Total hip replacement
What is a total hip replacement ?
Total hip replacement is an operation by which the damaged hip joint surfaces are substituted by artificial parts.
This surgery is necessary in various conditions in which the hip joint is damaged, as in arthritis, rheumatoid arthritis, aseptic osteonecrosis and others.
Above, radiogram of a normal hip joint: the joint space is clearly visible.
Below, radiogram of a hip with arthritis: the joint space has disappeared, and the femoral head appears "worn out".
In such a case, there is considerable pain and the walking capacity is greatly diminished
First, the femoral head is removed; then, a metal stem is inserted in the femur, and a ball is fixed on top of the stem. A titanium cup is inserted into the acetabulum (pelvis), which will then receive the ball, thereby reconstituting a friction-less joint.
Preparation to the surgery
Before surgery, you need to go to your family doctor for a check-up. It will help our anesthetists to choose the anesthetic tecnique that is most appropriate for you.
In order to diminish blood loss during surgery, non-steroidal anti-inflammatory drugs such as Aspirine, Voltaren, Ponstan, Olfen, Brufen, Tilur must be discontinued 10 days before surgery.
Some physiotherapy may be prescribed preoperatively, in order to improve muscle strength and to get comfortable with crutches.
For total hip replacement, patients usually are hsopitalised the day before surgery around 4 PM. The anaesthetist will examine you and discuss different option, and you will choose the method of anesthesia that is best suitable for you. The surgery can be performed under general or epidural anesthetic.
I perform this surgery with the patient lying on the opposite side. The incision is lateral, and curves towards the buttock at the top. The procedure lasts about 2 hours.
You will stay in recovery room for about 2 hours, after which you will be brought back to your room. The day after surgery will be spent resting in bed for transfusion and pain control. 1 or 2 suction drains will be kept until day 3 to avoid hematoma formation. in some cases, a urinary cathether is inserted during the anesthesia, and removed after 2 to 3 days.
On day3, a physical therapist will get you up and start walking exercises with full weight-bearing on two crutches. These are to be used for about 3 to 6 weeks, and be discontinued progressiveley as you make progress and gain self-confidence.
Postoperative pain is usually limited to the lateral aspect of the thigh, they are not all too intense and diminish steadily from day one onwards.
Some mouvements must be avoided in the early rehabilitation, in order to prevent dislocation of the prothesis. The physical therapist will show you which mouvements to avoid.
one must be poarticularly cautious when standing up from a low sitting position, clinmbing in or out of a car, and picking something up from the ground.
Deep vein thrombosis (DVT) (obstruction of a vein of the leg by a blood clot): in order to lower the risk of DVT, a blood-thinning medication must be taken for 4 weeks after surgery (one subcutaneous injection per day).
Infection: even long after your surgery, the prosthetic joint can become infected, particularly if you have a severe infection (pneumonia, or septicaemia for example). During the first year after implantation, it is recommended that you take oral antibiotics before and after dental surgery or dental cleaning, coloscopy, gastroscopy, cystoscopy or sinuscopy.
Follow-up visits of you new hip are performed 4 weeks and 3 months after surgery, then every year.
Some prosthetic parts may ring in metal detectors at airports or at building doors. A certificate will be issued to you, attesting that you bear a metallic implant in your hip.
After 3 to 6 months, alomst all aspects fo everyday life have usually been resumed. Some sports are to be avoided: all ball sports, long-distance running, tennis, squash.