Total hip replacement (THR), also known as total hip arthroplasty, is a surgical procedure to replace a damaged or diseased hip joint with an artificial implant. This procedure is typically recommended for individuals with severe hip pain and limited mobility due to conditions such as osteoarthritis, rheumatoid arthritis, avascular necrosis, or hip fractures.

Common Symptoms

• Chronic hip pain, especially during weight-bearing activities
• Stiffness and limited range of motion in the hip joint
• Difficulty walking or bearing weight on the affected leg
• Swelling and tenderness around the hip joint
• Reduced quality of life and inability to perform daily activities

Cause & Anatomy

• Osteoarthritis: Degenerative wear-and-tear of the hip joint cartilage.
• Rheumatoid arthritis: Autoimmune disease causing inflammation and damage to the joint.
• Avascular necrosis: Death of bone tissue due to interrupted blood supply.
• Hip fractures: Breaks in the bones of the hip joint due to trauma or injury.

Anatomy

• Hip joint: A ball-and-socket joint formed by the femoral head (ball) and the acetabulum (socket) of the pelvis.
• Articular cartilage: Smooth tissue covering the surfaces of the bones in the joint, allowing for smooth movement.
• Synovial membrane: Thin lining of the joint capsule that produces synovial fluid, lubricating the joint.

Diagnosis

• Physical examination: Assessment of hip pain, range of motion, and stability.

Imaging tests:

• X-rays: To visualize the extent of joint damage and deformity.
• MRI or CT scans: To assess soft tissue damage and evaluate the surrounding structures.

Prevention

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Types Of Implants

• Metal-on-polyethylene: Metal femoral head articulating with a plastic (polyethylene) acetabular cup.
• Ceramic-on-ceramic: Ceramic femoral head articulating with a ceramic acetabular cup.
• Metal-on-metal: Metal femoral head articulating with a metal acetabular cup.
• Hybrid: Combination of different materials for the femoral head and acetabular cup.

Surgery

• Preparation: The patient is positioned on the operating table, and anesthesia is administered.
• Incision: An incision is made over the hip joint to access the damaged joint.
• Hip dislocation: The femoral head is dislocated from the acetabulum.
• Bone preparation: The damaged bone and cartilage are removed from the acetabulum and femur to prepare them for the implant.
• Implant placement: The artificial components (acetabular cup, femoral stem, and femoral head) are secured in place with cement or press-fit technique.
• Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Rehabilitation

• Hospital stay: Typically 1 to 4 days, depending on the patient’s overall health and progress.
• Physical therapy: Exercises to improve strength, flexibility, and mobility begin soon after surgery and continue for several weeks.
• Gradual return to activities: Most patients can resume light activities within a few weeks and gradually increase activity level under the guidance of their healthcare provider.
• Follow-up appointments: Regular check-ups with the surgeon to monitor healing and function of the hip joint.

Complications

• Infection: Risk of surgical site infection, especially in the weeks following surgery.
• Dislocation: The artificial hip joint may become dislocated, particularly in the first few months after surgery.
• Implant loosening: The artificial components may loosen over time, requiring revision surgery.
• Leg length discrepancy: A difference in leg length may occur due to surgical technique or implant positioning.
• Blood clots: Risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) after surgery.

Long-Term Outlook

• Pain relief: Most patients experience significant reduction or elimination of hip pain following total hip replacement.
• Improved mobility: Restoration of hip joint function allows for improved range of motion and mobility.
• Longevity of implants: Modern implants can last for 15-20 years or more with proper care and follow-up.

FAQ’s

How long does a total hip replacement surgery take?
The surgery typically takes about 1 to 2 hours, but the total time in the operating room may be longer including preparation and recovery.

What activities should be avoided after total hip replacement?
High-impact activities such as running, jumping, or heavy lifting should be avoided. Low-impact activities like swimming, walking, and cycling are usually recommended.

Can a total hip replacement be done using minimally invasive techniques?
Yes, minimally invasive hip replacement techniques involve smaller incisions and less disruption of surrounding tissues, resulting in potentially faster recovery and less scarring.

How long does it take to fully recover from a total hip replacement?
Recovery time varies, but most patients can resume light activities within a few weeks and return to normal activities within 3 to 6 months.

Are there any restrictions on driving after total hip replacement surgery?
Patients should avoid driving until they are no longer taking opioid pain medications, have good control of the vehicle, and can perform emergency maneuvers comfortably. This typically takes 4 to 6 weeks.

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