Hip Replacement: Both the socket and the stem components are fitted into the bone without using acrylic bone cement. This is a precision operation and the bone grows into the surface of the components holding them securely. This type of replacement is advised for younger patients.
2 Cemented Total Hip Replacement: Both the socket and the stem are fixed into the bone using acrylic bone cement. This is advised for elderly patients above the age of 65 years.
3 Hip Surface Replacement: Instead of sacrificing the worn out head of femur (ball), only the surface is shaved off and a new surface is fitted onto the socket and the head of femur. This is a bone preserving operation that allows patients faster recovery and patients can have full range of movements allowing them to squat and sit cross legged.
What to Expect from Hip Replacement Surgery
An important factor in deciding whether to have hip replacement surgery is understanding what the operation can and can't do. The vast majority of individuals who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. However, hip replacement surgery will not enable you to do more than you could before your hip problem developed. For example if you could not run for 5 kilometers before your hip problem started, do not expect to do so after your surgery.
Following surgery, you will be advised to avoid certain activities for the rest of your life including jogging and high-impact sports.
Even with normal use and activities, an artificial joint (prosthesis) develops minimal wear over time. If you participate in high-impact activities or are over-weight, this wear may accelerate and cause the prosthesis to loosen and become painful.
Hip Replacement Surgical Procedure
You will most likely be admitted to the hospital on the day before your surgery. After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia for hip replacement surgery are general anesthesia (which puts you to sleep throughout the procedure) or spinal anesthesia (which allows you to be awake but anesthetizes your body from the waist down). The anesthesia team will discuss these choices with you and help you decide which type of anesthesia is best for you.
Surgical Procedure: The surgery itself takes about 90 minutes. However preparation and anesthesia before surgery and recovery after surgery will keep you in theater for a total of about three hours. Your orthopedic surgeon will remove the damaged cartilage and bone, then position new metal and plastic joint surfaces to restore the alignment and function of your hip.
Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal) and the socket component (a durable plastic cup which may have an outer metal shell).
Acrylic surgical bone cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint.
A noncemented prosthesis has also been developed which is used most often in younger, more active patients. The prosthesis may be coated with textured metal or a special bone-like substance which allows bone to grow into the prosthesis.
A combination of a cemented ball and a noncemented socket may be used.
Your orthopedic surgeon will choose the type of prosthesis that best meets your needs.
After surgery, you will be moved to the recovery room where you will remain for one to two hours while the recovery from anesthesia is monitored. After you awaken fully, you will be taken to your hospital room.
Things to Take Care After Surgery
Your Stay in the Hospital
You will stay in the hospital for a few days. After surgery, you will feel pain in your hip. Pain medication will be given to make you as comfortable as possible.
To avoid lung congestion after surgery, you will be asked to breathe deeply and cough frequently.
To protect your hip during early recovery, a positioning splint, such as a V-shaped pillow placed between your legs, may be used.
Walking and light activity are important to your recovery and will begin the day after your surgery. Most hip replacement patients begin standing and walking with the help of a walking support and a physical therapist the day after surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.
Possible Complications After Surgery
The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2 percent of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit your full recovery.
Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. Your orthopedic surgeon may prescribe one or more measures to prevent blood clots from forming in your leg veins, such as special support hose, inflatable leg coverings, and blood thinners.
Your Recovery at Home
The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery.
Wound Care: You will have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed about two weeks after surgery.
Avoid getting the wound wet until it has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.
Diet: Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.
Activity: Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within three to six weeks following surgery. Some discomfort with activity, and at night, is common for several weeks.
Your activity program should include:
- A graduated walking program initially in your home and later outside.
- Walking program to slowly increase your mobility and endurance.
- Resuming other normal household activities.
- Resuming sitting, standing, walking up and down stairs.
- Specific exercises several times a day to restore movement.
- Specific exercises several times a day to strength your hip joint.
- May wish to have a physical therapist help you at home.
Avoiding Problems After Surgery
Blood Clot Prevention Follow your orthopedic surgeon's instructions carefully to minimize the potential risk of blood clots which can occur during the first several weeks of your recovery.
Warning signs of possible blood clots include: Pain in your calf and leg, unrelated to your incision. Tenderness or redness of your calf. Swelling of your thigh, calf, ankle or foot. Warning signs that a blood clot has traveled to your lung include: Shortness of breath.
Chest pain, particularly with breathing.
Notify your doctor immediately if you develop any of these signs.
Preventing Infection
The most common causes of infection following hip replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your prosthesis.
Following your surgery, you should take antibiotics prior to dental work, including dental cleanings, or any surgical procedure that could allow bacteria to enter your bloodstream.
Warning signs of a possible hip replacement infection are: Persistent fever (higher than 100 degrees orally). Shaking chills. Increasing redness, tenderness, or swelling of the hip wound. Drainage from the hip wound. Increasing hip pain with both activity and rest.
Notify your doctor immediately if you develop any of these signs.
Avoiding Falls
A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails, or have someone help you until you improve your balance, flexibility and strength.
Your surgeon and physical therapist will help you decide what assistive aides will be required following surgery, and when those aides can safely be discontinued.
Other Precautions
To assure proper recovery and prevent dislocation of the prosthesis, you must take special precautions. Do not cross your legs. Do not bend your hips more than a right angle (90 degrees). Do not turn your feet excessively inward or outward. Use a pillow between your legs at night when sleeping until you are advised by your orthopedic surgeon that you can remove it. Your surgeon and physical therapist will give you more instructions prior to your discharge from the hospital.
