Hip Arthroplasty
Total Hip Arthoplasty
Welcome to the Total Hip Arthoplasty section. The pages are laid out in the same order as treatement will take place so to read about the procedure for the first time choose introduction and follow on from there.
Total Hip Arthroplasty - Introduction
What is Total Hip Arthroplasty ?
Total hip arthroplasty is undertaken for hip arthritis. With age or following rheumatoid arthritis the weight bearing surfaces of the hip joint become worn away. They are no longer smooth and free running and this leads to stiffness and pain. Eventually the joint wears away to such an extent that the bone of the femur grinds on the bone of the pelvis or acetabulum. Joint replacement is then required. New technology, new techniques and new types of hip replacements have made this procedure in recent years very successful and the results are now very reliable.
Total Hip Arthroplasty - Indications / Contra-indications
Anatomy / Ailment detail
The hip comprises the joint between the upper end of the femur and the pelvis or acetabulum. Either or all of these parts of the hip may be affected by arthritis to various degrees. The procedure of joint replacement includes removing the affected joint surfaces and replacing them with metal components usually with a high-density polyethylene-bearing surface between the metal components. The metal components are usually (but not always in special circumstances) cemented to the bone. Using new techniques often joint replacement may be undertaken using minimal access surgery utilising much smaller incisions than previously utilised. This assists with rapid recovery and return of function.
Who Needs it / Who Doesn't ?
The symptomatic arthritic patients with pain, limp, deformity or a restricted function are those which should consider hip replacement. The symptoms include hip pain, or alternately pain is commonly experienced in the buttock, groin, lower thigh or in the knee joint.
Total Hip Arthroplasty - Non-operative Treatment
Management usually includes a detailed history of the condition, details of the current symptoms and disability, current and previous medications and past medical history. Clinical examination is undertaken by Mr. Johnson and subsequently radiographs or MRI scans can be arranged if necessary.
Total Hip Arthroplasty - Surgery
Prior to Surgery : -
Walking Aids: - If pain is experienced during walking this may be eased in several ways. A walking stick may be helpful when used in the opposite hand to the painful hip. If there is a difference in the length of your legs, help may be gained by a shoe raise on one side. This can be manufactured to fit un-noticed into your shoe.
Surgical Technique : -
A general anaesthetic is generally used, sometime a spinal injection is preferred. To be able to replace the hip joint an incision is made down the side of the hip and the joint is opened. The length of incision may vary from 5-10 cm if minimally invasive surgical techniques are used to 15 - 20 cm in conventional surgery.
Minimally Invasive Surgery (MIS) : -
Minimally invasive surgery involves the use of smaller wound incisions and special instrumentation to enable surgery to be undertaken. These techniques can result in advantages in respect to improve the speed of recovery, speed of mobilization, shorten hospital stay reduce the period off work and reduce the time until functional and sporting activities can be resumed.
Wound Dressing and Sutures : -
The wound dressing which is applied in theatre may be removed after 4 days if the wound is satisfactory. The sutures should be removed by the General Practitioner or Practice Nurse after 12 days. Sometimes arrangements are made for patients to return directly to the hospital for this.
Total Hip Arthroplasty - Recovery and Rehabilitation
Medication : -
If the joint replaced was the only area of arthritis no further anti-inflammatory tablets will be required. If other joints are affected or you suffer from rheumatoid arthritis, the tablets may be restarted if possible after an interval of 6 weeks. Pain killers may be taken during this time.
Physiotherapy : -
After 1 days the physiotherapist will get you out of bed to commence walking with the help of crutches or a walking frame. The physiotherapists will also begin to encourage you to bend the hip and knee.
Results and Complications
Modern techniques and technology ensure that the complication rate is minimal. Beside the anaesthetic risks, which are very low, infection that involves the joint is less than 1:200. This would present as the hip becoming hot, swollen, throbbing and painful after 2-4 days, or alternatively at any period thereafter. Venous thrombosis is in the order of 1:5. To avoid thrombosis anti-coagulant therapy will be given for a short period after the operation. Thrombosis presents with a swollen, tender calf muscle, or intermittent pain in the chest on deep breathing. There is a risk to the major vessels and nerves of the hip, but this is very rare.
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