Hip replacement joint surgery is a surgical
procedure whereby the damaged parts of hip joint are replaced with prosthetic
implants (artificial parts). The hip replacement surgery is categorised into
two: Total replacement also referred to as total hip arthroplasty and the hemi
or half replacement also referred to as hemiarthroplasty. The total hip
replacement involves replacement of both the femoral joint and the acetabulum
(hip bone) while the hemiarthroplasty consists of replacing only the femoral
head. Nowadays, hip replacement surgery is the most popular orthopaedic operation, although the patient's short term and long term satisfaction varies
widely.
When is
the right time for a hip replacement surgery?
Hip replacement procedure should be carried out
when the hip joint is experiencing painful symptoms that can no longer be
controlled through medicinal treatment. Depending on the severity of the hip
damage, your surgeon will recommend a total hip replacement or a
hemiarthroplasty.
What
leads to hip replacement surgery?
Complications
during a hip replacement surgery
- Nerve damage: The sciatic nerve is at risk of being
accidentally surgically cut due to its close proximity to the capsule of the
hip joint. This same nerve may also become over-stretched during hip
manipulation during surgery. Depending on the extent of the nerve damage,
temporary or permanent damage may result. There may be loss of muscle power and
feeling in parts of the leg. It may take up to 6 months or more for recovery.
Most patients have some numbness around their incision site which may be
permanent.
- Vascular damage: The damage involves direct trauma to the blood
vessels in the area of the surgery. The damaged blood vessel can be repaired by
a vascular surgeon if it is caught in time.
- Femur fracture: Force is applied during the surgical procedure. This can result in a femoral shaft fracture, especially in older or
osteoporotic patients. Again, the problem is addressed during surgery, but may
lead to extended rehabilitation. The surgeon may place weight bearing
restrictions while you are walking.
- Leg length discrepancy: In some cases, it may be difficult to
get the exact same leg lengths. The result is usually a longer leg on the
surgical hip. It may be unavoidable and deliberate in order to improve muscle
function or stabilise the hip. If there is more than a quarter of an inch
difference, a shoe lift may be necessary. In some patients, both legs are the
exact same length but they think their surgery leg "feels" longer. In
most cases this "feeling" goes away as the patient adjusts to their
new hip. Rarely does shortening of the leg occur. If the leg is significantly
shortened after surgery, it may have dislocated.
- Anaesthetic complications: Complications can
occur, and in rare cases even death. Your anaesthesiologist will explain the
risks involved prior to your surgery.
Complications
after hip replacement surgery
- Blood Clots: This is one of the most common complications
after hip replacement. The most common area is in the calf. Increased leg pain
is usually the most obvious symptom. Redness around the area of the clots may
also occur. It's a minor problem if the clots stay in the leg. But if they
dislodge, they can reach the lungs (pulmonary embolism) and can possibly result
in death (very rarely). If your surgeon suspects blood clots, he will
immediately order an ultrasound to confirm or rule out clots. Most surgeons
will order bed rest until the test results come back positive or negative for
blood clots. He will prescribe a blood thinner. Compression boots and ankle/leg
exercises help reduce the chance of blood clots.
- Infection: Infection can occur during surgery or develop
afterwards. It is one of the most serious risks to the joint replacement. If
the infection settles deep into the joint and surrounding tissues, the new
joint often has to be removed until the infection clears with treatment. If the
patient develops an infection elsewhere in the body (bladder, teeth, chest), it
must be controlled to prevent the possibility of it spreading through the blood
to the new joint. If you have rheumatoid arthritis or diabetes, or have been
taking cortisone for a long time, you are more prone to infection in the weeks
following your surgery. Infection can occur many years after the surgery.
Bacteria can travel through the bloodstream from an infection in other parts of
your body (bladder infection, infected wound, kidney infection). Oral
antibiotics may need to be taken before and after routine dental work years
after your hip replacement operation.
- Hip dislocation: The first six weeks after hip replacement is
the most vulnerable time for your new hip. During this period, muscle tension
is the only thing holding the metal ball in the socket. If the metal ball slips
out of the socket, it's dislocated. As the hip muscles regain their strength
and scar tissue forms around the ball, the risk of hip dislocation diminishes.
- Bowel complications: Constipation frequently occurs for the first
week or so after surgery. This can be caused by medication, immobility, loss of
appetite, not drinking enough fluids. Stool softeners or enemas may be needed.
- Loosening of the prosthesis: The harder your bones
are, the longer your hip replacement will last. Hard bones create a stronger
bond. People with rheumatoid arthritis and osteoporosis are more at risk.
Running and heavy impact activities can also loosen the bond of the implant.
Keep your weight down, as this will put more stress on the hip joint. Every
pound you gain adds three pounds of force on your hip. Choose a surgeon who has
performed many hip replacements. Talk to some of his previous patients to see
how they are doing after their hip replacement.
Most people who undergo hip replacement surgery
will never need to replace their artificial joint. But because more and more
people are having hip replacements at a younger age, the wearing away of the
joint surface can create problems. After 15-20 years of wear and tear,
replacement (revision surgery) of the artificial joint is becoming more common.
Revision surgery does not have as good an outcome as the initial surgery.
Remember to consider all the hip replacement complications before you decide on
surgery.
