The Hip is one of the largest joints in the human body. It is a ball and socket joint wherein the socket is formed by part of the pelvic bone (acetabulum) and the ball is the upper end of the thigh bone (femoral head). Cartilage (a smooth tissue) cushions the end of the bones, enabling their easy movement. The synovial membrane (a thin tissue) surrounding the hip joint produces a fluid that lubricates the cartilage, which reduces friction during the movement of the hip. Ligaments connect the ball to the socket and are responsible for providing stability to the hip joint.
The most common cause of hip pain and disability is arthritis.
Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are common forms of this condition.
Osteoarthritis is caused by wear and tear that is age-related. It usually happens to people who are above 50 or those with a family history of arthritis. The cartilage covering the bones of the hip gradually wears away and the bones start rubbing against each other, which causes hip pain and stiffness. Osteoarthritis may also be accelerated by irregularities in the development of the hip during childhood.
Rheumatoid arthritis is an autoimmune disease wherein the synovial membrane becomes swollen and expands. This chronic inflammation can result in damage to the cartilage, and cause pain and stiffness.
Osteonecrosis is caused when due to a hip injury the blood supply to the femoral head is insufficient. This is called osteonecrosis (or avascular necrosis). The lack of blood may lead to the collapse of the surface of the bone.
Childhood hip disease Sometimes infants and children face hip problems. And even after successful treatment of the same during childhood, they may get arthritis at a later stage in life. This may happen due to improper growth of the hip which affects the joint surfaces.
Post-traumatic arthritis usually follows a severe hip injury or fracture. The cartilage may get damaged and gradually result in pain and stiffness in the hip.
Reasons for a Hip Surgery
If the hip is damaged by arthritis, fracture, or another condition and basic activities like walking and sitting or standing up become too painful, limiting daily activity and the pain persists while resting, then one should consult an orthopedic and start treatment immediately.
If the medication, lifestyle changes, physical therapy, and walking supports are unable to provide adequate relief, then the doctors may recommend hip replacement surgery. Hip surgery is a safe procedure and effective in relieving pain and improving motion. It slowly helps the patient to be able to carry out day-to-day activities without discomfort.
Before The Surgery
A medical evaluation is done by the doctor prior to surgery.
The medical history is gathered by the surgeon to plan the treatment.
Tests like X-Ray & MRI or EKG and urine tests may be needed by the doctor.
The skin should be free from infections.
Physical examination may be done to assess the alignment, strength, and mobility of the hip.
Medications are reviewed and advised by the doctor.
If required, the doctor might suggest losing some weight before the surgery to minimize stress on the replaced hip.
Assessing the support system is necessary as the patient needs help for a few weeks after the surgery in performing even the basic tasks.
If any house modifications are necessary for patients’ ease post-surgery, they may be suggested by the doctor. Most important among them being the installation of handrails in the shower and toilet, raised toilet seat, a stable chair with a firm cushion, etc.
Total Hip replacement - Arthroplasty
During a hip replacement surgery, the damaged bone and cartilage are replaced with prosthetic components.
The patient is given anesthesia to numb the pain. The team of doctors will determine if general or regional anesthesia is suited for the patient.
The implant consists of two basic components: the ball component (made of metal or ceramic) and the socket component (a durable cup of plastic, ceramic, or metal, having an outer metal shell).
The prosthetic components may be press-fitted into the bone to allow the bone to grow onto the components or they may be cemented into place. The decision is based on factors like the strength and quality of the bone.
The procedure takes between 1-2 hours. The orthopedic surgeon will remove the damaged cartilage and bone and replace them with implants to restore the alignment and enhance the functioning of the hip.
Recovery Post Surgery
After the surgery the patient is monitored in the recovery room for a few hours till they are ready to be shifted to the room or discharged. After that care at home and adhering to the treatment plan is very important.
Management of Pain: Medications are given to provide relief from pain. The dosage has to be monitored and may be increased or reduced based on the need of the patient.
Surgery wounds: There will be stitches or staples over the wound which are usually removed after a couple of weeks. Till then it is necessary to keep the wound dry and keep it covered with a bandage.
Diet: Balanced diet and supplements may be suggested for proper healing restoring of muscle strength. Drinking plenty of fluids is recommended.
Physical activity: Exercise is very important, especially within the first few weeks after surgery. Physical therapy is advised by a physiotherapist, in consultation with the orthopedic team. The patient is usually able to resume daily light activities within 3-6 weeks of surgery.
Complications to look out for post-surgery
For the initial period after the surgery, it’s necessary to monitor and report any potential risk or warning signs.
Inequality in the length of legs
Any new damage or injury due to fall
Dislocation of the implant
Apollo Hospitals, Mumbai
Wockhardt Super Specialty Hospital Mira Road, Mumbai
Apollo Hospitals, Mumbai
SevenHills Hospital, Mumbai, India
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