HIP Replacement-Surgery






Why Do People Have Hip Replacement Surgery?


For the majority of people who have hip replacement surgery, the procedure results in:


·         a decrease in pain


·         increased mobility


·         improvements in activities of daily living


·         Improved quality of life.








Who Should Have Hip Replacement Surgery?


People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.


In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.


Today, a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs, tend to recover more easily and have better outcomes.








How to Prepare for Surgery and Recovery


People can do many things before and after they have surgery to make everyday tasks easier and help speed their recovery.


Before Surgery


·         Learn what to expect. Request information written for patients from the doctor, or contact one of the organizations listed near the end of this publication.


·         Arrange for someone to help you around the house for a week or two after coming home from the hospital.


·         Arrange for transportation to and from the hospital.


·         Set up a “recovery station” at home. Place the television remote control, radio, telephone, medicine, tissues, wastebasket, and pitcher and glass next to the spot where you will spend the most time while you recover.


·         Place items you use every day at arm’s level to avoid reaching up or bending down.


·         Stock up on kitchen supplies and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily.


After Surgery


·         Follow the doctor’s instructions.


·         Work with a physical therapist or other health care professional to rehabilitate your hip.


·         Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.


·         Use a long-handled “reacher” to turn on lights or grab things that are beyond arm’s length. Hospital personnel may provide one of these or suggest where to buy one.




















Anatomy of the hip




Joints are formed where bones meet. Most joints are mobile, allowing the bones to move without friction or discomfort. The hip joint is a ball-and-socket joint, which allows backward, forward, sideways, and rotating movements. The ball part of the hip joint is the head of the femur (thigh bone), and the acetabulum is the socket, a cup-like structure in the pelvis. The hip joint has significantly more bony contact and stability compared with other joints, such as the shoulder. 


A hip joint consists of the following:


·         Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.


·         Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.


·         Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.


·         Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.


·         Bursa. A fluid-filled sac located between bones, ligaments, or other adjacent structures that helps cushion joints.


·         Femur. Thighbone or upper leg bone.


·         Acetabulum. A socket or cuplike structure that holds the femur head.








Total Hip Replacement: A Minimally Invasive Procedure


GTC Cairo, offers a high-technology, minimally invasive hip replacement surgery technique that can significantly reduce overall surgery trauma and recovery time. With two small incisions, surgeons have the advantage of being able to optimize access to both the socket and the femur with minimal soft tissue trauma and no cutting of the tendon.


Although the hip replacement procedure represents a major advance in minimally invasive surgery, it is not recommended for patients who are obese, have osteoporosis, or who have severe bone deformities. Further, the procedure is complex, requiring surgeons to undergo special training and takes time for them to learn. This surgery offers an exciting option for many patients requiring hip replacement, particularly young, active working people for whom it would be costly to take time off from work.


The small incisions enable the surgeon to see the hip joint from two different angles and maneuver smaller instruments within the small spaces. Tiny fiber-optic lights guide very small surgical instruments, in order to place the ball and socket joint prosthetics very precisely between muscles, tendons, and ligaments. This avoids having to cut through soft tissue. The rounded head of the thigh-bone, or femur is then cut off, and the arthritic bone is removed from the socket. The ball and socket are then replaced by two prosthetic devices, which are tightly fitted into the bone of the femur and the pelvis. Currently, Cedars-Sinai Medical Center is one of a handful of centers in California, performing the procedure.

Benefits of the minimally invasive procedure typically include:


  • Patients experience less pain after surgery due to less manipulation and more precise placement
  • Eliminates the amount of cutting we have to do to replace the hip joint, patients recover more quickly
  • Hospital stay is typically two days versus four to six days
  • Less time is need for rehabilitation therapy
  • Return to work and normal activities usually within a couple of weeks versus up to month or more.


 In addition, surgeons performing traditional hip replacement must dislocate the hip by pulling the leg into an extreme position, which causes additional soft tissue trauma.











Total Hip Replacement: Traditional Procedure




With hip replacement surgery, the surgeon replaces the ball and socket portion of the hip with a metal ball and a plastic socket.










Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal) and the socket component (a durable plastic cup which may have an outer metal shell). The metal is usually made from chrome or titanium; the plastic from polyethylene.












The artificial joint is either cemented into place or non-cemented secured by the natural bone growing back in around it. Sometimes a combination of approaches is used, depending on the patient's bone structure and the surgeon's judgment.




In a cemented hip replacement, the cement acts as a grout by holding the artificial components in place. If cement is not used, the natural bone is allowed to grow into the rough surface of the prosthesis. Sometimes screws are used to fix the cup to the pelvis during the early stages of bone growth. Your orthopedic surgeon will remove the damaged cartilage and bone, then position new metal and plastic joint surfaces to restore the alignment and function of your hip.

A non-cemented replacement has also been developed which is used most often in younger, more active patients. The prosthesis may be coated with textured metal or a special bone-like substance, which allows bone to grow into the prosthesis.