9552532038 / 9822020130    HELPLINE: 020 67286728      appointment@lokmanyahospitals.in

  9552532038 / 9822020130    HELPLINE: 020 67286728      appointment@lokmanyahospitals.in

  9552532038 / 9822020130

 HELPLINE: 020 67286728

Hip Replacement Surgery

Hip Arthroplasty

Hip Joint – Basic introduction

The hip joint is a Diarthroidal Joint whose unique anatomy enables it to be both extremely strong and amazingly flexible, so it can bear weight and allow for a wide range of movements. The primary function of the hip joint is to provide dynamic support the weight of the body/trunk while facilitating force and load transmission from the axial skeleton to the lower extremities, allowing for ambulatory and mobility functions

The hip is located where the head of the femur, or thighbone, fits into a rounded socket (Acetabulum)of the pelvis. This ball-and-socket construction allows for three distinct types of flexibility:

  • Hip flexion and extension – moving the leg back and forth;
  • Hip abduction and adduction – moving the leg out to the side (abduction) and inward toward the other leg (adduction); and
  • Rotation – pointing toes inward (internal rotation) or outward (ext ernal rotation) and then moving the straightened leg in the direction of the toes.

The hip joint is comprised of these basic components:

  • Hip bones, including the femur and pelvic bones;
  • Hip articular cartilage – Labrum- rings the outer edge of the acetabulum. The labrum deepens the socket joint, making the joint more stable, but its elasticity allows for flexibility and decreases friction between the bones and allows for a smooth gliding motion
  •  Hip muscles that both support the joint and enable movement; The groups of muscles supporting the hip are Gluteal muscles, located on the back of the hip (buttocks);
  • The adductor muscle on the inner thigh;
  • The iliopsoas muscle, which extends from the lower back to upper femur;
  • Quadriceps, a group of four muscles that comprise the front of the thigh; and
  • Hamstrings, a group of muscles that comprise the back of the thigh and extend to just below the knee
  • Hip ligaments and tendons, tough, fibrous tissues that bind bones to bones and muscles to bones; and

Synovial membrane and fluid:  A synovial membrane encapsulates the entire hip joint. This membrane produces synovial fluid, a viscous substance that lubricates and circulates nutrients to the joint.

Understanding Hip Arthroscopy

Hip arthroscopy is a minimally invasive form of hip surgery in which an orthopaedic surgeon creates access points for arthroscopic needles, scalpels or other special surgical tools to examine or treat the inside of the hip joint and surrounding soft tissues. During the procedure, a small camera, called an arthroscope is inserted into your hip joint through small incisions, usually about 1 cm, thereby avoiding large cuts as compared to a conventional open surgery. The camera is connected to a video monitor that relays the detailed pictures of the hip joint. The surgeon can now directly observe the inside of the joint, evaluate numerous key anatomic structures and helps verify the safe placement of other specialized instruments. This exploratory surgery allows the hip replacement surgeon to diagnose the cause of hip pain or other joint problems that is creating discomfort for the patient.

Surgical Procedure

At the start of the procedure, the patient will be administered anaesthesia and the patient’s leg will be put in traction. This allows the hip to be pulled away from the socket enough for your surgeon to insert instruments, see the entire joint, and perform the nest step of the procedure. Small incisions are then made around the hip to insert the arthroscopy camera and other necessary instruments. Hip Replacement Surgeons typically draw lines on the hip to indicate specific anatomy structures such as bone, nerves, and blood vessels, as well as incision placements and portals for the arthroscope. An x-ray machine is used to guide the tools into the hip joint to repair the damage areas.

Benefits of Hip Arthroscopy

Some of the benefits that hip arthroscopy offers are:

  • Reducing hip pain and scarring post-surgery
  • Faster recovery time
  • Controlling the prospect of developing hip arthritis by treating its cause in the early stages.
  • Delaying the possibility of a total hip replacement by correcting th conditions that can cause osteoarthritis of the hip
  • Fewer complications and less risk of infection

CONDITIONS TREATED

Hip Arthroscopy may be recommended for hip conditions that do not respond to non-surgical treatment. Hip arthroscopy may be recommended as treatment for the following conditions.

  • Hip impingement (femoroacetabular impingement)
  • Labral Tears
  • Removal of loose fragments of cartilage inside the hip joint

Post-Operative Care

Once the surgery is complete, the patient is moved to the recovery room and closely monitored. The patient will be strictly asked to use crutches or walking support in the initial days post-surgery or till all signs of limping have stopped. Physical therapy and specific exercises are necessary to achieve the best recovery and restore strength and mobility to the joints. The orthopedic surgeon will draft the post-operative care plan to best achieve the results of the hip arthroscopy surgery.

Limitations

Hip Arthroscopy is case dependent and if the extent of damage is more, then its outcomes are doubtful therefore proper planning with the help of investigations, X rays and MRI is mandatory.

Hip Replacement Surgery

A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced to relieve the patient of h is discomfort. If the hip has been damaged by arthritis, a fracture, or because of heavy impact; performing regular activities may become painful and difficult. One will find stiffness in the hip, and discomfort while walking, or bending and perhaps even while resting.

Why Hip Replacement Surgery?

The orthopaedic surgeon may advise hip replacement surgery to offer long-term solution when

  • Hip pain that limits everyday activities and impairs overall quality of life, 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

Total hip replacements are performed most commonly because of progressively worsening of severe arthritis in the hip joint. The most common type of arthritis leading to total hip replacement is osteoarthritis of the hip joint. The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease. Avascular necrosis, Childhood hip disease are the other possible reasons for Hip Replacement.

A hip replacement can

  • Relieve pain
  • Help your hip joint work better
  • Improve walking and other movements

It is a decision that is made after proper investigations and clinical examinations, previous medical history with an understanding of the potential risks and benefits. A detailed understanding of both the procedure and expected results should be discussed at length with the orthopaedic surgeon.

Hip Replacement Surgery Procedure

In Hip Replacement Surgery, the surgeon removes the damaged sections of your hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint or prosthesis helps reduce pain and improve function. The joint replacement surgeon will make a cut along the side of the hip and move the muscles connected to the top of the thighbone (femur) to expose the hip joint. Next, the ball portion of the joint is removed by cutting the thighbone with surgical devices. An artificial joint is then attached to the thighbone using either bone cement or a special material that allows the remaining bone to attach to the new joint. The doctor then prepares the surface of the hipbone, removing any damaged cartilage and attaches the prosthetic socket part to the hip bone. The new ball part of the thighbone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.

The prosthetic components could either be ‘press fit’ into the bone or they may be cemented into place. Based on a number of factors, such as the quality and strength of your bone, the orthopaedic surgeon will decide to press fit or to cement the components or use a combination of both.

Post-Surgery Care

Most often than not, the complication rate following hip replacement surgery is low. With the advancement in Technology the post operative complications are lower and recovery of the patient is faster. After the operation you’ll need a walking aid, such as a walker for support initially. You may also be enrolled on an exercise programme that’s designed to help you regain and then improve the use of your new hip joint. But with proper exercise and nutritional diet rich in protein, Calcium and Vit D the recovery time is shorter and patient satisfaction is extremely high

It is imperative that your orthopaedic surgeon is well-equipped and highly skilled to conduct these joint replacement surgeries with proper infection control. Improper treatments can lead to dislocations, change in leg length, clots, etc, among others.