How Is Total Hip Replacement Used ?
Total hip replacement is primarily performed in middle age, without an upper age limit. Indicated for those with completed or nearly completed bone development, it particularly offers effective solutions for young individuals (20-40 years old) facing issues like developmental hip dysplasia or avascular necrosis of the femoral head, addressing pain, limping, and shortening.
Commonly applied for childhood conditions such as osteoarthritis, hip dysplasia, growth plate disorders, rheumatic diseases, inflammation sequelae, tumors, advanced age hip fractures, and post-vascular necrosis, hip replacement is recommended when non-surgical treatments prove ineffective or are anticipated to be ineffective.
How Is Hip Replacement Surgery Performed ?
1.If the patient is free from active infections (such as urinary tract, throat, or dental infections), blood samples are taken and consultation with the anesthesiologist is sought for surgical preparations.
2.Assuming no complications arise, the patient is admitted to the hospital either on the day of the surgery or one day before.
3.Diabetes and blood pressure diseases do not prevent this surgery. But it should be under control.
4.Smoking is not recommended because it increases the risk of infection.
5.The surgery can be performed under anesthesia, called general anesthesia, or while the patient is awake by anesthetizing the waist.
6.For the surgery, a 10-20 cm skin incision made on the hip is used according to the surgeon’s preference.
7.After removing the damaged bones and replacing them with prosthetics; The capsule, muscle, fascia, subcutaneous tissues and skin are stitched.
8.After the surgery, the patient goes to change in the ward.
9.Patients are allowed normal oral nutrition approximately 4-6 hours after the surgery.
10.Patients walk with support immediately on the evening of surgery or the day after surgery.
11.Patients are forced to use compression stockings and shoes during this period.
12.Wound dressing is done once every 2 days.
Frequently Asked Questions Abaout Hip Replacement Surgery
Indications and Considerations for Total Hip Arthroplasty
Severe pain stands out as the most common symptom for individuals considered candidates for total hip arthroplasty. Initially experienced during walking, the pain tends to persist even at rest and during nighttime sleep.
Signs and Symptoms:
- Severe pain, initially triggered by walking, progressing to discomfort during rest and nocturnal hours.
- Limited range of motion.
- Shortening of the leg, a prevalent sign in many cases.
Consequences of Delaying Hip Arthroplasty: While non-surgical interventions such as medications, physical therapy, intra-articular injections like PRP or stem cells, and the use of canes may be applied based on the patient’s indication, delaying surgery for those who require it can lead to detrimental effects. Postponing the procedure may expose not only the affected hip but also both knees, the contralateral hip, and even the lumbar and sacral regions to the risk of severe osteoarthritis and deterioration. With increased stress on these areas, the likelihood of future surgeries also rises if hip arthroplasty is delayed.
Viability of Stem Cell Therapy as an Alternative: Stem cell therapy may be considered for specific cases, but careful patient selection is crucial. It does not act as a preventive measure for cases where hip arthroplasty is undoubtedly necessary. However, for appropriately chosen patients, the therapy can be administered after explaining the objective results of the treatment.
Age Limit for Hip Arthroplasty: While there are exceptional cases of this surgery being performed in early adulthood, total hip arthroplasty is primarily conducted in middle age. There is no strict upper age limit for this surgery, and it can be applied to individuals who have completed or are on the verge of completing their bone development, depending on the indication.
Ineligible Candidates for Hip Arthroplasty: Contrary to common belief, the surgery can be successfully performed on young women considering future pregnancies. However, individuals with poor personal hygiene, dementia, or mental illnesses, those with active hip infections, and those with advanced arterial or venous insufficiency should not be considered suitable candidates. Additionally, individuals with hip muscle paralysis due to neurological diseases are not appropriate candidates for this surgery. It is also crucial that the surgeon is experienced, and the healthcare facility has adequate conditions and uses high-quality implants; otherwise, hip arthroplasty may not be deemed suitable.
Types of Total Hip Prostheses and Their Structures: Contemporary prostheses have main components fitting onto the femur and pelvis, typically made of chrome, cobalt, or titanium. The intermediate components where these articulate can be constructed from ceramic, polyethylene, or metal. For example, the term “ceramic hip prosthesis” implies the use of ceramic in these intermediate parts, while the components fitting onto the bones are metal, ensuring complete compatibility with the body.
Cemented vs. Cementless Hip Prostheses: Cementless hip prostheses are often preferred in younger patients. In these cases, the prosthesis is tightly fitted onto the bone, providing excellent fixation as the bone grows onto the prosthesis. Cemented prostheses, using a special filling material to attach to the bone, are used in elderly patients or when the bone quality is not optimal. When properly executed, the outcomes of cemented prostheses are comparable to cementless ones.
Lifespan of Hip Prostheses: When crafted by a skilled surgeon using quality materials in a reputable facility, the aim is for the hip prosthesis to last a lifetime. Although influenced by various factors, adhering to high-quality standards can ensure a lifespan of at least 15 years. Some patients experience a prolonged lifespan of 30 years or more. In cases where the prosthesis has completed its lifespan, it may be possible to replace only the intermediate components rather than the entire prosthesis, maintaining a comparable lifespan to the initial implant.
Postoperative Home Planning: Upon discharge, detailed instructions are provided on how patients can ascend and descend stairs using crutches. Initially, patients are advised to use supportive chairs and seats when sitting and rising. These chairs should not be too low, and the knees, when sitting, should not be higher than the hips. Measures to prevent slipping at home should be taken, especially during bathing. For the first two weeks after surgery, patients can use a high shower stool or stand with support if necessary.
Postoperative Walking: Patients are encouraged to walk as early as the day after hip arthroplasty since the alleviation of movement restrictions, pain, and limping typically occurs. Initially, patients may walk with the support of a walker, transitioning to crutches or a cane within 2-3 weeks depending on their condition.
Postoperative Running: Engaging in light sports activities such as running can commence approximately four months after hip arthroplasty.
Postoperative Sleeping Position: The recommended postoperative sleeping position may vary depending on the surgical technique applied. Patients are usually advised to sleep on their backs for a certain period after the surgery. The duration and the side to which they can turn may depend on the type of surgery performed.
Postoperative Bathing: Patients can resume bathing two weeks after hip arthroplasty.
Postoperative Driving: Patients can usually start driving, based on the surgeon’s preference, approximately one month after total hip arthroplasty. After two months, patients may resume cycling.
Postoperative Prayer: Patients can consider praying while seated in a chair after hip arthroplasty.
Postoperative Toilet Use: Using an Eastern-style toilet is not recommended for the first six months after hip arthroplasty. Crossing the legs may be discouraged for the initial two months.
Postoperative Sexual Activity: Patients can resume sexual activity six weeks after hip arthroplasty, with specific positions varying for male and female patients. Schematic visuals are provided to patients to illustrate these positions.
Postoperative Complications: While total hip arthroplasty is a highly satisfying procedure, it can pose potential risks in inexperienced hands. However, when performed by experienced individuals in well-equipped centers with high-quality materials, the success rate is notably high. Infection is the most feared complication and is meticulously prevented in reputable centers. In cases of infection, prosthesis replacement may be considered, accompanied by long-term antibiotic use. The risk of infection is extremely low in renowned centers. Other potential complications include the dislocation of the prosthesis, vascular and nerve injuries, and periprosthetic fractures.