Total Hip Replacement (THR)


Dr Sanket Diwanji is the Best Hip Surgeon in surat.

Total Hip Replacement is one of the most successful surgery of 21st century. It is usually done for osteoarthritis of hip joint, avascular necrosis of hip joint or fracture neck of femur in elderly patients. In total hip replacement head of femur is removed and it is replaced by metal or ceramic head.  A stem is inserted in medullary canal of femur to support this metal or ceramic head. In total hip replacement the acetabulum (socket of hip joint) is also resurfaced.

When Surgery Is Recommended

There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

  • Hip pain that limits everyday activities, such as walking or bending
  • Hip pain that continues while resting, either day or night
  • Stiffness in a hip that limits the ability to move or lift the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

(Left) The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip.

Types of Total Hip Replacement (THR)

Based on prosthesis used for surgery, THR can be classified broadly into three types: 1) Cemented THR- here prosthesis is fixed with host bone with help of bone cement. It is usually done in patients with weak bones.cemented

2)Cementless /uncemented THR- here prosthesis is fixed press-fit to the bone, a screw can be used to reinforce the fixation. It is usually done in patients having strong bone.

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3) Hybrid THR- here one component is cemented and other one is cementless.

Articulation for THR:

Today mainly three type of articulations are used for THR:

1) Metal-on-poly: here metal head articulates with polyethylene acetabular liner

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2) ceramic-on-poly: here ceramic head articulates with polyethylene acetabular liner

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3) ceramic-on-ceramic: here ceramic head articulates with ceramic acetabular liner. Implants having ceramic-on-ceramic articulation have longer survivorship and less wear.

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Orthopaedic evaluation:

  • Medical history. we will gather information about your general health and ask questions about the extent of your hip pain and how it affects your ability to perform everyday activities.
  • Physical examination. This will assess hip mobility, strength, and alignment.
  • X-rays. These images help to determine the extent of damage or deformity in your hip.
  • Other tests. Occasionally other tests, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your hip.
Preparing for Surgery

Medical Evaluation

If you decide to have total hip replacement surgery, you will be asked to undergo blood and urine test, chest x ray, ECG and Echocardiography. These tests will tell us regarding your physical fitness for surgery.

  • Blood Investigations: CBC. FBS. PPBS, Se Creatinine, Se Protein, Se Electrolytes, Prothrombin Time, APTT, HIV and HBsAg.These are the routine blood investigations done.
  • Urine Routine and Microscopy.
  • ECG and 2 D Echocardiography: to evaluate cardiac status.

Medications

Usually patients are sent to Physician (internist) to assess problems such as High blood pressure, Diabetes, Heart disease, Asthama, Thyroid problems, Kidney or liver disease. Physicians recommends apporpriate medications to control such problems. Usually blood thinner medications such as Aspirin needs to stopped 4 days prior to surgery.

Hospital Admission:

Dr Diwanji normally operates at Mahavir Superspeciality Hospital, Unique Hospital and Nirmal Hospital in Surat. He also operates at Amit Hospital and Zenith Doctor House in Valsad. Patients can choose hospital depending up on their insurance provider or their personal choice. Cashless admission at these hospitals may be possible depending up on tie up between TPA of insurance company and the hospital.

Patients are suppose to report to emergency room of the hospital on a day before surgery, where medical officer on duty will examine him/her and inform Dr Diwanji regarding the admission. At this stage any remaining investigation are performed. Blood samples are collected to send to Blood bank for Cross matching. Usually blood transfusion is not required during routine hip replacement surgery, but two units of blood are reserved as precautionary measure.

From emergency room, patients are shifted to rooms of their choice (general, Semi special, Special or deluxe) or as per availability. Here Anesthetist visit him/her for pre anesthetic evaluation.Patients can take usual diet on day before surgery, usually they are advised to stop taking food or liquid 8 hours before surgery. Nurse and medical officer on duty will explain about any medication required to be taken on morning of surgery.

The extremity on which the surgery is planned, is cleaned with antiseptic solution on night prior to surgery and also on morning of surgery. Patients can take bath before surgery if they wish to.

Anesthesia

After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

Procedure

The procedure itself takes approximately 1 to 2 hours. Your orthopaedic surgeon will remove the femoral head, and then position the new implants to restore the alignment and function of your hip.

surgical technique video:

After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.

Your Hospital Stay

You will most likely stay in the hospital for three days.

Pain Management

After surgery, you will feel some pain, but your surgeon and nurses will provide medication to make you feel as comfortable as possible. Pain management is an important part of your recovery. Walking and slight movement  will begin soon after surgery.

Blood Clot Prevention

Your will receive blood thinner to prevent blood clots and decrease leg swelling. In addition to that we will apply intermittent pneumatic compression pumps to both legs.

Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots.

Physical Therapy

 mostly the exercise will begin the day after surgery. A physical therapist will teach you specific exercises to strengthen your leg and thigh to restore hip movement to allow walking and other normal daily activities depending on the type of your surgery.

Your Recovery at Home

All patients go home walking with a walker support. They are able to sit in a regular car and rarely require an ambulance at the time of discharge.

Patients are encouraged to move around every 2 hours at home.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed 2 weeks after surgery. A suture beneath your skin will not require removal.

Avoid soaking the wound in water until it has thoroughly sealed and dried. Patients are allowed to take bath after covering the wound with a plastic.

Diet

Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to help your wound heal and to restore muscle strength.

Complications of THR:

1)Infection

Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

2)venous thrombosis and embolism

3)Dislocation: The incidence of dislocation is 0.5% to 2% in Primary THR and 2-3% in Revision THR. The cause for dislocation may be muscle weakness, impingement or implant malposition. Dislocation can be treated by close reduction in most of the cases. If dislocation occurs for more than 2 times, it is called recurrent dislocation and that requires surgical correction.

 

 

 


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