Hip Replacement

What is hip replacement?
Hip Replacement Surgery- Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis.
Goals- The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.

What are the different treatment methods?

  • Traditional Surgery.
  • Minimally Invasive Surgery.
  • The Artificial Joint.
  • Cemented and Uncemented Parts


The two major types of hip replacement surgery: traditional and minimally invasive, also called mini-incision hip replacement.
Traditional Surgery- In a traditional surgery, the surgeon makes a 10- to 12-inch incision through some of the muscles around the hip to expose the joint. Then the surgeon removes the damaged bone and cartilage and replaces them with an artificial joint, or prosthesis.
Minimally Invasive Surgery: In minimally invasive surgery, the surgeon makes one or two much smaller incisions between the muscles. These incisions may be in the back, side, or front of the hip. The recovery time for the mini-incision surgery is shorter than for traditional surgery.
Doctors tend to recommend minimally invasive surgery for younger patients and those who are of normal weight and healthier than those who are candidates for traditional hip replacement surgery.
The Artificial Joint: The artificial joint will consist of two basic parts: a ball made of highly polished strong metal or ceramic material and a socket made of plastic, ceramic, or metal. The ball attaches to the top of the thigh bone, or femur; the new socket attaches to your pelvis.


Cemented and Uncemented Parts

  • These components come in two basic varieties: cemented and uncemented, which refers to the way the parts are attached to your existing bone.
  • Surgeons fasten cemented parts to existing, healthy bone with a special glue or cement. Uncemented parts rely on a process called biologic fixation to hold them in place. This means that the parts are made with a porous surface. Over time, the patient’s own bone grows into the holes in the joint surface to secure them.
  • Sometimes surgeons use an uncemented part for the socket and a cemented part for the femur. This combination is called a hybrid replacement.
  • Studies show that cemented and uncemented joints are similarly successful; however, doctors usually use cemented joints for older, less active people and people with weak bones.
  • Uncemented joints are often reserved for younger, more active people. The main disadvantage of uncemented joints is a longer recovery time because it takes time for bone to grow into the surface of the replacement part(s). Also, recovery may be more painful as bone grows into the prosthesis.


What are Hip Implants?
Hip implants are medical devices intended to restore mobility and relieve pain usually associated with arthritis and other hip diseases or injuries. Factors that influence the longevity of the device include the patient’s age, sex, weight, diagnosis, activity level, conditions of the surgery, and the type of implant chosen.
There are currently five types of total hip replacement devices available with different bearing surfaces. These are:

  • Metal-on-Polyethylene: The ball is made of metal and the socket is made of plastic (polyethylene) or has a plastic lining.
  • Ceramic-on-Polyethylene: The ball is made of ceramic and the socket is made of plastic or has a plastic lining.
  • Metal-on-Metal: The ball and socket are both made of metal.
  • Ceramic-on-Ceramic: The ball is made of ceramic and the socket has a ceramic lining.
  • Ceramic-on-Metal: The ball is made of ceramic and the socket is made of metal.


What is Hip Resurfacing?
Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a cobalt-chrome metal cap, which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup (similar to what is used with a THR) is placed in the acetabulum (pelvis socket), replacing the articulating surfaces of the patient's hip joint and removing very little bone compared to a THR. When the patient moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position. The surgeon's level of experience with hip resurfacing is most important; therefore, the selection of the right surgeon is crucial for a successful outcome. Health-related quality of life measures are markedly improved and patient satisfaction is favourable after hip resurfacing arthroplasty.

How is it diagnosed?
The diagnosis required before the procedure is:

  • Blood Tests
  • Urine
  • EKG
  • Chest X rays


What are the Recent advances in hip replacement surgery?
Advances in surgical technology have improved the longevity and recovery time for total hip replacement. Replacement surgery previously required a long posterior incision with an extended recovery time, usually three to four months.
Today, less invasive techniques, including the procedure known as a direct anterior total hip replacement, allow surgeons to replace the joint through one small incision made at the front of the thigh.
This approach provides a significantly shorter and faster recovery period. With this approach, the large gluteal muscles remain intact, which reduces the chances of dislocation. This advancement also allows patients to resume their normal activities much more quickly.
The advances in orthopaedic surgery also have improved the hip arthroscopy procedure.
Hip arthroscopy is a minimally invasive procedure done with two or three tiny incisions. Pencil sized instruments are placed in the hip and torn cartilage can be resected. In this manner, some patients can avoid joint replacement surgery. Those that have advanced arthritis can be treated with injection therapy or joint replacement.
Metal-on-metal implants in total hip replacement have been introduced with the goal of reducing wear particles and increasing the life of the total hip replacement. However, the newer designs are constructed with aluminumoxide ceramic, which promises lower incidence of breakage and wear.
The latest advanced technology, a percutaneously-assisted “SUPERPATH™” approach, involves sparing the surrounding muscles and tendons when performing total hip replacement surgery. This technique builds a traditional hip implant in-place without cutting any muscles or tendons. Additionally, this is done without having to dislocate the hip during surgery, a common element to all other hip replacement surgery techniques. The SUPERPATH™ hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. The advantages are:

  • Shorter recovery times
  • No activity limitations
  • Less pain
  • Decreased dislocation
  • Less scarring
  • More natural feeling hip


What is the Cost?

  • The cost for single hip replacement is 6000 USD and if both are replaced then the cost is around 11000 USD.


What is the success rate?

  • The success rate for hip replacement surgery in India is about 90-95 per cent.


What is the treatment duration?

  • The time required for the hip replacement is 2-3 hours whereas the hospital stay would last for 4-6 days. The patient would have to stay in the hospital for 4-6 weeks.


What are the precautions after the surgery?
Some of these precautions are:

  • Do not cross your legs when you are sitting, standing or lying down.
  • Sit in a firm chair with a straight back and armrests.
  • Avoid chairs that are too low. Your hips should be higher than your knees when you are sitting.
  • Avoid soft chairs, rocking chairs, stools, or sofas.
  • Do not dress, standing up. Sit on a chair or the edge of your bed, if it is stable.
  • Try not to sit in the same position for more than 30 to 40 minutes at a time.
  • You must have a pillow between your thighs if you lie on your side.
  • Lie on your back while resting in bed. Keep a pillow between your thighs to prevent your knees from touching.
  • Do not cross your legs.
  • Do not drive until your doctor says you may.
  • When you are bathing or showering, do not sit in the bottom of a regular bathtub. You may stand in the shower if you like. You can also use a special tub seat or a stable plastic chair for sitting in the shower.