What Does Hip Replacement Surgery Mean?
A surgical procedure of building an artificial hip with prosthesis or a hip implant in order to restore the functions of the joint is known as a hip replacement surgery. This procedure makes use of metals and plastics to replace the ball end and socket part of the joint. Wearing away of the joint can occur due decrease in synovial fluid causing friction during movements either due to ageing or infections. Dislocations are common due to trauma and accidents where surgery is the only option. Team MedcureIndia provides an insight into the subject to its readers in the following lines.
Causes of Hip Diseases:
- Congenital abnormalities, birth canal passage defects leading to childhood hip defects
- Autoimmune disorders like rheumatoid arthritis develop due to host cells
- Trauma in the form of accidents, fights leading to dislocations and fractures
- Friction as a result of inflammation in synovial fluid causes arthritis
- Wearing a way of cartilage surrounding the joint also leads to arthritis
Signs & Symptoms of Hip Diseases:
- Mild to severe pain and discomfort in the pelvic region
- Swelling and tenderness in and around the hip region.
- Limping while walking, difficulty while movements
- Limited unidirectional movements
Diagnostic Tests Prior To Hip Replacement Surgery:
- Medical history: It is a verbal questionnaire between the orthopedic surgeon and the patient concerned so as to gather information about the general health, degree of pain and stiffness and restricted movements of hip in daily activities.
- Physical examination: This helps the surgeon to palpate and confirm the findings of inspection. The hip mobility, strength and alignment are checked for in this step.
- Imaging techniques: To know the extent of deformity and also learn about the defect in the bony and soft tissue components of the joint, CT scan and MRI are also recommended apart from the x-rays taken routinely in various angels.
Types of Hip Disorders:
- Osteoarthritis: It is an age related wear and tear of the bony components of the joint, commonly seen in people above 50 years or in individuals with a family history of arthritis. As a result of wearing away of the cartilage, the cushioning effect goes away leading to pain and stiffness in the joint. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in prenatal period or early childhood prior to or during the fusion of ossification centers.
- Rheumatoid arthritis: It is an autoimmune disorder in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness.
- Post-traumatic arthritis: It occurs as a result of trauma or fracture of the hip. The cartilage may become damaged and lead to hip pain and stiffness over time.
- Avascular necrosis: As a result of injury to the hip, blood supply to the femoral head may get diminished. This leads to a condition called as osteonecrosis or avascular necrosis which may cause surface of the bone to collapse eventually leading to arthritis.
- Childhood hip disease: Some genetic mutations, congenital abnormalities, birth canal passage defects or disordered fusion of ossification centers may lead to hip disorders in children. These can be corrected at early stages but may eventually lead to arthritis in adulthood.
Types of Hip Replacement Surgery:
- Total hip replacement/Traditional hip replacement: The typical surgical approach involves removing the defected or diseased portion of the hip joint be it the femoral end or the pelvic socket. An artificial hip, commonly known as a prosthesis is used to replace the hip joint. The four parts in an implant include a stem which fits into the thigh bone, a ball at the top end of the stem mimicking the ball of the femur, a shell to fit into the pelvis and a liner to snap into the shell. An implant is available in various sizes and can be chosen accordingly by the surgeon.
- Latest in hip replacement surgery: Quite a few advancements have been made in the techniques of incision making and the type of implants used which deviate from the traditional approach of hip replacement. Advancements such as anesthetic techniques like peripheral nerve blocks, local anesthetic injections and multimodal analgesic combinations make the procedure much less painful in addition to decreasing the side effects and dependence on opioids or painkillers post operatively. Joint implants were initially fixed without cements. A latest trend of new cements with high strength and hardness are used to ensure a good union and stability of the implant. Joint implants that are fixed to the bone without cement have been used for many years. Improvements in the plastic portion of the prosthesis’ socket have drastically reduced the chances of plastic wearing out and resulting into failure of the replacement. Ceramic joint surfaces reduce friction and avoid the chance of metal corrosion in the joint. The result of these improvements is a joint that should function well for many years.
Technique used in the Hip Replacement Surgery
Traditional Hip Replacement Surgery normally involves making an incision of 10-12 inches on the side of the hip the incisions can be of different types which is in relation to the gluteus medius muscle of the thigh.
- Lateral approach – this is the most common approach used by the surgeons. It is also known as Hardinge’s or Liverpool approach. Here the gluteus medius and gluteus minimus are elevated are elevated to gain access to the joint. The muscles are lifted either by osteotomy of the greater trochanter or by dividing them at their functional tendon and suturing them afterwards.
- Posterior approach- in this the approach is through the posterior muscles namely piriformis muscle and the short external rotators of the femur. It gives an excellent access to the the acetabulam and femur and preserves the abductors muscles.
- Antero- lateral approach- in this approach from the anterior the gluteus medius, gluteus minimus and hip are detached for the greater trochanter and femoral neck.
- Anterior approach- in this the access to the hip joint is made through an interval between the sartious muscle and tensor fascia latae.
Minimally Invasive Hip Replacement Surgery is performed with either one or two incision. Smaller incisions do less damage to the tissues.
- Single incisions surgery- The surgeon makes a single incision that measures 3-6 inches. The incision is made over the outside of the thigh. The muscles and tendons are split or detached to a lesser extend and it encourages faster healing.
- Two- incision surgery- in this method the surgeon makes two incisions. The first one is madeover the groin for placing the socket. The incision is of 2-3 inches. The second incision is made on the buttock for placing the femur stem. Here the incision is of 1-2 inches long. The surgery takes a little longer time to perform then compared to traditional hip replacement surgery.
Complications & Risk Factors Associated With Hip Replacement Surgery:
- Blood clots can form in the veins in the legs post operatively
- Infections can occur at the site of incision
- Fractures and dislocations may occur
- Change in the length of the leg can occur as a result of the variable size of the length of the stem in the implant
- Hyper and hypo thyroidism can have variable effect on the implant.
Success Rate in India:
Hip replacement surgeries are one of the most finest and efficient major surgical procedures ensuring correction and relief in about 89.65 percentage of cases treated. Autoimmune reactions to reject or destroy the implant are quite minimal.
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