What is Total Hip Replacement?
Any patient who is advised Total Hip replacement starts looking for Best Hip replacement Surgeon in India or Best Hip Replacement Surgeon in Delhi. Moreover, they have curiosity to understand as to What is Total Hip replacement? Let me answer, What is Hip Replacement, elaborately.
Total Hip Replacement or Total Hip Arthroplasty is the removal & replacement of damaged femoral head (ball of thigh bone) and damaged lining of socket in pelvis bone (Acetabulam) that join to form the hip joint. In Total Hip Replacement surgery the surgeon replaces the old, damaged joint with a prosthesis or an artificial Joint. The damaged cartilage and ends of the bones of the hip joint are removed. To understand it better we need to understand the fact, what is hip joint?
What is Hip Joint?
The hip joint is formed by junction of two bones, the thigh bone (Femur) and hip girdle bone (Pelvis). In simple terms it is a junction where the hip bone & thigh bone meet & glide over each other. Hip Joint has a lubricating weight bearing layer called the cartilage. This cartilage layer helps in frictionless movement of this junction. It is a ball & socket joint which means a rounded ball like end of one bone (Thigh bone) fitting into a cup like socket of another bone (Pelvic Bone).
What actually is Cartilage? The lubricating layer between the two bones is actually is CARTILAGE, which is not liquid. It is in the form of a layer at the upper end of femur (thigh bone) and lower end of pelvis (Hip bone). It is like having a capping at the end of bones forming the hip joint (see the pictures below). Normal (uninjured and youthful) cartilage is like glass or ice — very smooth. The ball moves very easily in the socket because the smooth cartilage-covered surfaces rub against each other like ice on ice or glass on glass i.e. Frictionless !!!!!
How does the Hip Work?
This ball and socket joint acts much like a car’s ball joint connecting the wheel to the axle allowing you to turn in different directions while supporting the body. The ball is at the upper end of your thigh bone and this fits into a socket . Cartilage covers the ball and lines the socket allowing the ball to move easily in the socket. You are given only one coating of this cartilage in your lifetime; when it is damaged or worn out it cannot repair itself!!!!
Hip replacement is mainly done to relieve hip pain & stiffness caused by arthritis or any injury. A new joint is created using an artificial ball made of Metal or Ceramic and very strong plastic liner in a cup. The cup replaces the worn hip socket of the pelvis. The new ball is attached to a stem that fits into the femur and may be cemented in place with special bone cement. In uncemented version of Total Hip replacement, the metal stem has a porous surface that the bone grows into as it heals to create bonding between thigh bone and stem.
Causes of damage to the Hip Joint
The hip joint can be affected by various types of arthritis or trauma. These are :
i. Osteonecrosis or Avascular Necrosis of Femoral Head leading to degenerative Arthritis (bone death caused by inadequate blood supply)- It is a condition that happens when there is loss of blood to the bone. Because bone is living tissue that requires blood, an interruption to the blood supply causes bone to die. If not stopped, AVN can cause the bone to collapse. It most often affects your hip. In India, not uncommonly caused by excessive consumption of Alcohol.
ii. Inflammatory or Rheumatoid arthritis — It is an inflammation of the synovial membrane and persistent inflammation of synovial membrane leads to cartilage damage and arthritis.
iii. Traumatic arthritis- It is an arthritis due to injury, may cause damage to the cartilage of the hip.
iv. Osteoarthritis — This disease, in hip joint per se, is very uncommon in India. It is a degenerative joint disease that affects mostly middle-aged and older adults. It may cause the breakdown of joint cartilage and adjacent bone in the hip. The most frequent reason for osteoarthritis is genetic, since the durability of each individual’s cartilage is based on genes. If your parents have arthritis, you may also be at risk of suffering from degenerative joint disease or it may be a result of your own anatomy
Diagnosis
The diagnosis of Hip Arthritis is done by a detailed medical history, performing a physical examination, and X ray of the affected joint. Usually, a X ray is sufficient to establish a diagnosis of arthritis as it reveals the presence and extent of the problem. In some cases a Hip Replacement Surgeon might ask for MRI or CT Scan.
Indications for Hip Replacement Surgery
- Moderate to severe arthritis of the hip joint, that causes pain and/or interferes with activities of daily living like walking, going up stairs, and bending to get in and out of a chair.
- Pain is moderate to severe even while resting, and may affect sleep.
- Stiffness of hip joint affecting the hip’s range of motion during normal activities. The person may have a limp.
- Symptoms are not adequately relieved by conservative treatment
The goal of Hip Replacement Surgery is to resurface the parts of the Hip joint that have been damaged and to relieve Hip pain that cannot be controlled by other treatments. The procedure involves cutting away damaged bone and cartilage from your thighbone & hip bone and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers. As a result of this surgery, the hip function is improved, pain is removed and mobility is enhanced.
Following are the few types of Hip Replacements
1. Uncemented Total Hip Replacement- In this type of surgery, the implants are specially textured to allow the bone to grow onto it and adhere to it over time. The Uncemented THR is also called a press-fit prosthesis, in which the initial fixation is achieved by inserting a prosthesis press fit in the prepared bone bed. Later on new bone forms over the implants, forming a biological bond between bone and implant, providing secondary long term stability.
2. Cemented Total Hip Replacement- It involves the usage of fast-drying bone cement to help hip replacement implants affix it to the bone. The cemented THR involves the use of polymethylmethacrylate (PMMA or Bone Cement) to function as a filler, producing an interlocking fit between cancellous bone and prosthesis for long term stability.
3. Hybrid Total Hip Replacement Where only one part is fixed with cement (usually the stem) it’s known as a Hybrid Hip Replacement. It is a variation that employs cemented fixation of the femoral component and cement less fixation of the acetabular component. It consists of cemented stems and cement less cup. Cement less prostheses although the most expensive, with hybrid prostheses are also quite popular.
Majority of surgeon prefer Uncemented Total Hip Replacement implants. But if bone quality is poor, a surgeon may choose cemented or Hybrid implant to get stability of implants with the use of Bone Cement.
4. Articular Surface Replacement — Articular Surface Replacement was designed to be the most bone-preserving hip resurfacing permitting high demand activities like sports, skiing and impact sports. However it fell into disrepute because of Metal on Metal Complications. Many companies have withdrawn it.
5. Revision Hip Joint Replacement Surgery: Once an Artificial Hip replacement has lived its life, it may require revision. In revision surgery, the original hip joint replacement components are removed and replaced with new ones. Revision surgeries are more complex. Revision Implants are also larger and costly. In majority of cases, hip joint will last two or three decades, or may be more. Sometimes the joint fails when too much stress is placed on it over time. It is extremely important to follow the long term precautions to protect your joint.
Common Myths about Hip joint pain & Hip Replacement Surgery
Advances in surgical techniques have brought a huge change to the approach to surgery for a hip replacement & the quality of implants has also improved over the years. That is why thousands of patients are benefitted from this treatment. Below are some common myths related to Hip pain & Hip replacement Surgery
- Hip arthritis is an unavoidable part of aging and one has to deal with the condition — Arthritis of hip bone affects millions of people every year. But fear of surgery & myths related to the process of aging makes them suffer in silence. They manage their life on cortisone injections and pain killers.
- A hip replacement will feel ‘artificial’ -There has been much change in the technique & technology used for hip replacement. The design of prosthesis and the techniques of surgery have advanced so much that majority do not feel that one has had surgery after one year.
- Better to delay the time of surgery as much as possible- Many patients fear that after surgery, they cannot resume normal physical activity, so they delay surgery and suffer from pain and immobility. But the fact is that surgery does not impact the quality of life of a person and more and more young persons are seeking the procedure.
- Hip replacement surgery is only for the old- Two decades back, the hip replacement did not last for more than 20 years. Hence surgeons would not conduct this procedure on persons below fifty. But with progress in technology, the impact of the surgery is found to last more than 20 years. Hip replacement is thus a powerful procedure to help young persons who want to stop suffering and enjoy a normal life.
- All surgeries for replacement of hips are similar and use the same type of prosthetics- the type of prosthetics and the surgical techniques depends on the advice of your surgeon based on the extent of hip damage and your overall status of health. Some are advised open procedure while others, minimally invasive techniques.
- The more severe your hip arthritis, the less effective will be hip replacement- Any patient who suffers from the damage of hip joint causing pain and immobility can benefit from surgery for hip replacement.
- You may be immobile for weeks after surgery- with new techniques of surgery and prosthetics, patients are able to walk the after one day from the surgery. This depends on the type of surgery and the health of the patient. A physical therapist can help you be mobile and driving within 6 to 12 weeks of the surgery. But full recovery may take about 3 to 6 months.
Before undergoing surgery, you may hear and read a lot of things which may sound scientific and accurate, but you should always verify before believing in these myths. Hip replacement surgery not only saves you from the unbearable pain of arthritis but also helps you to stand up again and leave that wheelchair and stick of yours for good.
Key factors to consider for choosing Best Hip Replacement Surgeon or Best Joint Replacement Surgeon:
i. Expert Joint Replacement Surgeon- The surgeon must be qualified and enough experience in joint replacement to ensure the best possible surgery.
ii. Volume Surgeon: Doing Sizeable number of Hip Replacement annually.
iii. Appropriate Infrastructure for the surgery & infection control practices.
iv. Has a plan and full support for surgical wound care, dressing, rehabilitation & physiotherapy after surgery.
v. Availability of 24X7 support & guidance after the surgery
About Author
Prof. Dr Anil Arora
Minimally Invasive, PINLESS Computer Navigated
Advanced Knee and Hip Replacement Surgeon
Senior Director & Chief Surgeon
Prof. Arora Knee and Hip Surgery Clinics
Branches: Delhi-92 & Indirapuram
Head of Department & Principal Consultant
Dept of Orthopaedics and Joint Replacement
Max Super specialty Hospital, Patparganj, Delhi
Contact: 011–42141516, 22378910, 9650100800, 9292929236
www.jointreplacementdelhi.in
Email: aakneehip@gmail.com
