Replacing The Hip Joint
Most degenerative problems of the hip will ultimately require replacement of the painful hip joint with an artificial hip joint. Once the decision to proceed with total hip operation is made, there are several things to be done. Your orthopedic surgeon may suggest a complete physical examination by your medical or family doctor. This is to ensure that you are in the best possible condition to undergo the Hip Replacement Surgery.
Deciding On Artificial Hip
An artificial hip is required once the medical treatment is ineffective or the disease has progressed to severity. The indications include severe pain, loss of movements and inability to perform activities of daily life. The contraindications of the surgery also need to be discussed in detail. The hip to be replaced can be viewed by arthroscopy on video for a better view. The analgesia can be administered intrathecally for effective pain management. Hip replacement surgery can be done using general spinal or epidural anesthesia. The patient is anesthetized and positioned for surgery. The surgery can be done using the traditional approach of ten to twelve inches cut or the recent technique of minimally invasive procedure with three to four inches cut. The surgery lasts for approximately one hour. The postoperative care and exercises are very important in the final outcome of the Hip Replacement Surgery.
The Preoperative Preparation
The patient may need to spend time with a physiotherapist who will be managing your rehabilitation after the surgery. The therapist may begin the teaching process before the surgery. You may also be asked to donate some of your blood before the operation. This blood can be donated once a week beginning about three to five weeks before the surgery. If you need to have a blood transfusion at the time of surgery, you will receive your blood that has been stored in the blood bank.
Artificial Hip Joints – Lasts Longer Than Life
The Basics Of Hip Joint
Hip joint is made of bones and cartilages, each of which if diseased can cause trouble for the bearer. Hip joints can become inflamed with rheumatoid arthritis, a humoral condition. Osteoarthritis that damages the cartilages aiding smooth and pain free movements to the hips. Congenital conditions of the hips in some cases may make the movements impossible. These disease conditions are capable of affecting daily performance.
Implant Material
Implants are made of variety of materials depending upon the purpose served by the artificial implant. Polyethylene is utilized to make the acetabular socket. Most of the implants use this material for acetabulum component owing to its strength and flexibility. Metals have been used since long for making the femoral component by virtue of its tensile strength and sturdiness. Metals are also considered to wear less than the polyethylene. Metals such as chromium, cobalt and titanium are currently used for making implants. Ceramic hip implant material is wear resistant and long lasting. Bones are living tissue and hence are liable to get damaged.
Implant Fixation
The hip replacement implant fixation can be cemented, non cemented or hybrid. The cemented type fixation uses a material that percolates into the small pores in the bone. The non cemented types implant have microporous components in which the natural bone tissue can grow in. the hybrid type includes both types of fixation methods. The traditional type of hip replacement technique involves an incision of ten to twelve inches through the skin and soft tissues. The minimally invasive Hip Replacement Surgery are a better option with a cut of only three to four inches. As minimum of tissue is severed, healing time is remarkably less. The support system of hips is spared during replacement hence implants are strongly held. This facilitates early ambulation and rehabilitation. Post operative complications are less owing to the small incision.
The Hip Operation – Steps Of Surgery
Approach And Exposure
The hip replacement may be done with various approaches to the hip joint. The patient is given appropriate anesthesia and positioned to access the hip joint. The surgeon makes an incision of about 8 inches over the hip joint. The length of incision varies with the type of approaches and can be shortened or extended. The surgeon decides the type of approach based on his expertise and preference. The incision reveals a layer of ligaments and muscles covering the joint. These are separated to have a better view of the part to be operated. This process makes these structures weak and it takes about six weeks to heal. Hence it is advised to take precations till the time the supporting structures heal well.
Preparation Of Femur And Acetabulum
The surgeon after accessing the hip joint, disengages the femoral and acetabular components. The head of the femur is cut through the neck to make place for the artificial head. The articular cartilage is removed and the acetabulum is reamed into hemispherical shape to receive the prosthetic acetabular component.
The Acetabular Component
To ensure that the person gets the right size of the artificial hip, a trial component is used. The trial version determines the accurate size which is then inserted into the reamed acetabulum. The cemented prosthesis are held in place by special epoxy type cement whereas in uncemented types of joints , the metal cups are held either by screws or by the accurate fit of the cup.
The Femoral Component
The femur shaft is prepared into exact size in order to hold the metallic femoral component. It is hollowed and shaped according to the artificial femoral head. In the cemented type, the hollow is a bit larger than the prosthesis to accommodate the epoxy cement used. The surgeon tests the mobility of the joint as well as the correct shape and size with the help of a trial component. The stem of the prosthesis is then inserted into the hollow created into the femur shaft. In the uncemented variety the femoral component is held by the perfect fit of the femoral insert. The leg may not be of same length before surgery. it may be shorter or longer than the other leg.
Hip Replacement Surgery Complications – The Other Side Of The Coin
Complications of Hip Replacement
Nerves in the vicinity of the total joint replacement may be damaged during the total replacement surgery, although this type of injury is infrequent. This is more likely to occur when the surgery involves correction of major joint deformity or lengthening of a shortened limb due to an arthritic deformity. Over time these nerve injuries often improve and may completely recover.
Blood clots may occur as a complication of hip replacement. Thrombophlebitis is one of the causes of blood clot resulting from slow moving blood in the veins that is caused by decreased mobility after surgery. It is manifested by pain and swelling in calf and thighs. The doctor may suggest several preventive measures for occurrence of blood clot. These include medications that cause thinning of blood, use of elastic stockings, increasing mobility of leg through exercises, and use of special boots that compress the muscles to enhance circulation.
Even after following all precautions, the blood clots do occur. In such cases, the doctor should be immediately contacted and advice sought.
Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Urinary tract infection may also occur. Any infection in your body can spread to your joint replacement.
The implanted prosthesis is an artificial device and may loosen. Loosening of prosthesis may be a cause of pain after the surgery. In such cases, the surgery has to be performed again. This shortcoming of artificial joints can be minimized by newer techniques of implantation.
Hip joint is a ball and socket joint. An artificial femoral ball can get dislodged from the prosthetic acetabulum. In minor cases, it can be rectified without the need of surgery. The dislocation can be corrected by wearing a metal brace for sometime. Dislocations are commonly seen after revision surgeries. Wear and tear are common in all hip replacements but excessive wearing down can lead to loosening and can be a reason for revision surgery. Rarely, the metal or the [plastic component of the joint may break.
Hip Replacement After Care – Adjusting Your Hips
The Post Surgery Activities
On the first post operative day of surgery, generally bed rest is advised with legs abducted to prevent dislocation. However, mobilization out of bed depends on the Surgeon and may start on first day. Bed exercises such as quadriceps contraction and ankle exercises are encouraged for enhanced circulation. Routine chest physiotherapy is given to prevent chest complications. The procedures on the second day of operation include walking till bathroom with the help of a walker. The patient is gradually ambulated to walk with crutches and is taught special maneuvers to ease daily activities like climbing stairs. Following Hip Replacement Surgery, catheter remains in situ for two days and the patient is advised to use bedpan for his elimination needs. These post operative procedures may limit your activities and may feel troublesome. From the second day after the operation the patient would not require catheter and bedpan. The nurse will examine the bandage and apply a new dressing. On the third post operation day, a hip X-ray would be taken and reviewed by the surgeon. The patients are usually discharged forth to fifth day after operation. The use of crutches or a walker may be necessary for as long as 3 months, although most people who did not use them before are able to walk without them in several weeks.
Lifestyle Changes
There are certain hip maneuvers that need to be avoided for an uneventful recovery. Prefer to sit in a chair with arms; it supports your arms while getting up. Avoid prolonged sitting that can stress you new hip implant. Do not cross legs; it helps maintaining a specific angle to the hips after replacement. The knees should not be bent upwards above the hip level and a distance of twelve to eighteen inches should be maintained between the knees. Regarding footwear, try to don slip-on. Try not to bend while putting on shoes and socks. Elastic stockings are advised till your doctor tells you to stop. Avoid showers until the staplers are removed. Also, keep away from bathtubs until the doctor considers it safe. A raised toilet seat that fits over the top of your own toilet rim will make sitting down safer and more comfortable. A bath seat or board can make getting into the bath easier. A bath mat inside the bath can prevent slipping. Always keep the surgery incision clean and dry. Driving is not recommended for six weeks after Hip Replacement Surgery. Aftercare precautions do not allow you to bend over to pick up things from floor. Do not attempt to cut your own toe nails or put nail varnish on your toes as this will bend your hip beyond 90 degrees; perhaps a friend or relative could help you with this.
Hip Replacement Treatment – Conservative Before Invasive!
Chronic hip pain may be debilitating, but before opting for surgery, the orthopedic specialists usually try for conservative management. The decision is usually governed by the severity of the disease, the degree of patient handicap and the extent of movements possible. Medical treatment for hip replacement includes analgesic drugs, exercises, rest in few cases and physiotherapy. Not all hip conditions require a Hip Replacement Surgery as the initial treatment. Alternative treatments are tried to relieve pain and postpone the hip replacement as long as comfortably possible. Many people use a cane to ease off the chronic pain and temporarily help in walking. Medicines like anti-inflammatory medications may lessen the pain and inflammation associated with arthritis of the hip.
Treatment For Hip Pain
Hip replacement is not done until the daily activities are severely affected. Hip pain arising from tendonitis and bursitis can be conservatively managed to an extent. Snapping hip could be due to a sudden injury caused by a fall on the hip, a traumatic blow to the hip or knee, or twisting or bending of the leg out of the range of motion. Injuries that cause a snapping hip include broken hip or pelvis, severe fracture, dislocation of the hip, sprained hip, diplegia, muscle strain in the groin or buttock, or severe bruising. Finally, tears of the cartilage, or labrum, around the hip socket can cause a snapping sensation. In rare cases, some conditions of the knee also may also give rise to hip pain. The basic principle of medical treatment is to delay surgery until necessary.
Hip Replacement surgery cost in Dubai
Hip Replacement Surgery cost varies based on a wide range of criteria, including the surgeon, facility, diagnostic tests, surgical implants and the intricacy of the treatment itself. The average cost of a complete Hip Replacement Surgery in Dubaia for an uninsured patient is close to 80,000 AED, with expenses ranging between around 65,000 AED and 90,000 AED. In rare situations, institutions and surgeons may provide a lower cost for patients paying totally out-of-pocket for a surgery.
It’s vital to remember that these Hip Replacement Surgery cost statistics are for uninsured individuals and is not what most people with health insurance would end up spending in out-of-pocket fees. As anybody confronting health insurance-related and/or Medicare-related cost issues knows though, establishing a patient’s out-of-pocket expenditures depends on a highly complicated array of variables.