Total Hip Replacement
A total hip replacement, or total hip arthroplasty is a surgical procedure in which the arthritic portions of the hip are removed and replaced with a new, artificial joint. The new hip joint consists of 2 components, one to replace the head of the femur (the ball part of the thigh bone) and another which replaces the socket (acetabulum).
Advances in techniques and materials achieved in recent years have resulted in excellent outcomes and very high patient satisfaction, with significant pain relief and improvement in quality of life. Patients are able to perform day to day activities such as sitting, walking and driving much more comfortable than before, and many lead very active lives returning to full function including sports.
BENEFITS OF HIP REPLACEMENT
For many, the results are almost immediate but for the majority, full recovery can be expected to take between 6 and 9 months depending on the type of surgery you have, your overall health and how well you respond to rehabilitation. Patients may expect to be in hospital for approximately 3-4 days on average.
Risks associated with hip replacements include, but are not exclusively the following: infection, dislocation, clots (thrombosis), and wear/loosening in the long term. Various measures are put in place to minimise the risks of the above.
The longevity of a hip replacement depend on several factors, although for the majority of patients another operation is not required. The surgical expertise including surgeon volume and experience, the activity level of the patient, the weight of the patient and other factors would have an influence on the longevity of the implant. Typically, a hip replacement might be expected to last ten to fifteen years, although in some patients it could last for much longer. Total hip replacement is a technical procedure; studies have demonstrated that surgeons who perform large volumes of hip replacements have lower complications compared to surgeons who perform the occasional hip replacement.
ANAESTHESIA AND ENHANCED RECOVERY
A regional (spinal or epidural) anaesthetic and sedation or a general anaesthetic would be required to perform the operation, which takes approximately 1 hour.The operation begins with an incision length which is determined usually by the size of the patient, typically about five inches long over the hip joint. The ball and socket are removed and the new artificial parts fitted.
My preferred technique is a muscle sparing approach, optimally invasive technique, utilising an implant which has an established long term clinical outcome in terms safety, and survivorship of the implant. Enhanced recovery techniques, liaising closely with my physiotherapy colleagues is key to good clinical outcomes.
TIPS FOR A SUCCESSFUL OUTCOME
It is important that your arthritis is severe enough to warrant a hip replacement, meaning that the severity of your symptoms should correlate with radiological (xray) appearances of severe OA. Hip replacements are technical procedures, it is important to choose a surgeon who performs a significant number of hip replacements a year, as the number of hip replacements performed by a surgeon a year (the higher the better) appear to correlate with a good surgical outcome.
Total hip replacements are very successful operations for patients who have severe hip osteoarthritis. In this section I will briefly describe the procedure, indications for hip replacement, risks and complications associated with hip replacement.
MBChB, MSc, FRCSGlasg (Tr & Orth)
Consultant Orthopaedic Surgeon
Specialist in Hip and Knee Surgery
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