Hip Replacement: Principles, Operation, and Aftercare

When is a hip replacement recommended?

Hip replacement surgery is primarily performed due to the progressive effects of severe arthritis on the hip joint. The most common type of arthritis leading to total hip arthroplasty is degenerative arthritis (osteoarthritis) of the hip joint. This type of arthritis is typically associated with aging, a congenital abnormality of the joint, or a previous injury to the joint.

Other conditions that may lead to a hip replacement include bone fractures, rheumatoid arthritis, and avascular necrosis of the hip bone. Necrosis of the hip bone can be caused by a hip fracture, medications (such as prednisone and prednisolone), alcoholism, and systemic diseases (such as systemic lupus erythematosus). The progressive increase in chronic pain, along with difficulty performing daily tasks such as walking, climbing stairs, and even getting up, are some of the reasons to consider a total hip replacement. A hip replacement can wear down over time, making the decision to proceed with surgery not easy, especially for younger patients.

Total hip arthroplasty is generally considered when pain becomes so severe that it prevents a normal life despite the use of anti-inflammatory drugs or analgesics. This is elective surgery, meaning it's an option among others.

The decision must be made with knowledge of the potential risks and benefits. A thorough understanding of the procedure and the expected outcome is an important part of the decision-making process with the orthopedic surgeon.

GET A QUOTE

For more information

Different types of hip replacements

Total Hip Replacement

The traditional surgical approach to total hip replacement involves a large incision with significant exposure of tissues to access the hip joint.

In contrast, in the minimally invasive approach, it is possible to replicate the same procedure through a smaller incision (6-10 cm) in the anterior aspect of the hip, following the groin crease. This approach avoids cutting or detaching the important muscles of the hip (they are only retracted), which reduces postoperative limitations, blood loss, and muscle pain after hip replacement.

This approach, when performed by a specialized team, offers great advantages for recovery.

According to arthroplasty registry data, 80% of total hip replacements last at least 15-20 years. Newer prostheses with ceramic implants have a potentially longer lifespan due to their low wear.

There is limited scientific literature on the types of sports permitted after a hip replacement. Most recommendations are not based on objective data. Generally, only low-impact sports such as swimming, golf, cycling, hiking, etc., are allowed.

It is unclear whether hip prosthesis wear increases with high-impact activities, especially with low-wear implants.

Partial Hip Replacement

Partial hip replacement has a narrow implantation range and is limited to elderly or very frail patients with a mid-cervical femoral fracture. It consists of an acetabular component with an already installed insert and head, which does not require additional surgical work on the pelvis (it's simply pressed in). The femoral stem receives the same preparation as a total hip replacement. It involves less blood loss and fewer complications.

The skin incision extends approximately 10 to 15 cm over the greater trochanter, as does the underlying fascia latae and gluteal fascia. The hip rotator muscles are then detached and reattached using suture thread so they can be reinserted at the end of the procedure. The capsule is incised, the head is removed, and the neck is adjusted at the rima.

After a simple excision of the acetabular labrum, we proceed directly to the femoral phase, without performing other surgical procedures at the pelvic level, so that the femur is reamed and broached in the canal to the desired implant size. The osteointegrated titanium stem (cementless) is then positioned and the metal head is placed on the neck, onto which a second large metal head is mounted, inside which is a polyethylene insert to avoid metal-on-metal contact between the heads. Once the large head is lodged in the acetabulum, the rotator muscles are re-inserted and the strips and skin are sutured.

Hip braces and orthoses

A hip orthosis is a medical device that is worn externally. It is designed to stabilize, control, or correct the affected area. Orthoses are prescribed by a physician, who usually consults with a professional orthotist to select the most suitable device. The type of hip orthosis chosen depends on your diagnosis and actual symptoms. Hip abduction orthoses incorporate abduction pads that prevent certain movement patterns and increase stability when walking, standing, or sitting. If your hip orthosis cannot provide the level of stability you need, you may need to wear a hip-knee orthosis or a hip-knee-ankle-foot orthosis (HKAFO).

Hip supports are more flexible than hip orthoses. They are made from highly elastic or semi-elastic materials. However, they still have a stabilizing effect as they compress the hip joint and slightly tighten it. Hip supports are often used to relieve the joint, either to treat an existing disorder or preventatively.

[dt_sc_button title="Free Quote" size="medium" style="bordered" icon_type="" link="url:https%3A%2F%2F127.0.0.1/tds%2Fdevis%2F" textcolor="#ffffff" bgcolor="#0c73ba"]