Total hip replacement ( THR) is the Golden standard surgery for elderly patients. It may also be considered for younger patients but in this group, attention should be given to preserve bone. Conditions needing a total hip replacement include the following
- Hip arthritis
- Femoral neck fractures
- Femoral neck Non unions
- Avascular necrosis
- Protrusio acetabuli
- Slipped upper femoral epiphysis
- Perthes disease
- Rheumatoid arthritis
- Ankylosing spondylitis
Hip Replacement surgery has a proven track record over the past forty five years. In a conventional total hip replacement the surgeon replaces the head and neck portion of the thigh bone with a stemmed implant. The socket is lined with a liner.
Types of total Hip replacement-
Conventional total hip replacement are prostheses that are fixed in the upper shaft of femur. The fixation method can be either cemented or uncemented.
In a Mini or short stem hip replacement, the prosthesis on the femoral side is very small in comparison. It only is inserted into the upper part of the thigh bone
Prostheses for conventional Total hip replacements that are fixed with bone cement are cemented hip replacements. Those prostheses which rely on natural bony ingrowth to anchor the implant are called cementless or uncemented prostheses.
Risks
Like any othe surgical procedure, hip replacement surgery involves some risks. Basically, the risks are classified into two different types: risks during the surgery and recovery period and long-term risks. Long term risks may happen to patients months or even years after the hip replacement surgery.
Some of the risks involved during the hip surgery period and recovery period include the following:
* Neurovascular injury or injury to the nerves. This may not be common but can happen to some patients. Those patients with abnormal anatomy like chronic dislocations, altered limb length are at special risk. Patients who suffer from nerve injuries may feel numbness and a tingling sensation. They may also have difficulty moving some muscles and joints. Occasionally blood vessels may be injured in patients with abnormal long standing anatomy like DDH and pyogenic arthritis.
* Blood clots- In some instances, blood clots may form in the veins of the legs after hip replacement surgery. Blood clotting after hip replacement surgery often occurs to people who are overweight, elderly, have cancer or have suffered from blood clots in the past.
* Infections - People who are suffering from certain types of health problems such as diabetes, chronic liver disease, rheumatoid arthritis, and many other medical conditions are at higher risk of getting infections. This is because the organisms that cause an infection can spread rapidly to other parts of the body. When this happens, another surgery may be required to clean up the site and/or the implant may be removed. An antibiotic spacer may be implanted in the intervening period and you will receive intravenous antibiotics for six to eight weeks. When the infection has been controlled, you will get a revision hip replacement.
* Heterotopic Ossification- This condition happens when there is a formation of bone deposits in the soft tissues surrounding the hip joints. This is not extremely alarming and its effects may be minor but it may hinder normal movement of the hips. If the patient feels pain, another hip surgery may be done to remove the problem.
* Different Lengths of Legs- This can happen afer surgery. Often, difference is relatively small and there is no need to worry about it. It also does not cause any problem on the hips and the person may not feel pain. A shoe insert may be used to correct this problem.
* Difficulty in wound healing- This condition often occurs in people who are taking medications, particularly corticosteroids. This is also common in people who are suffering from medical conditions such as diabetes, rheumatoid arthritis, and other types of diseases that affect the immune system.
* Side effects of general anesthesia.- The usual side effects of anesthesia like nausea, vomitting, constipation are common risks that may be experienced by patients after surgery and in the recovery period.
Dislocations- The prosthesis can dislocate in some patients. You may have to remain non weight bearing or use a brace to keep the joint in place. If the surgeon feels that the components are not in the correct position, a redo procedures may be required.
The long-term risks involved in the process of hip replacement surgery include infections, dislocation and loosening of parts of the artificial hip joint.
