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​Remarkable surgical techniques involved in a hip replacement?

7th February 2018

Remarkable surgical techniques involved in a hip replacement?

Hip osteoarthritis is a condition that affects around 11% of the UK population over the age of 45. It is caused by a loss of cartilage around the hip joint, and this results in pain, stiffness and reduced mobility. While age is the biggest factor in developing hip osteoarthritis, other factors such as being overweight or not taking enough exercise can also play a role. After someone has been diagnosed with hip osteoarthritis, hip replacement surgery might be prescribed. This procedure may sound drastic but is actually relatively straightforward and not as invasive as it sounds.

What is hip replacement surgery?

Hip replacement surgery is a common procedure carried out when a hip joint is damaged and needs to be repaired. There are many reasons why hip replacement might be necessary: hip osteoarthritis is one reason, but osteoporosis and septic arthritis are also common reasons for the surgery. The aim of the surgery is to replace the damaged hip with an artificial hip known as a prosthesis. Once healed, normal hip function should be restored. Around 160,000 hip replacements are performed in the UK every year, and the risk of serious complications is less than 1%

Unlike many illnesses or conditions, and because hip surgery is so low-risk, age is not normally considered a barrier to surgery. In fact, most are carried out on patients between 60 and 80 years of age. The prosthesis will last around 15 years with typical daily wear.

When will I be offered hip replacement Surgery?

While the surgery is relatively risk-free and recovery rates good, it is still a major surgery which will require general anaesthetic or an epidural. For this reason, most doctors will look to exhaust all other treatment options before suggesting surgery. The most common treatments your doctor might suggest are physiotherapy or steroid injections. Some patients will start with steroid injections and then work up to physiotherapy. If either or these or the combination of the two doesn’t increase mobility and reduce pain, surgery will be recommended.

The level of severity in hip osteoarthritis is usually measured by how much it interferes with your daily life. If your pain is so severe that it interferes with your quality of life, undertaking everyday tasks and sleep, surgery will be considered. If you have always been an active person and your mobility is affected to the point where you begin to suffer mental health issues, your doctor will recommend surgery. Likewise, if you are still in work and the pain and mobility interfere with your job, hip replacement surgery is advisable. However, for very elderly patients whose mobility is already compromised or who would have trouble with the recovery physiotherapy, hip replacement is not effective.

What happens during hip replacement surgery?

Hip replacement surgery is most often carried out under general anesthetic. This makes the process much more comfortable and stress-free for the patient and easier for the surgeon too. However, for patients for whom general anesthetic is not recommended, epidural pain relief is also an option. In this case, the patient can remain conscious but a sheet will be placed between them and the surgeon.

To replace the hip, the surgeon makes an incision towards the hip and opens the muscle around the joint. The existing hip joint is removed completely. This means the upper part of the femur where it connects to the hip is removed and a socket is hollowed out to fit the new joint. The new hip is then inserted into the pelvis socket and the end is fixed on to the femur. The prosthesis consists of a cup and short angled metal shaft connected to a smooth ball. The cup and ball will then move together to act as a new joint. The components may be held in place with acrylic cement or simply pressed into position. The prosthesis can be made from a metal alloy or out of ceramic. The whole procedure, from the first incision to the closure of the incision, takes around an hour to an hour and a half.

Choosing your prosthesis

Once you’ve been selected for hip replacement surgery, you may be encouraged to consider what type of hip you want. This isn’t always the case, but most doctors are aware that their patients do research the differences.

Most prosthetic hips are made out of high-density polythene, titanium alloys and cobalt, chromium and molybdenum alloys. Polythene is a man-made plastic and very effective, but some surgeons will recommend a metal ball and socket if they think a longer-life product will be needed. In some cases, ceramic might also be suggested. The benefit of metal and ceramic over plastic is that it doesn’t wear out as quickly. However, metal-on-metal hip replacements can cause other problems such as more wear and tear on the bone.

All in all, there are around 60 different types and combination possibilities for the prosthesis. However, your surgeon will only consider the five they believe most suitable. The primary factors influencing their choice will be, safety, potential allergies and which devices have a 95% chance of lasting ten years or longer.

New minimally invasive hip replacement surgery

While traditional hip replacement surgery requires an incision of around 20-30cm, minimally invasive hip replacement surgery can be performed with an incision of just 10cm. The advantages of a less invasive surgery include a quicker recovery time and a smaller scar or site for healing. While this is a relatively new technique, there are plenty of surgeons trained in its delivery. However, the surgery requires the use of a set of very specific surgical instruments, and these are not as readily available. For this reason, while you may prefer this option and in some cases may choose to have this surgery, you may have to wait much longer.

Alternative surgical options

Many hip osteoarthritis patients still feel hip replacement surgery is too drastic a solution, or their doctors may see that fundamentally the hip is still sound. In these cases, an alternate surgery known as hip resurfacing might be offered. This is especially useful for patients suffering from spurs or women who have some symptoms of osteoporosis. In hip resurfacing, bone inside the hip joint is removed and replaced with a smooth metal surface. This should allow the hip to function normally again. However, although this surgery seems to be a gentler approach to restoring hip function, many surgeons are less willing to carry out the procedure. Resurfacing can bring problems, as the metal surface can cause damage to the soft surrounding tissues. In the end, the surgery could cause more problems than it cures. Some patients will still be good candidates for hip resurfacing, and if you are one, your doctor will talk to you about it as an option.

What happens after surgery?

Once the surgery is complete, you’ll be taken back to your ward or room to recover. You’ll probably wake up with a pillow between your legs and, after an hour or so, be offered something to drink. Many people are surprised to learn that the nurses will try to get you up and walking the same day or the following day. This is important, as moving around will help to prevent blood clots.

You will probably be in the hospital around five days but may be discharged sooner if recovery is going well. After this, your recovery programme will include physiotherapy and exercise. The good news is that most people notice an immediate reduction in pain following the surgery. Of course, you will have to recover from the surgery, but the root cause of the discomfort will have been eliminated.

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