Hip Replacement (THR)

Overview

 

Hip replacement surgery involves removal of the damaged part of the hip joint and replacing that with metal alloys, ceramic or hard by smooth plastic polymer lining. The artificial joint provides a pain free mobile joint. Replaced hip behaves as a normal hip in terms of movement once the initial post-surgery stiffness of the muscles settle.

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When to get Hip Replacement done?

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Osteoarthritis. Advanced stages of hip arthritis with severe pain, limitation of mobility affecting the daily activities would warrant a hip replacement.

Rheumatoid Arthritis. Persistent hip pain inspite of good control of rheumatoid arthritis affecting the activities of daily living warrant a hip replacement.

Avasular necrosis of Hip. Advanced stages of AVN hip with persistent pain needs a hip replacement.

Hip Dysplasia. With pain and limited mobility warrants a hip replacement.

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What symptoms warrant surgery?

 

• Persistent pain

• Night pain

• Limited mobility due to pain

• Difficulty with activities of daily living due to stiffness and pain

 

Risks

 

Any surgery would involve certain risks however the risks with hip replacement are low.

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Fracture. During the surgery there is a small risk of fracture of the thigh bone or the socket. Small fractures usually heal. Larger fractures though rare, may need further fixation with plates or wires.

Infection. Risk of infection is low with the advanced techniques and improvised theatre environment. Infection if picked up early, are likely to respond to antibiotics. In some instances it may need further washout or even removal of the implant.

Nerve Damage. Rare, but can lead to numbness or weakness down the leg. In most patients, that recovers within 3 months.

Clots in legs and lungs. To prevent clots (Deep vein thrombosis and pulmonary embolism), medications are given for first 45 days post-surgery.

Stiffness. Stiffness of the muscles is common post-surgery and needs good physiotherapy support.

Dislocation. Hip dislocation is a condition where the ball jumps out of the socket. If it happens repeatedly, then may need a further surgery to stabilize this.

Change in leg length. Leg length may differ by 1 to 3cm post-surgery. Small differences are often not noticeable. However, if that affects the mobility, a shoe raise may be needed.

Loosening of the implants. This is expected to happen in some patients usually after 15 years post-surgery. If it becomes painful, may then need a revision hip replacement surgery.

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Preparing for the surgery

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A good control of medical conditions such as diabetes and blood pressure is required. In addition to that a thorough check up by the physician and advice regarding the dosage of the medications and any alterations to that the days before and after the surgery needs to be taken. Stopping smoking is necessary as smoking affects the healing of the surgical wound.

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Total Hip Replacement surgery

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The surgery is either performed with injection in the back to numb the legs or alternatively under general anaesthesia where you are put to sleep for about the 2 hours of surgical time. Post-surgery you can expect to see a large dressing on the side of you hip. Lying down on the back with legs separated by a pillow for first 2-3 days is expected.

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Post-Surgery

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Post-surgery you can expect rehabilitation to start early. On the day 1 Physiotherapists will ask you to move your ankles and press your knee down. On day 2, you can expect to sit on the edge of bed also take a few steps with the help of walker and the physiotherapist. A stay of 3 to 5 days in hospital is expected. You can expect to walk comfortably without a walker support by 2 to 3 weeks.

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