Hip Replacement Surgery

History of Hip Replacement Surgery

The beginnings of hip replacement surgery can be traced way back to the 1800s when doctors in Germany tried to replace a femoral head with an ivory. It was not until the 1930s, however, when use of hip replacement surgery became widespread. Artificial hip joints made from metallic materials such as steel and chrome were created and used in some hip replacement surgery patients. These replacement joints were found to be better than arthritic joints; however, they also presented a number of disadvantages.

One of the main problems faced by doctors when using the metallic hip joints for hip replacement surgery was the susceptibility of these replacement joints to wear and tear. It was found that the body could not lubricate the surfaces of the metallic joints, causing them to loosen and to get damaged after some time. Consequently, doctors would have to perform revision operations on their patients, procedures where they have to replace the joints over and over again.

Another problem posed by the metallic replacement hips was infection. Patients who had undergone such a process became vulnerable to infections. Infections were not necessarily caused by the hip replacement surgery itself but by bacteria that may have entered the bloodstream during treatment. Patients who suffered from infections were subjected to another hip surgery operation.

In 1940, an American surgeon by the name of Dr. Austin T. Moore designed a proximal femoral prosthesis made out of Vitallium, a type of metal that is made from a mixture of chromium, cobalt, molybdenum, and many other substances. Unlike other types of metal that have been used in earlier femoral replacements, Vitallium was lightweight and was much better because it was resistant against corrosion. Moore designed the prosthesis to be inserted to the femoral shaft’s end as opposed to earlier models that were meant to be inserted into the femoral medullary canal. In 1952, an improved version of this prosthesis was introduced by Moore into the market and it was named Austin Moore after its designer. The Austin Moore prosthesis is still being used in today’s modern day hip replacement surgery.

Hip replacement surgery became even more advanced as years progressed. Surgeons found better ways to replace fractured hip bones. In 1960, Dr. San Baw, an orthopedic surgeon from Burma, used ivory hip replacements on his hip replacement surgery patients. He was able to perform a series of successful hip replacement surgery using ivory on over 300 patients in a span of three decades, from 1960 to the 1980s. Baw’s hip surgery procedure was reported to have a success rate of 88%. His patients were able to walk, play football, take a bicycle, squat, and do other somewhat strenuous things weeks after undergoing hip replacement surgery. Ivory was thought to bond well with human tissues biologically, making it a good material for use in hip replacement surgery.

Modern Day Hip Replacement Surgery

Modern day hip replacement surgery has become better in the passing of time. Modern technologies have made it possible for inventors and surgeons to come up with better equipment and more effective procedures to replace damaged hips. These days, total hip replacements can last up to twenty years or more and revision operations have been significantly lessened on some hip replacement patients. There are still some cases, though, where hip replacements may loosen after a period of 15 years or less.

The successes of modern day hip replacement surgery can be attributed to the work of British orthopedic surgeon John Charnley. Charnley pioneered the use of Low Friction Arthroplasty, a replacement femoral joint that consisted of a piece of stainless femur, teflon or polyethylene, acetabular component, and a poly-methyl-methacrylate (PMMA) bone cement. The process likewise uses a synovial fluid, which works as a lubricant to the hip femoral replacement. Charnley designed the femoral head to be small so that it would resist rapid wear and tear and so that it would be more durable against dislocation. This design, however, showed signs of instability and was therefore replaced later with the Ultra High Molecular Weight Polyethylene (UHMWPE). Charnley’s designs were used widely by surgeons in different parts of the world and they reached their peak of success in 1970 when all other designs were eliminated in favor of Charnley’s Low Friction Arthroplasty and other subsequent designs.

Approaches Used in Modern Day Hip Replacement Surgery

Modern day hip replacement surgery uses different techniques in replacing severed hips. These techniques include the following approaches: anterior approach, direct lateral approach, antero-lateral approach, posterior approach, and the minimal invasive approach. Each of these approaches refers to the type of incisions made during the hip replacement surgery. These approaches may also be an important factor that may lead to the success of the hip replacement surgery.

The anterior or front approach utilizes the technique used by Moore in his hip replacement surgery procedures. It is also widely known as the Smith-Petersen approach and is widely used in hip replacement surgery that utilizes the minimal invasive approach or MIS, a modern hip surgery technique that is aimed at reducing soft tissue damage during the hip replacement surgery process. This is also widely utilized when performing biopsies, pelvic osteotomy, and hemiarthroplasty.

Lateral approaches, such as the antero-lateral and direct approaches, require the incision to be made on the side portion. The posterior approach, on the other hand, requires the incision to be made at the rear near the buttocks.

How Hip Replacement Surgery is Done

Patients may be required to take antibiotics before the scheduled date and time of the hip replacement surgery. This is often done to minimize the risk of infections that may arise after the hip surgery. Doctors may also ask the patients to have their teeth checked by a dentist and to undergo major dental treatment before the hip replacement surgery to ward off any possible infections that may affect the replacement joint. A CT scan and other pre-operative procedures may also be performed on the patients to ensure that they are indeed ready for the actual hip replacement surgery and for the doctor to gauge the overall health condition of the patients.

On the scheduled date of the hip replacement surgery, the patient may be injected with anesthesia before the actual hip surgery operation is commenced. The anesthesia will numb the patient’s body, allowing the person not to feel pain throughout the entire hip replacement surgery process. The anesthesia also allows doctors to perform the needed skin incisions without having to worry about violent reactions from the patient. Usually, general anesthesia is given, wherein the person is put to sleep and made unconscious all throughout the duration of the hip replacement surgery. In some instances, however, doctors use regional anesthesia. Unlike general anesthesia, regional anesthesia only numbs a portion of the person’s body, particularly the area where the incision for the hip replacement surgery is to be made. The person will not be unconscious; he or she will be awake throughout the process of hip replacement surgery but put into a sleepy state. The type of anesthesia to be used will depend on several factors, depending on the doctor, the preference of the patient, as well as on the overall health of the patient.

Doctors will then make the skin incisions using the type of approach that best fits the condition and anatomy of the patient. The damaged joints will be removed and replacement femoral prostheses will then be attached in place. Doctors may use cement to attach and glue the prostheses to the bone. They may also use a porous coating that is designed to make the artificial joint hold strongly to the existing bone. Unlike the cement, the porous coating allows the bone to grow in time and become attached to the artificial joint.

What Happens After Hip Replacement Surgery

Patients who have undergone hip replacement surgery are often injected with antibiotics right after the operation. They are also given pain medications and anticoagulants to prevent the formation of blood clots. They may also be advised to stay in bed for a few days. Moreover, they may be put under rehabilitation under the close supervision of their surgeons. The duration of the patients’ rehab will depend largely on the type of joint replacement used. For replacement hips that were attached using porous coating, rehabilitation may run for up to 6 weeks. All throughout the rehab period, the patient may not be allowed to stand or put any amount of weight on the legs and hips. For cemented hips, patients may be allowed to stand and walk, provided they are supported by other people. They also need to use crutches, a cane, or a walker.

There are several exercises that may be taught by physical therapists to the hip replacement surgery patient for faster recovery. The physical therapists, however, have to consult the surgeons about the limitations of the patient. Any wrong movement may cause dislocation of the new hip.

After the rehabilitation period, the hip replacement surgery patient may then be allowed to go home. However, close monitoring of the hip surgery area is still necessary. The patient will have to report to the surgeon about any problem that may be noticed on the hip replacement surgery site, such as swelling and redness. Furthermore, the patient will have to continue working closely with the physical therapist until he or she is able to function normally again. This process may take up to six months before the patient can be considered as fit to perform normal functions without outside help.

Even when the hip replacement surgery site has healed, the patient may still be required to see the doctor once a year for the monitoring of the replacement hip.

Risks Involved in Hip Replacement Surgery

Like any other types of surgical procedure, hip replacement surgery may involve some risks and dangers. Basically, the risks involved in hip replacement surgery are classified into two different types: risks during the hip surgery and recovery period and long-term risks. Long term risks may happen to patients months or even years after the hip replacement surgery.

Some of the risks involved during the hip surgery period and recovery period include the following:

* Neurovascular injury or injury to the nerves. This may not common happen during the hip replacement surgery period but it does happen to some patients. People who suffer from nerve injuries on the hip replacement surgery site may feel numbness and a tingling sensation. They may also have difficulty moving some muscles.

* Blood clots. In some instances, blood clots may form on the veins of the legs after hip replacement surgery. This condition can be dangerous, particularly when blood flow to the heart is blocked and when blood starts flowing to the lungs instead. Blood clotting after hip replacement surgery often occurs to people who are overweight, have cancer, or have suffered from blood clots in the past. Older people may also be susceptible to this condition.

* Infections. People who are suffering from certain types of health problems such as diabetes, chronic liver disease, rheumatoid arthritis, and many other medical conditions are at higher risks of getting infections on their hip replacements. This is because the organisms that are causing the infections can spread rapidly to other parts of the body. When this happens, another hip surgery may be required or the replacement may be removed. People who are under corticosteroid medications are also at higher risks of infection.

* Heterotopic Ossification. This condition happens when there is a formation of bone deposits in the soft tissues surrounding the hip joints. This is not extremely alarming and its effects may be minor but it may hinder normal movement of the hips. If the patient feels pain, another hip surgery may be done to remove the problem.

* Different Lengths of Legs. This can happen during the hip replacement surgery and recovery period. Often, difference is relatively small and there is no need to worry about it. It also does not cause any problem on the hips and the person may not feel pain. A shoe insert may be used to correct this problem.

* Difficulty in wound healing. This condition often occurs in people who are taking medications, particularly corticosteroids. This is also common in people who are suffering from medical conditions such as diabetes, rheumatoid arthritis, and other types of diseases that affect the immune system.

* Side effects of general anesthesia. The usual side effects of anesthesia are other common risks that may be experienced by patients during the hip replacement surgery and recovery period. People who are suffering from heart disease, kidney disorders, liver problems, and chronic lung disease are at higher risks.

The long-term risks involved in the process of hip replacement surgery include infections and loosening of some parts of the artificial hip joints.

Revision Hip Surgery: What Happens When Surgery Fails

A failed hip replacement surgery involves the loosening of the new hip joint or it can be that the new hip has become dislocated. In such cases, another surgical operation called revision hip surgery or revision operation is needed to be performed. This will correct the problem that has occurred to the new hip after the first hip replacement surgery.

Revision operation is a complex process and not many surgeons may be skilled or experienced enough to handle it. Technically, the steps involved are the same with hip replacement surgery only that surgeons have to perform additional procedures. Mistakes in performing this type of hip surgery can lead to more complications, such as infection, dislocation, stem breakage, nerve injuries, loosening of the prostheses, pseudomembranous colitis, femur fracture, and even death.

A successful revision operation, however, can provide a number of advantages, such as restoration of the functions of the hip and relief from pain and discomfort.

Who May Undergo Hip Replacement Surgery?

Not all people who have arthritis may need to undergo hip replacement surgery. Most of the time, doctors may just recommend arthritic people to take certain types of medications to alleviate the pain caused by arthritis. Likewise, not all people who may have suffered from injury may be subjected to hip replacement surgery. Doctors may first recommend physical therapy, exercise and other methods before deciding for hip replacement surgery. Hip replacement surgery is given only as a last resort to the patient when no other types of medication or treatment may work for the patient.

Certain types of conditions that may necessitate people to undergo hip replacement surgery include the following:

* Rheumatoid arthritis

* Bone tumor

* Osteoarthritis

* Broken or extremely damaged hip

* Osteonecrosis, a condition where there is inadequate supply of blood to the joints of the hip, particularly the ball portion.

There are several signs and symptoms of the above-mentioned diseases that may make people consider having a hip replacement surgery. Symptoms include:

* Severe pain that usually occurs at night. People who go through such symptoms may not be able to get a good night’s sleep due to such condition.

* Difficulty going down and/or up the stairs

* Persistent pain despite taking pain medications

* Difficulty standing up from a seated position

* Extreme pain even while walking

It is important to consult a doctor when there is persistent occurrence of these symptoms. The doctor will decide whether or not the person needs hip replacement surgery based on the diagnosis that has been made. The doctor will also base his decision on the overall health condition of the person. There are cases where a patient may not be eligible for hip replacement surgery even if he or she badly needs one. People who may not be eligible for hip replacement surgery include those who are obese, have poor health conditions, and who may not be able to tolerate the procedures involved. People who are at high risk of infection or who are currently suffering from an infection are also not advised to undertake hip replacement surgery. In addition, individuals who are active in extreme sports or are involved in strenuous manual labor may not be eligible for hip replacement surgery.

Preparations to Take Before Undergoing Hip Replacement Surgery

People who are considering undergoing total hip replacement surgery may want to get themselves ready before the actual operation. Preparations that they need to undertake include a consultation with their physician and undergoing blood tests, MRI, Xray, and other laboratory examinations that may be ordered by their doctor. They may also want to ensure that they are healthy enough for the hip replacement surgery. Doctors may recommend an exercise program that they need to take in order to prepare their muscles and body for the hip replacement surgery. It is believed that people who are physically fit and who have undergone a flexibility and muscle-building program have faster time for recovery.

Precautionary Measures to Take for Faster Recovery and Avoid Dislocations After Hip Replacement Surgery

Dislocations and other problems that may occur to a newly implanted hip can be avoided if patients follow their doctor’s instructions strictly. Furthermore, the following tips may help:

* Avoid bending for more than 90 degrees.

* Avoid sitting on low chairs, toilets, and beds.

* Avoid leaning forward in all instances.

* Do not make movement combinations, particularly those that involve the hip.

* Avoid crossing your legs when sitting.

* Keep toes pointed forward and keep legs from rotating too far in or too far out.

* Take extra care when getting out of bed or when getting out of a car.

Physical therapists may recommend certain exercises that may help with the faster recovery of patients after hip replacement surgery. These exercises may include muscle strengthening and muscle stretching. Patients are advised not to undertake any type of exercise that is not recommended by their doctors or physical therapists. They may also be advised to ask the assistance of other people in performing simple activities on the first few days after hip replacement surgery.