What is Hip Replacement Surgery? In Which Situations Is It Applied?

What is Hip Replacement Surgery?

Hip replacement surgery; destruction of the hip joint; It is applied in cases where it may cause results such as thinning of the cartilage layer on the joint surface, deterioration of the shape of the bones, difficulty in walking, pain, difficulty in movements and motion stiffness.

Losing weight in the early stages , physical therapy applications, intra-articular injections ( hyaluronic acid , PRP , stem cells, etc.), use of assistive devices such as a cane can alleviate the symptoms. However , when the joint is damaged to such an extent that it cannot function, hip replacement surgery may be the only option.

In Which Situations Is Hip Replacement Surgery Applied?

  • Hip Osteoarthritis  (calcification)
  • Inflammatory rheumatism ( Rheumatoid Arthritis , Ankylosing Spondylitis etc.)
  • Hip dislocation sequelae (Congenital or traumatic)
  • Legg-Calve-Perthes hastalığı shekel
  • Sequelae of femoral head epiphyseal slippage
  • Sequelae of acetabulum fracture
  • Bone tumors
  • In cases where there is no possibility of union after fracture
  • Hip replacement surgery is performed in cases such as Paget’s disease, osteonecrosis, septic arthritis or joint damage due to osteomyelitis, joint damage due to 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.

How is Hip Replacement Surgery Performed?

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 pelvic cavity (acetabulum) where the femoral head sits is removed and replaced with a metal socket. The socket can be fixed in place with screws or cement. A plastic, ceramic or metal inner liner (spacer, liner) is used so that the head and socket can move over each other without friction .

In the past, patients were hospitalized in the orthopedic service for a week or more for hip replacement surgeries, but today this period has decreased to 2-3 days in patients with good general health status .

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What Are Possible Complications ?

During and after surgeries; There are complications such as dislocation of the prosthesis, 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. However, the incidence of these complications is relatively low and hip replacement surgery has a high success rate.

Post-Surgery Considerations

There are some issues that people who have this 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.

Postoperative restrictions depend on the implant used and the surgical technique. At this point, the surgeon’s patient-specific recommendations gain importance. Some surgeons may emphasize patient-based restrictions more, while others may favor less patient-based restrictions. Patients should not hesitate to talk to their doctor about the reasons for the restrictions they must comply with.

A hip replacement is not as stable as a normal hip joint, so there is a risk of dislocation. In this case, the joint implant can sometimes be repositioned by intervention in the emergency room. But if this is not possible, re-operation is required. Prosthetic dislocations are among the factors that reduce the chance of success after surgery.

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 is necessary to put a pillow between the knees to prevent the legs from getting too close to each other while lying down.
  • The hip should not be bent more than 90 degrees. That is, the knee should not be higher than the hip while sitting. Avoid using low toilets and deeply padded low seats.
  • It may be necessary to avoid side lying in order not to load on the hips.
  • In addition, excessive inward rotation of the hip is also undesirable.
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Precautions After Anterior Surgical Approach

  • Excessive backing of the hip should be avoided.
  • Excessive outward rotation of the hip should be avoided.
  • Sleeping face down can be inconvenient.
  • Bridge exercises are not recommended.

Physical Therapy After Hip Replacement Surgery

Physical therapy exercises start from the first day so that the person can return to his daily life quickly. While the patient is still in the orthopedic service, the exercises taught by the physiotherapist are applied. Starting physical therapy early reduces the risk of complications such as muscle wasting, joint stiffness and vascular occlusion .

Generally, from the first day, the patient is asked to sit up in bed, sit in a chair and walk with a device such as a walker. These movements should be done in a way that does not cause the prosthesis to come out of place and should be accompanied by a physiotherapist.

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 pre-operative 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.

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