How is a hip replacement performed?

Recreating a Joint

The hip is one of the most flexible and important joints in our body. It allows us to walk, run, and jump, climb and descend stairs. The hip bears a heavy load; it is the joint that bears the highest load of the entire body. It performs very important movements, supporting loads far exceeding body weight due to the muscle tension required to maintain balance.

The hip joint is composed of the acetabulum and the femoral head, the former concave and the latter spherical. Both are covered with articular cartilage.

A hip orthopedist can diagnose and treat problems with this crucial joint.

Hip joint pain can become severe enough to compromise a person's gait and quality of life.

Osteoarthritis, fracture sequelae, hip dysplasia, and vascular disorders (Perthes) can compromise the osteo-cartilaginous tissue, altering joint movement.

In moderate coxarthrosis, grafting mesenchymal or fat cells from abdominal adipose tissue is indicated. This regenerates articular cartilage, improves function, and reduces pain.

For significant coxarthrosis pain, or when surgery is undesired, hip radiofrequency is an option. An electrode “stuns” the femoral and obturator nerves, responsible for groin and thigh pain.

When walking becomes difficult and pain unmanageable, hip replacement is the best solution.

Minimally invasive techniques preserve periarticular soft tissues, reconstruct the articular capsule, reduce pain, and shorten recovery time.

The hip prosthesis has three elements: a ceramic head on a metal stem replacing the damaged femoral head; a cup (metal) replacing the pelvic cartilage; and a ceramic (or polyethylene) insert between the cup and head to facilitate sliding.

Minimally invasive techniques extend surgical indication to young people and athletes.

Convalescence is rapid; physiotherapy begins the same day, and walking resumes the same evening. Minimally invasive hip prosthesis offers advantages: selective peripheral anesthesia; minimal blood loss (transfusions are rarely needed); minimal postoperative pain; avoidance of dislocation risk; rapid discharge (as early as 4 days); and quick abandonment of aids like walkers and crutches (15-20 days). Driving can often resume quickly.

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Operated, then immediately rehabilitated

A thorough orthopedic assessment determines when hip surgery is necessary.

Specific treatment pathways address various causes, the three most common being:

• Osteoarthritis: The most common arthrosis, characterized by articular cartilage degeneration (“wear and tear arthritis”). Elderly patients experience pain and motor difficulties;
• Rheumatoid arthritis: An autoimmune disease affecting synovial joints, causing inflammation, stiffness, and joint deformation;
• Bone fracture: Hip fracture is frequent in the elderly. Depending on type and location, spontaneous healing may be insufficient to restore mobility;

Except for fractures, hip replacement is only recommended if severe pain or stiffness limits daily activities (walking, standing, sitting, dressing).

Surgical indication is based on pain and disability, not age. Most patients are 50-80, but surgeons evaluate individually.

Hip replacement aims to:

• Reduce pain;
• Improve joint mobility;
• Improve motor skills;
• Significantly improve quality of life;

However, it won't restore pre-osteoarthritis activity levels.

Normal use gradually wears down the prosthesis. Excessive activity or weight accelerates this, potentially requiring earlier replacement.

Sports involving direct or indirect hip trauma or contact are discouraged. Low-impact activities like tennis, running, swimming, and cycling are recommended.

Regardless of the reason, once the indication for hip replacement arises, surgery should ideally be performed as soon as possible for quicker recovery.

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