Hip replacement surgery (arthroplasty) is an operation for the treatment of various conditions in which the hip joint is damaged. It is most commonly applied in calcification (osteoarthritis) and inflammatory rheumatism (rheumatoid arthritis, ankylosing spondylitis, etc.). Destruction of the hip joint, thinning of the cartilage layer on the joint surface, deterioration of the shape of the bones, difficulty in walking, pain, strain and stiffness of the movements may result. Losing weight in the early stages, physical therapy, intra-articular injections (hyaluronic acid, PRP, stem cell, etc.), use of assistive devices such as a cane can alleviate the symptoms. However, hip replacement surgery may be the only option when the joint is impaired enough to perform its function.
In hip replacement surgery, damaged bone and cartilage tissues are removed and replaced with prosthetic components. The head of the thigh bone (femur) is removed, and a metal prosthesis is placed in its place. The root part of the prosthesis is embedded in the center of the thigh bone, which is the cavity. The metal or ceramic hemispherical head is located on the upper part of the prosthesis. The damaged cartilage of the acetabulum, the pelvic cavity where the femoral head sits, is removed and a metal socket is placed in its place. The socket can be fixed in place with screws or cement. A plastic, ceramic or metal spacer is used so that the head and socket can move over each other without friction.
In Which Diseases Can Hip Replacement Surgery Be Performed?
- Hip osteoarthritis (calcification)
- rheumatoid arthritis
- Ankylosing spondylitis
- Slipped femoral head epiphysis
- Legg-Calve-Perthes disease
- Congenital hip dislocation
- Traumatic hip dislocation
- Acetabulum fracture
- Bone tumors
- Paget’s disease
- Joint destruction due to septic arthritis or osteomyelitis
- Joint destruction associated with hemophilia
The decision for surgery is made according to the level of pain and limitation of the person. Pain that interferes with daily activities, pain that continues even at rest, joint stiffness that prevents raising the leg, and not benefiting from non-surgical options make surgery stand out. Age alone is not a determining factor. Most prosthetic surgeries are performed between the ages of 50 and 80, but can also be performed on younger or older people.
Importance of Physical Therapy
Hip replacement surgery (hip replacement) is a frequently performed surgery with a high success rate. Physical therapy exercises start from the first day so that the person can return to his normal life quickly. While the patient is still in the orthopedic service, movements such as ankle pumping, heel sliding, isometric exercises are applied. Most patients are asked to sit up in bed, sit in a chair, and walk with a device such as a walker from the first day after surgery. These movements should be done in a way that does not cause dislocation of the prosthesis.
In the past, patients were hospitalized in the orthopedic service for a week or more for hip replacement surgeries, but today this has decreased to 2-3 days in patients with good general health status. Starting physical therapy early also reduces the rate of complications such as muscle wasting, joint stiffness, and vascular occlusion. Physiotherapists apply exercise programs on subjects such as muscle strength, movement and walking. Occupational therapists, on the other hand, can provide specific training for daily tasks such as dressing, doing housework, and using the toilet.
The course of physical therapy is affected by factors such as surgical technique, general health status of the person, and body weight. Increasing the condition in the preoperative period and paying attention to being at a normal weight may help the postoperative period to pass more comfortably.
For patients whose exercise programs will be difficult to implement at home, outpatient or inpatient physical therapy can be performed after discharge from the orthopedic service.
Movements to Avoid After Surgery
There are some issues that people who have hip replacement surgery should pay attention to. These are intended to prevent dislocation of the joint. There may be different limitations in anterior (anterior) and posterior (posterior) surgical approaches.
Precautions after Posterior Surgical Approach
The legs should not be crossed and crossed. For example, it is wrong to cross the legs to bring the foot closer to the body while wearing socks. It may be necessary to avoid side lying in order not to load on the hips. Putting a pillow between the knees while lying down prevents the legs from coming closer together and the prosthetic head coming out of the joint socket.
The hip should not be bent more than 90 degrees. That is, the knee should not be higher than the hip while sitting. Low toilets and deeply padded low seats can be a problem. In addition, internal rotation (internal rotation) of the hip is also undesirable.
A hip replacement is not as stable as a normal hip joint, so there is a risk of dislocation. If this happens, the joint implant can be repositioned, sometimes in the emergency room. But if this is not possible, it is re-operated. Prosthetic dislocations are among the factors that reduce the chance of success after surgery.
Precautions After Anterior Surgical Approach
Backward (extension) and outward rotation of the hip should be avoided. Sleeping face down can be inconvenient. Bridge exercises are not recommended.
Postoperative restrictions are dependent on the implant used and the surgical technique. At this point, the surgeon’s recommendations become important. Some surgeons may emphasize more restrictions, while others may favor less. Patients should not hesitate to talk to their doctor about the reasons for the restrictions they must comply with.
Apart from dislocation of the prosthesis, there is a risk of complications such as internal bleeding (hematoma), ossification in the muscles (heterotopic ossification), clot formation (deep vein thrombosis), nerve injuries, vascular injuries, leg length difference, fracture, nonunion, infection, loosening of the prosthesis, and death. These risks are relatively low and hip arthroplasty is an operation with a high success rate. You should not hesitate to discuss your personal risks with your doctor.