Hip Arthroplasty: Hip Replacement Surgery

Hip Arthroplasty: What is it?

Hip arthroplasty, or total hip replacement, is the surgical replacement of damaged bone and cartilage in the hip joint with a prosthetic implant that mimics the joint's natural mechanism as closely as possible. The procedure involves surgically removing the acetabular cavity of the pelvis and the proximal part of the femur (head and neck), which are replaced with artificial components made of metal alloys, plastics, and/or ceramics.

The hip prosthesis replicates both the form and function of the removed bone parts. The choice of prosthesis is always made in consultation with a specialist doctor, taking into account various parameters such as gender, age, severity of osteoarthritis, obesity, and other factors to select the most suitable implant.

Prosthetic orthopedic surgery effectively treats degenerative joint diseases, primarily osteoarthritis, and to a lesser extent, other disorders including arthritis and fractures. Thanks to new surgical techniques and materials, prosthetic surgery achieves lasting results: it can stop pain and restore mobility and functionality to the joint, and in younger patients, may allow the resumption of certain sporting activities.

Hip Arthroplasty: Who is it for?

It's important to note that surgery is generally only performed when the symptomatic stage of osteoarthritis is advanced, and the hip's condition is severe. The operation is indicated when conservative therapy, which may include physiotherapy and pharmacological treatment, has failed or was not possible.

When considering hip replacement surgery, several aspects related to the patient's medical history and the results of a thorough clinical examination must be evaluated. The underlying pathology leading to osteoarthritis, the patient's age, and previous medical conditions are all relevant factors that significantly influence this type of operation.

There is no weight or age limit for hip replacement; however, it's important to know that the implant is not permanent, and excessive weight may further reduce its lifespan. Furthermore, the indication for surgery is based on the patient's pain and disability, not solely on age. While most patients undergoing hip replacement surgery are between 50 and 80 years old, orthopedic surgeons assess patients individually.  

How is hip arthroplasty performed?

There are two main types of hip replacement surgery:

• Traditional Technique: In arthroplasty surgery using the traditional technique, the hip joint is accessed through three types of approaches: anterolateral, posterolateral, or lateral. The main advantage of this approach is the greater visibility and exposure of the joint during surgery, as the skin incision is larger;
• Minimally Invasive Technique: In the minimally invasive technique, the surgical procedure is very similar to the traditional procedure. However, the incision is smaller, meaning less tissue and bone are dissected. This allows for a shorter recovery time and a less visible postoperative scar compared to the standard technique;

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What is recovery like?

After hip replacement surgery, rehabilitation is crucial for regaining full joint mobility and independence. Joint mobility is the ability of joints to perform free and unrestricted movements without pain or limitation. It is essential for maintaining correct posture, developing strength in muscles, tendons, and joints, and establishing overall physical well-being.

The recovery time after a hip replacement greatly depends on the postoperative rehabilitation. While the postoperative period is much shorter than for a knee replacement, rehabilitation can last between 8 and 10 weeks. Sessions with a physiotherapist may take place 2 to 3 times a week, depending on the needs and specifics of each patient. Prohibited Hip Replacement Movements: Especially in the first few weeks following hip replacement surgery, it's best to avoid certain movements.

Prohibited Hip Replacement Movements:

• flexion of the joint beyond 90°;
• external movements of intrarotation and abduction, combined with maximum flexion load.

Therefore, during the first 8 to 10 weeks, certain precautions are necessary, such as:

• not putting on your own shoes and socks without a shoehorn (it's best not to squat with a hip replacement)
• not sleeping on the operated side and without a pillow between your legs (to avoid abduction of the joint)
• not driving;
• not crossing your legs;
• avoiding low chairs.

It is also necessary to use crutches for walking and to remove all obstacles in living areas, such as rugs, floor wax, and objects.

What are the risks and complications of hip arthroplasty?

As this is an invasive surgery, complications can occur, although they are very rare. The outcome of arthroplasty is generally positive and the risk rate is very low.

To be fully aware, let's examine the possible risks and complications associated with a hip replacement:

• Hip dislocation: This occurs when the implant head dislocates from its natural seat, the acetabulum;
• Infection is a risk that characterizes any surgical intervention: generally, the patient's immune defenses prevent this complication, but sometimes they are insufficient;
• One of the rarest risks is the appearance of thrombi in the leg veins: However, there are a number of procedures to prevent this risk, such as the use of anticoagulant medication, wearing elastic stockings during the postoperative period, and early mobilization;

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