Total Hip Arthroplasty
Total hip arthroplasty is the complete replacement of a damaged hip with a prosthetic one. This surgery is performed to relieve pain and restore function to a hip deteriorated by osteoarthritis, rheumatoid or psoriatic arthritis, avascular necrosis, congenital abnormalities or traumatic injury. Total hip arthroplasty involves replacing the entire diseased joint, composed of the natural ball and socket and its protective cartilage. The damaged joint is replaced with a prosthetic hip, usually made of a metal ball and a plastic socket.
The artificial hip will help the patient to move more normally and without pain. While total hip arthroplasty has a very high rate of success (90-95 percent), this surgical procedure is normally considered only after more conservative treatments have proven ineffective.
The Total Hip Arthroplasty Procedure
A total hip arthroplasty is performed with an arthroscope under general anesthesia. Because of relatively new technology, an incision is made in the joint to carefully remove the damaged bone and the ends of the cartilage, and replace them with the prosthetic joint. The prosthesis may be cemented in place or remain uncemented. While cemented prostheses have more durability, they do not provide as much mobility as uncemented joints. The determination of which technique is best used will be decided during a presurgical consultation. The surgery lasts between two and four hours, followed by another few hours spent under observation in a recovery room.
The relatively new technology or arthroplasty has allowed for minimally invasive techniques to be employed during the hip replacement procedure. This allows for smaller incisions, into which a camera and tiny surgical instruments will be inserted for increased precision and accuracy. Patients reap the benefits of shorter recovery times and less scarring with minimally invasive total hip replacement.
After a total hip replacement, patients will stay in the hospital for a few days and will likely experience discomfort, swelling and bruising in the area for which pain mediation will be prescribed. The presurgical pain resulting from arthritis or other conditions, however, should be gone.
Physical therapy starts as soon as the first day after surgery with the goal of strengthening the muscles and preventing contracture or excessive scarring. Therapy begins with the patient sitting in a chair and progresses to stepping, walking and climbing stairs, first with crutches or walkers and then without supportive devices. Patients are encouraged to stand up and walk around as soon as they feel comfortable doing so. Occupational therapy and at-home exercises help patients learn how to function in everyday activities.
On average, artificial hips last 15-20 years, after which time the patient must have another surgery. Nonetheless, the great majority of patients who have undergone arthroscopic hip replacement are very well satisfied with their postsurgical level of comfort and their increased ability to perform necessary and enjoyable activities.
Risks Of Total Hip Arthroplasty
Most total hip arthroplasty surgeries are effective and patients heal well, gaining strength, agility and freedom from pain. As with any surgical procedure, however, there are some risks involved. In addition to the general risks of any operation, including excessive bleeding, blood clots and infection, hip arthroplasty may also, in rare cases, result in a dislocation or loosening of the prosthetic device, sensitivity to the metal in the device itself, nerve palsy, osteolysis, and postsurgical stiffness.
A hip fracture is a break in the upper part of the thigh bone (femur) where the bone angles toward the hip joint. The hip is a “ball-and-socket” joint where the “ball” at the top of the thigh bone (femur) fits inside the “socket” of the pelvis (acetabulum). It allows the upper leg to bend and rotate. Most hip fractures are caused by falls or an injury from direct impact to the side of the hip. Hip fractures are more common in elderly adults as a result of osteoporosis or bones that have weakened over time. In addition to advanced age, factors such as certain medications, chronic medical conditions, or a history of heavy tobacco and alcohol use, may weaken bones and make individuals more susceptible to hip fractures.
Symptoms Of A Hip Fracture
Immediately after a hip has fracture, the individual may find it difficult to stand and may experience the following symptoms:
- Severe pain in the hip and groin
- Inability to put any weight on the leg
- The leg may appear shortened or turn outward on the side of the injured hip.
Diagnosis Of A Hip Fracture
A hip fracture is diagnosed after a physical examination of the hip and leg as well as imaging tests that may include X-rays, CT scans or MRI scans. Imaging tests allow the physician to identify the exact location of the fracture and determine the severity of the broken bone.
Treatment Of A Hip Fracture
Treatment for a hip fracture often involves surgery. The surgical procedures may vary depending on the severity of the fracture, but may include:
- Surgery to insert screws and rods to hold the bone together
- Total hip replacement
- Partial hip replacement
Hip replacement surgeries involve replacing part of the femur bone or hip socket with prosthetic devices. After surgery, a physical therapy program is created to help the individual regain flexibility, increase range of motion and strengthen the hip and leg.
In rare cases, stable hip fractures may be treated through prolonged immobilization and bed rest. However, these instances are uncommon, and this form of treatment is usually only considered when the patient is too ill to undergo surgery.