Hip Replacement


Today, the healthcare industry is simmering with innovation and new ideas. Transformation is happening at an astonishing pace and redefining the way in which patients are treated for any health-related issues. New-age technologies have boosted the success rate and are also turning out to be less invasive as compared to older methods. Especially, when it comes to treating hip pain and improving patient’s quality of life, hip replacement surgery is one of the most advanced and successful procedures in today’s medical space. Traditionally, Orthopaedic surgeons use to prefer a total hip replacement surgery by incising back or on the side of your hip. However, in recent times, surgeons prefer incising a cut in the upper part of the front thigh. This approach is called an anterior approach or anterior hip replacement. These surgeries may likewise be called small mini, modified, minimally invasive, or muscle-saving surgeries. The procedure involves replacing a damaged hip joint with an artificial hip that can be of metal or ceramic.

Though there are various approaches to the hip that can provide an exemplary outcome, over the past several years, the anterior approach has become more popular because of its minimally-invasive technique. Also, it lowers the risk of complexity before, amid and after the surgery. However, adopting this technique is highly preferred in patients with arthritis, but can also be used for patients undergoing THR due to any other reason like hip fracture, disorders that cause unusual bone growth (bone dysplasias), etc. A lateral or posterior hip replacement surgery and anterior hip replacement approach vary in certain ways but both the approaches share the same objective. Both the approaches are devised to provide adequate pain relief from the hip joint and allowing the patient to perform their normal chores with great comfort. Now let’s take a look at some benefits of Anterior Total Hip Replacement.

Benefits of anterior Total Hip Replacement

  • Compared to ancient science, after anterior THR, a patient suffers from less pain without causing much damage to surrounding tendons and muscles, which leads to a rapid and smooth recovery.
  • The patient will no longer need to be kept under observation post-surgery and can be allowed to go home immediately as per doctor’s advice.
  • Once the surgery is completed, it allows an option for the patient to walk out of their bed and cover small distances independently using any walking aid as soon as it’s comfortable.
  • The patient can also navigate through stairs with ease and comfort. While pursuing the stairs, lifting the stronger leg first onto the steps and starting with the weaker leg when coming back down through the stairs helps in preventing dislocation of the new implant. It is common for the patients to use cane, walker or any other equipment for walking assistance immediately after the surgery.
  • With the lateral or posterior approach, patients have to avoid bending and even sitting with their legs crossed for 6 – 8 weeks as this could result in hip dislocation. But with anterior approach patients are not restricted from any of these activities.

Life after anterior Total Hip Replacement

After implementing a successful anterior THR surgery, patients are able to bear weight on their new hip and can walk easily using any walking aid as per their support. The only thing that patients need to make sure is that their home stairs have a guardrail or banister installed, as to avoid any temptation of walking up or down the stairs unsupported. However, patients will need a personal trainer to restore the strength and movement in their joints and surrounding muscles. Mostly it will take up to 4-6 weeks to gain ample strength for the movement and performance of the daily routine activities. One can resume work after anterior THR, as it allows the majority of patients to start working after a month but we would recommend waiting for up to 3 months if it involves physical labour. Patients can expect their lifestyle to be a lot like how it was before having surgery but without the pain.

Summing up, anterior hip replacement by far is less painful and leads to a faster recovery of mobility and strength compared to a lateral or posterior approach. However, the recovery process still involves distinct phases to ensure the tissue is healing properly which will allow optimum functionality. It is important for every patient to know that every case is unique and the progression will completely depend on their unique set of circumstances. But, an anterior hip replacement approach is mostly likely to add more quality to a patient’s life.

Whether you have just commenced exploring treatment options for your hip pain or already have decided to go for a hip replacement surgery, we’ve got some information that might help you in your decision making. It has been proven that hip replacement surgery is one of the most successful procedures performed by orthopaedic surgeons for relieving chronic hip pain. With more than 90% success rate, hip replacement implants have managed to drastically reduce pain and improve function for people with damaged joints. The most conventional reason for having a hip replacement is osteoarthritis while other possible reasons include rheumatoid arthritis, a hip fracture or hip dysplasia; a condition where the hip joint hasn’t developed properly. It is essential to understand that a hip replacement implant is usually done when all other options including medication have failed to provide sufficient pain relief. The main objective behind the procedure is to relieve a sore hip joint, thus making walking and other activities easier.

The surgery involves taking off parts of the hip joint that are problem causing (usually the ball and socket) and then replacing them with new parts made from metal, plastic, and ceramic. Many people undergo this surgery every year and it usually brings great effects in terms of enhanced strength and well-being. However, it’s always vital to discuss with your doctor about the probable risks involved in it.

The material for the hip implant is normally selected by your surgeon depending on your medical condition and unique requirements. Full metal implants are now not readily preferred by surgeons due to the high risk of metal poisoning. Thus came titanium metal and ceramic implants at your rescue. Let’s find out how both of these are different from each other and which one can be the right fit for you.

Ceramic Implants

Ceramic hip implants are among the latest type of prosthesis being used for hip replacement, giving greater resistance to damage and smooth movement of the joint. For those who are not aware of Ceramic material, it’s a tough substance and does not get worn out easily as compared to metals and plastic. However, ceramic is also not completely devoid of problems. They tend to develop cracks and breaking down easily. However, newer ceramic materials have demonstrated lesser problems but, long-term clinical outcomes with ceramic implants are less published contrary to the metallic implants. This fact somewhat restricts the preference for ceramic implants.

Titanium Implants

Most hip implants these days consist of Titanium. Both the ball and the socket of the hip joint are replaced with a titanium implant, and a plastic spacer is placed in between. Titanium metal has a long history of established effectiveness in hip replacement and continues to be preferred by many surgeons. Based on current practice, metal (Titanium) implants are preferred in aged patients, while ceramic implants are being increasingly recommended in younger candidates due to their reliable durability.

Despite rising concerns over metal and other material implants used in the surgery, the majority of the hip replacement implants have been successful and have improved the quality of life and function.

To round off, when it comes to choosing the best material, both have their pros and cons. While ceramic does not get as worn out as metal or plastic, they can develop cracks or break suddenly.  It will eventually depend on the surgeons to pick the best one for you after analyzing the risks and benefits of various implants.

Hip pain is not normal and can cause serious trouble if not treated wisely. Any discomfort or painful sensation near the thighbone or pelvic girdle can be termed as hip pain. The hip joint is a ball and socket synovial joint that is responsible for providing a wide range of motion for the lower torso. It is because of the hip joint one can stand, walk, dance or lift. It is also considered as one of the most important joint when it comes to stability. However, as the person ages, the joint may undergo wear and tear.

Though hip pain to an extent can be treated with medication, injections and physical therapy, hip replacement surgery is the safest and the best option to treat hip-related problems when nothing else finds success in relieving the pain. A hip replacement could be recommended to any patient, in case they are suffering from chronic hip pain which is hindering their daily activities and other non-invasive methods of pain reduction have proved to be ineffective or are no longer effective to improve their condition. A patient with symptoms of severe hip arthritis, including as stated below, could be suggested to go for Hip replacement surgery.

1) Hip pain: An aching hip can make any patient’s life miserable. The most vital factor in selecting to have a hip replacement is quantifying the extent to which pain is affecting a patient. Pain that leads to interference in performing daily activities, even not letting anyone have a sound sleep, and is restricted between hip and knee could indicate arthritis of the hip. Some patients need the support of a cane or are also seen limping. A set of such patients regularly rely on pain-killer consumption to deal with their pain. In such cases, doctors usually suggest a patient with a replacement surgery to get long-lasting relief.

2) Stiffness: Difficulty in performing certain normal activities like doing weight training, cycling or even bending down for picking basic objects

3) Sprain: A sprain in a muscle occurs when the ligament is stretched than the usual limit causing the area to swell. A sprain can be caused by any sudden fall, twist, and turn of the muscle groups/joints.

 4) Difficulty in weight-bearing: In case a patient is not able to stand on his/her paining leg even for a minute with support, it indicates that their hip’s condition is very bad and they need a total hip replacement surgery.

5) Muscle stress: When the body is stressed, muscles tense up. Muscle tension is the body’s way of guarding against injury and pain. For e.g when you sit in one position for some time, you may end up making them stressed. This causes a change in the body’s nervous system by contracting blood vessels and reducing blow flow.

6) Fractures. A hip fracture is a fracture of the upper region of the femur or the thighbone. Fractures lead to swelling, difficulty in walking, sitting, etc causing severe pain.

Also, if the patient is suffering from Osteoarthritis or Osteoporosis, they can be advised to undergo a Total Hip Replacement. With Osteoarthritis, the joints become stiff and swollen due to inflammation and a breakdown of cartilage, causing pain and deformity are observed. Talking about Osteoporosis, it is a bone disease that occurs when the body loses too much bone, makes too little bone, or both.

So, in case you are experiencing severe pain with no sign of pain killers bailing you out of the dreadful situation, a hip replacement surgery then can be regarded as the best treatment option. Remember that the surgery option should only be considered when all other conservative treatment options have failed to provide relief from continuous hip pain and restricted mobility.

Also, remember that whatever the cause is, hip pain is more common as you grow older. And over time, your joint will see a lot of wear and tear. So make sure you are taking adequate care of the joints by eating healthy and doing the right exercises to keep your bone health at its best. 

Pain in any part of our body can be severely restricting. More so when the pain prevents us from leading our normal lives and carrying out our favorite activities, like the pain experienced by those who have chronic hip pain whether due to trauma or arthritis. The most unfortunate part about this pain is that it severely hampers the patient’s mobility; leaving them confined to their rooms or at the mercy of a cane or walker.

Total Hip Replacement or Total Hip Replacement is most and often the best option for patients in this situation. But how does one come to the realization that surgery is required or what is an orthopedic surgeon looking for before recommending surgery?

More often than not, these symptoms are:

  1. Chronic hip pain that hinders daily activities and is unabated by non-invasive therapies like weight reduction, physical therapy and painkillers. Lack of sleep due to pain is also an indicator that a Total Hip Replacement is required.
  2. If the stiffness of the hip prevents the patient from going about their daily lives.
  3. Inability to stand on the affected leg without support for even a minute.
  4. The patient can no longer walk short distances.
  5. Pain that is beginning to affect the patient mentally as well as physically
  6. The patient is experiencing severe side effects of pain-killers.
  7. Last but not the least, the doctor has determined that non-invasive or conservative treatments are no longer effective or helpful.

Is a hip replacement safe and successful and what restrictions will that place on the patient?

A large majority of Total Hip Replacement Surgery  are successful with most patients experiencing significant relief from their symptoms. While there are some risks like infection and blood clots associated with Total Hip Replacement, they are easily preventable. Overall, the procedure is one of the safest surgeries to undergo, with millions of patients getting their hips replaced every year. The evolving technology and surgeon skills are also improving the procedure every day. New and improved implant design also reduces the chances of dislocation. As to post-surgery restrictions, patients who decide to undergo a Total Hip Replacement should adapt a few permanent changes to their posture for the maximum benefit and in order to prevent any negative effect to the hip implant.

For preventing such incidents, certain movements or activities need to be avoided. They are:

  1. Cross-legged sitting
  1. Forward Bending: Avoiding bending one’s knees beyond 90 degrees is a crucial thing to keep in mind. Postures where the knee is not below one’s hip joints can lead to complications and difficulties.

As with anything surgery related, any doubts related to one’s condition should be cleared with one’s surgeon. 

How do I convince my loved ones to undergo a hip replacement?

The possibility of undergoing a major surgery can be quite intimidating to anyone especially elderly patients. Convincing them requires patience and time. While the final decision rests in their hands, here are some things that may help you in helping them make the right choice.

  1. Firstly, have a sit-down conversation with your loved one and their orthopedic doctor to fully understand the procedure, the risks and expected results. Encourage your loved one to get their doubts cleared by the doctor no matter how insignificant they may seem.
  2. Have a heart to heart conversation with them about how the procedure can help get rid of the chronic pain.
  3. Take them to meet other people who have undergone Total Hip Replacement recently, preferably those who have been operated on by their orthopedic surgeon. This will help them see how the procedure has helped these patients.
  4. Describe to them how people undergoing Total Hip Replacement can not only get relief from their pain but also regain their normal movements like navigating stairs and sit on the floor with folded legs.
  5. Discuss how current technology and expert surgeon availability means that they can undergo the procedure both successfully and with fewer chances of side effects.
  6. Alleviate their fears by providing them encouragement and assuring them that you will be with them every step of the way.
  7. Explain to them how keeping a positive attitude with regard to the operation will help them come through the procedure with much better outcomes.
  8. If they are worried about the physical therapy that will follow, then convince them that it will strengthen the muscles supporting the hip and allow them to recover faster.

The idea of undergoing surgery can be immensely daunting, even if the patient is already in significant pain. Coupled with the thought of physical therapy and recovery period, it is quite understandable for patients to refuse surgery or put it off until it’s too late. But the thing to know here is that beyond the surgery, physical therapy, and recovery, lies the light at the end of the tunnel. A light that is not only the promise of a pain-free life but also one in which the patient can regain their old life back.

By far the second most common form of joint surgery, after total knee replacement is total hip replacement or to put it medically, total hip Arthroplasty. It is also not only one of the most successful joint surgeries performed today but, also one of the most effective in reducing the pain and resulting side effects of having damaged hip joints. While this can seem like a daunting process for both patients and their families, the hip is an important joint that helps us conduct the most basic activities of our daily lives like walking, jumping, running etc. When the joint is diseased, whether due to osteoarthritis or injury, it reduces the patient’s ability to be mobile. However, truth be told, there is little cause for worry when it comes to total hip replacement surgery. The rate of complications is low and with proper care, the patient can soon regain mobility. That aside, the reliable pain relief and sizable functional improvement that arthritis patients experience post-surgery make it extremely beneficial for those suffering from intense pain and restrictive movement. Around 3 lakh Total Hip Replacement procedures are carried out globally every year. Still concerned? Here’s some information to help you make this decision.

There is no difference between hip replacement and total hip replacement.

Depending on the components of the hip joint that are going to be replaced, the procedure can be called as either total hip replacement surgery or partial hip replacement surgery. As you must already have learned from your orthopedic surgeon, the hip joint is a ball and socket joint, which means a ball-like structure, in this case, the head of your thigh bone or femur fits in a socket or the pelvic bone or acetabulum, to form a joint. With Total Hip Replacement orthopedic ball and the socket is replaced, while partial hip replacement only requires the ball or the head of the femur to be replaced.

Now both surgeries are called hip replacement surgeries, differing only in technicality, but Total Hip Replacement surgery is most common as partial replacement is considered sub-optimal and less recommended. Another point to be noted is that bilateral hip replacement is not the same as Total Hip Replacement. The former requires surgery on the hip joint of both legs while Total Hip Replacement simply requires replacement of the ball and socket components of any one leg.

Anyone with significant joint damage is a candidate for total hip replacement

Living with hip pain can be a challenge for anyone, young or old. Whether it is through arthritis or trauma, a hip injury can result in intense pain while carrying out regular activities. Even resting may not bring relief as the hip may be stiff and painful. While medicines, lifestyle modifications, and walking aids may help to a large extent, in severe cases, surgery is the best option.

Since 1960, advances in joint replacement operative techniques and technology have greatly improved the efficacy of total hip replacement.

Getting a Total Hip Replacement is the best option in case of significant pain and mobility reduction.

Every patient is different and their need for surgery may depend on various factors. That being said, any patient suffering from chronic hip pain which is hindering their daily activities and for whom other non-invasive methods of pain reduction have proved to be ineffective can be considered as a candidate for Total Hip Replacement.

Total Hip Replacement is recommended if:

  • The patient is in significant pain. If the hip pain is preventing the patient from conducting their daily activities, interfering with their sleep and rest and restricts their hip and knee movements, then surgery may be the best way out. Ditto, if the patient requires walking aids to move or cannot stand on their aching leg even for a minute without support.
  • Painkillers no longer work: In some situations, the pain may no longer be controlled by the use of painkillers or the patient starts to experience severe side-effects from said painkillers.
  • Increased stiffness: Stiffness in the hip joint that prevents one from going about one’s daily life may require the use of Total Hip Replacement for long-term relief.
  • Doctor’s recommendation: If less invasive and conservative treatment efforts fail, then a doctor will recommend a Total Hip Replacement.
  • The situation is becoming unbearable: Severe pain can be physically, mentally, and emotionally traumatizing, especially for the elderly. If the patient feels that they can no longer live with the pain, then Total Hip Replacement is by far the best option to help them heal.

Here’s what one can expect from a Total Hip Replacement surgery

Total Hip Replacement involves the following steps:

  • The damaged ball of the hip joint is taken out and replaced with a metallic stem and is placed into the femur’s hollow centre. The stem could either be cemented or “press-fit” into the bone.
  • A metal or ceramic ball then replaces the worn out femoral head which was removed. This artificial ball is positioned on the stem’s upper part.
  • The cartilage surface of the socket which is damaged gets replaced with a metallic socket. In order to hold the new socket in place, screws or cement is used.
  • Finally, a metallic or plastic spacer is positioned between the new implants to permit a smooth gliding surface for frictionless movement of the joint.

How soon you can be discharged depends on your doctor
As much as you would like to go home and get back on your feet, Total Hip Replacement surgery will require you to stay at the hospital for a few days. The length of your stay and discharge will depend on your doctor’s recommendation.

One can expect to be walking freely within 6 weeks post-surgery
Independent walking may not be possible immediately after the surgery. However, post-physical therapy, most Total Hip Replacement patients can find themselves walking with a walker or on crutches on a levelled surface. They can even navigate through stairs in both ways. Most patients require the walker for 2 weeks maximum. Getting back to walking depends on your recovery rate, though free and easy movement will be regained fairly soon after the pain decreases. Resumption of normal activities, including driving, can be achieved well within 6 weeks post-surgery. Normal recreation can be resumed 12 weeks post-surgery and one can be expected to be completely back to one’s normal routine within 6 months post-surgery.

Physiotherapy is an important part of the recovery process
Physiotherapy is extremely important post- Total Hip Replacement. The therapist will not only assist you with the exercises taught in the hospital but will also ensure that you can walk safely in your house. A physiotherapist will also help you keep a check on post-surgery dos and don’ts and be the ones assessing your need for a walker. Once the patient is moving freely at home, the physiotherapy sessions will be shifted to a clinic to further increase the strength of the muscles around the joint.

Patients will require around-the-clock care for at least 6 weeks post-surgery
In the initial days after surgery, most patients will be fatigued from the after-effects of anesthesia and painkillers and may require help with their daily activities. This phase may last for up to 6 weeks. So if you or your loved ones live alone, it is best to arrange for care during the recovery period.

Expect to be on painkillers for at least 4 weeks
Pain is an unfortunate side effect of any surgery and one does need to take painkillers to control it. Total Hip Replacement patients mostly require painkillers in the initial 2 to 4 weeks post-surgery, post which they can sit down with their surgeon to discuss further pain relief strategies. A large majority of patients can expect excellent pain control after 4 to 6 weeks.

So, as you can see, undergoing a Total Hip Replacement procedure is nothing to worry about. With a good surgeon and the availability of excellent implants, a hip arthritis patient can easily regain their mobility and previous quality of life within months.