The hip essentially is a ball-and-socket joints on the side of the pelvis is a cartilage line socket that sits facing outwards and a top of the femur the thigh bone there is a ball again coated with cartilage and the most common reason to have a total hip replacement is because that joint becomes arthritic by which essentially we mean at the layer of cartilage on both sides of the joints wears away so what an orthopedic surgeon then can do is to open up the hip can remove the damaged cartridge lining from the inside of the socket similarly can remove the ball bit at the top of the the thigh bone and both of those are replaced with a new artificial articulation that can be made out of a variety of different materials depending on individual patient requirements.
But because then the two sides of the joint the damaged sides of the joint both been replaced the logic is that the source of the pain is removed and the patient can then return to a full level of pain-free focus on when you get to the stage where your hip arthritis is beginning to have an adverse effect on you being able to do the things on a day to day basis that you need to do and that’s the time for orthopedic doctor to have a discussion about whether hip replacement is right for you and probably the commonest things that doctor hear from patients are that their walking distance is starting to be limited by their pain that they’re increasingly finding and need painkillers on a day to day basis whereas previously they were not needing such regular analgesia and also increasingly patients start to feel that they’re being woken up on a nightly basis by their pain so even at rest their arthritis really is is this cause numb quite a significant amount of discomfort well.
The aim of a hip replacement is to get back to the the level of pain-free function that you had before the arthritic process started and really to allow you to to go back to doing the things that you most loved in life and one of the really exciting things that orthopedic doctor often look to try and achieve is to get back to what we call the the silent hip which we mean really that on a day-to-day basis once your hip has been replaced and you’ve gone through the recovery process that you don’t even remember on a day-to-day basis that you’ve had the surgery in the first place and it’s very exciting for doctor.
When doctors see people 6 or 12 months down the line and they come back and they show us photographs of them swimming in the sea or riding a bike or going on a skiing holiday and that really does show us that their hip is working exactly as it would if they had never had the pain and the arthritis in the first place.
Normally a patient would be admitted on the day of surgery and haven’t been checked in you would be taken around to the anaesthetic room where you’ll be given an anaesthetic now increasingly we’ve got to move towards using a spinal anesthetic rather than a general anaesthetic so general anaesthetic is where you have formally put to sleep often for joint replacement surgery now we favor a spinal anaesthetic where an injection is given in to your spine before numb you from the waist down normally with the patient lying on their side the certain will then gain access to the hip joint by dissecting through the skin part in between the different muscle layers around the hip joint and then using special surgical instruments to remove the damaged ball and socket joint after inserting a series of different trial implants to make sure that the correct size of prosthesis is selected we would then put in an artificial articulation to restore the normal function and anatomy of the hip as it was before the arthritic process started the wound is there normally sewn up in layers with dissolvable stitches and usually we would hope to have patients already up and walking around the ward within a few hours of their surgery most patients do find however a couple of weeks at least there is quite a bit of discomfort something often it is very psychologically empowering however is that they feel even early on when they’re experiencing quite a bit of pain from the surgery itself that the deep-rooted arthritic pain that they experienced in the months and years leading up to the decision to have the surgery often is resolved instantaneously and patients then can feel on the day-to-day basis that the surgical pain improves and improves and improves and they can see a time when and in the future they know they’re going to be completely pain-free.
Recovery is actually surprisingly fast we would normally expect to have patients up and walking around the wards on the same day as their operation and normally would be discharged within 48 to 72 hours of surgery the majority of patients are able to mobilize independently without crutches within 10 to 14 days of surgery an outpatient physiotherapy and ongoing engagement with the rehabilitation process is absolutely crucial and some patients are surprised to find that within 3 to 4 weeks of their operation they’re actually able to go out and walk a mile or two a day and certainly the majority of patients by the time they come back for their their six week follow-up starting to reach really quite a good level of independent mobility.
Hip replacement like all surgery does of course carry with it a small degree of risk there are risks that are generic risks inherent in all surgery for example the risk of infection the risk of bleeding the risk of blood clot formation and the risk of injury to nerves or blood vessels these are all very low risks and the likelihood of any of these occurring after a standard hip replacement would be expected to be less than 1% there are then also risks that are specific to hip replacement surgery in particular there is a risk of fracture or a crack to the bone normally worthless to occur the surgeon would repair the fracture at the same time and this wouldn’t be expected to have an adverse effect on the longer-term outcome of the operation there is a risk of dislocation by which we mean that the ball and the sockets can become separated from one another following the surgery and the final thing also specific to hip replacement surgery is that there is a small risk that the patient can be aware of a slight discrepancy in the leg length after the hip replacement this is often actually due to the fact that the arthritic process itself causes shortening of the hip as the cartilage wears away the leg becomes shorter and the surgeon invariably will try to restore the anatomy back to the correct position at the time of surgery some patients report afterwards for a few weeks they can feel that things feel a little bit tight because the ligaments have been stretched back out to the correct length and most patients find out within 5 to 6 weeks this stops being something they were aware of.