Dr. Pradeep Bhosale, director of arthritis and joint replacement, Nanavati Hospital, Mumbai, talks about life after a hip replacement surgery, the longevity of the implants and shares a special message for the patients.
Dr. Pradeep Bhosale, director of arthritis and joint replacement, Nanavati Hospital, Mumbai talks about the difference between a partial and total hip replacement surgery and the different kinds of hip implants.
Dr. Darius Soonwala a leading orthopedic surgeon from Mumbai explains the hip replacement procedure and what to expect after the surgery.
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:
- 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.
- If the stiffness of the hip prevents the patient from going about their daily lives.
- Inability to stand on the affected leg without support for even a minute.
- The patient can no longer walk short distances.
- Pain that is beginning to affect the patient mentally as well as physically
- The patient is experiencing severe side effects of pain-killers.
- 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:
- Cross-legged sitting
- 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.
- 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.
- Have a heart to heart conversation with them about how the procedure can help get rid of the chronic pain.
- 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.
- 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.
- Discuss how current technology and expert surgeon availability means that they can undergo the procedure both successfully and with fewer chances of side effects.
- Alleviate their fears by providing them encouragement and assuring them that you will be with them every step of the way.
- Explain to them how keeping a positive attitude with regard to the operation will help them come through the procedure with much better outcomes.
- 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.
Dr. Harish Bhende, an Arthroplasty Surgeon with 20 years of practice explains what a hip replacement surgery is, the difference between an original and artificial hip, and some pointers to keep in mind before opting for the procedure.
Getting a hip implant is a huge boon for those whose lives have been significantly affected by hip trauma and arthritis. Millions of patients across the world have undergone this surgery and found a new lease on life. However, as with any surgery, apprehensions remain. Will it work for me or my loved ones? Will they or I be able to go back to our normal routines again? What are hip implants made of? While the previous two questions and many more have been or will be covered in our other blogs, this blog will focus on the last question, “What are hip implants made of?”
After all, a hip implant is likely to last for the patient for the next 15-20 years, which is a significant part of one’s life. Having a thorough knowledge of the entire process takes the fear of the unknown out of the picture, and helps the patient approach their surgery with an open mind.
So the question you must be asking yourself is that “Is a hip implant really necessary?” The answer to that differs from case to case. A THR is only recommended if the patient suffers from chronic hip pain that hinders their daily activities and is unabated by non-invasive therapies like weight reduction, physical therapy, and painkillers. Another factor that is considered is, if pain affects the patient’s ability to sleep.
In simple terms, a Total Hip Replacement procedure will consist of 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 center. This stem can be either cemented or press-fit into the bone.
- A ceramic or metal ball is then positioned on the stem’s upper part. This serves as the replacement for the worn-out femoral head.
- The damaged cartilage surface of the socket is replaced and held in place with cement or screws.
- Finally, a metal or plastic spacer is positioned between the new implants to facilitate a smooth and frictionless movement.
To know more, click: (Video link)
The final decision of which implant to use rests on the orthopedic surgeon.
However, the selection will take into account one’s level of activity, weight, age, lifestyle factors and most importantly, the extent of damage and the optimal fit. Each implant is different in its own way and thus, surgeons prefer to rely on 1-2 styles and brands depending on their practice and experience.
What makes for a good implant?
While each surgeon has their own reasons for preferring one implant over another, what they all look for in an implant are that it should:
Help the patient regain their usual activities and movement
Have expected durability of 15 to 20 years
Should have a good track record of minimum 5-10 years in Total Hip Replacement use
Meets the patient’s unique requirements and needs
A brand or a style that is familiar to them.
Depending on the patient’s need the surgeon may choose a press-fit or cemented implant.
Cemented Implant: The artificial implant is stuck to the natural bone with a quick drying cement.
Press-fit Implants: The preferred standard of care presently, press-fit implants allows the natural bone to grow and hold the implant in place.
What constitutes a hip implant?
While the natural hip joint has only two components, the ball and the socket, a Total Hip Replacement implant has four different parts.
1) Acetabular component (socket)– This is the part that makes up the socket portion of the new hip. The cup-shaped component is fit into the patient’s resurfaced socket. In traditional hip implants, this component is composed of metal but there are a few implants whose acetabular component is made of ceramic or a combination of plastic and metal.
2) Acetabular liner: This high-grade polymer or plastic liner fits into the acetabulum and permits the ball to glide normally in the socket.
3) Ball: This is the other main component of the hip joint and fits directly into the new plastic socket. The ball in a normal hip is the upper end of the femur. In an implant, the ball is attached to femur with the use of a femoral stem. Balls can be manufactured from metal, plastic, ceramic or even a combination of these materials. They come in different sizes and shapes to fit different patients.
4) Femoral stem: This is the part that attaches the ball to the femur. This component is especially important as it supports the entire joint. Usually made of a porous metal, the stem allows natural bone growth and facilitates attachment to this piece and replaces the thighbone.
What the implants made of?
Total Hip Replacement implants are composed of high-grade plastic polymers, metal, ceramic or a combination of them all. The femoral stem is usually made of titanium, titanium-cobalt alloy, stainless steel, cobalt-chromium alloy or other metallic alloys. The other components, on the other hand, can be composed of either metals, plastic or ceramic material or even a combination of these materials. The reason these metals are chosen is that they have been proven to be both strong yet flexible enough to allow regular movement. These materials also do not cause immune reactions in the patient’s body.
Depending on their composition, implants can be categorized as:
1. Metal on Metal/MOM in which both the ball and socket components are metallic in nature.
2. Polyethylene and Metal on Polyethylene (MOP): When the socket is made of plastic/polyethylene and the ball is metallic, it is termed as MOP.
3. Ceramic on Metal (COM), Ceramic on Polyethylene (COP) and Ceramic on Ceramic (COC): These are rare compositions and not preferred by many surgeons. These are usually used for patients who are allergic to metals.
Which material is better?
When it comes to implants, no material is significantly better than the other. The choice depends on surgeons and their assessment of their patient’s needs. For the longest time metal on metal Total Hip Replacement implants were thought to be the best. All this changed in 2010 with the Depuy metal implant debacle where it was found that the implants came with a high risk of metal poisoning. Many surgeons prefer titanium implants as they have a long record of proven effectiveness. As of now, metal on plastic and ceramic implants are the standards of care. The former is more preferred for aged patients, while the latter is more suitable for younger, more active patients.
When it comes to choosing the best material, both have their own pros and cons. While ceramic does not get as worn out as metal or plastic, they can develop cracks or break suddenly. However, these problems have been ironed out in the newer generation of implants that show fewer incidences like these. The main issue restricting the use of ceramic implants is that compared to metallic implants, fewer long-term clinical outcomes with ceramic implants are published.
It is normal to be a little apprehensive when faced with the prospect of having something semi-permanent implanted in one’s body. But the truth is that there is little to worry about. Total Hip Replacement is a common surgery with high rates of success. So go out there and get ready to get back on your feet!
Undergoing surgery can be stressful for anyone, especially when you are not sure about how soon you can recover and jump back to your routine. For Total Hip Replacement surgery (THR) patients, the recovery period can be even more stressful due to fatigue and reduced mobility. However, following the doctor’s advice especially during the initial few weeks post-surgery can ensure a faster and seamless recovery.
Need a little help figuring out the dos and don’ts while recovering from a Total Hip Replacement surgery? Here’s a short guide.
Wound care: Proper wound care is crucial to healing. A typical surgery wound may have sutures or staples till about approximately 2 weeks post-surgery. Keeping the wound dry till it is completed healed is one of the biggest things to look out for. Ideally, one should continue to bandage the wound to prevent chafing and irritation from clothing.
Diet: It is normal for Total Hip Replacement patients to experience a loss of appetite; after all, the body has been through major surgery. The medicines too can aid in amplifying this effect. However, this is no excuse to skip a meal. A balanced diet and plenty of fluids are key to a complete recovery.
Physical Activity: The best way to gain the capacity to resume your normal activities is exercise. Exercising in the first few weeks post-surgery is very important in the recovery process. A Total Hip Replacement patient is expected to gain the capacity to go back to their light normal activities within 3-6 weeks after surgery. Don’t be afraid of any discomfort caused during the first few weeks while going about your activities, this is a natural part of healing.
You should slowly start walking around indoors and gradually move outside. Following the physiotherapist’s instructions and regular exercises can go a long way in restoring your mobility and hip strength. After a while, you should be able to go back to our routine.
- For the initial 6 to 8 weeks, one cannot cross one’s legs from the knees
- Don’t elevate the knee higher than the hip
- Take care not to lean in a forward position while sitting or while you are about to sit
- Don’t try to pick anything from the floor in the sitting position
- Don’t excessively turn your feet inward or outwards while bending down
- Don’t bend at the waist more than 90 degrees
- Do keep the legs facing forward
- Keep the operated leg in front while sitting or standing
- Kneel on the knee on the operated side
- Apply ice to decrease pain and swelling only through an ice pack or wrapped in a towel
- No direct application on the skin
- Apply heat before any activity to help with Range of Motion
- Reduce but don’t stop performing your exercises if you experience pain in your muscles
So there you have it. The essential guide to recovering from Total Hip Replacement in an easy and relatively painless manner.