ALL ABOUT HIP REPLACEMENT SURGERY

Hip replacement surgery (also called hip arthroplasty) is usually performed in patients with severe hip pain due to osteoarthritis. It is the best option for pain relief, restoring lost mobility, correcting hip deformity, and improving the patient’s quality of life.

Even though hip replacement is considered major surgery, its success rate is very high. The risk of infection of the prosthesis occurs only in 1% or 2% of cases.

So, if you are considering hip replacement surgery, keep reading to find out everything about this procedure.

HOW THE HIP WORKS?

The hip joint is considered a ball-and-socket joint. So, basically, it is a spherical-shaped surface (femoral head) that fits into a cup-like bone depression called the acetabulum.

The femoral head is the upper, round end of the femur (thighbone), and the acetabulum is part of the pelvis. Both the ball and socket bone surfaces are covered with a smooth tissue lining known as cartilage. It acts as a cushion and improves mobility between the hard bone surfaces.

Also, the synovial fluid lubricates the cartilage and minimizes the friction between the bones during hip movement. And there are a series of ligaments or bands of tissue that stabilize the hip joint.

Knowing how the hip works, you can understand pain develops due to a “wear and tear” mechanism in patients with osteoarthritis. The cartilage is diminished so that the bones rub together, causing hip pain.

WHICH PATIENTS SHOULD HAVE HIP REPLACEMENT SURGERY?

Hip replacement surgery involves replacing a worn-out or damaged hip affected by osteoarthritis, or a fracture, with an artificial hip prosthesis.

There are no age or special restrictions for total hip replacements. Surgeons evaluate each case individually.

In most cases, patients who undergo hip replacement surgery are older than 50 years with osteoarthritis or other degenerative diseases. But, the procedure can be done on younger patients who have juvenile arthritis, for example.

Hip replacement is usually carried out on patients suffering from severe pain, even while resting. You could also present reduced mobility, stiffness, and swelling that greatly limit your everyday activities.

Hip arthroplasty is the best option if other non-invasive treatments, including physiotherapy or steroid injections, have been unsuccessful. It is a safe and effective procedure to relieve hip pain and increase mobility.

In less advanced cases, it is possible to perform an arthroscopy (minimally invasive technique) that involves cleaning the cartilage and delaying hip implant surgery.

Orthopaedic surgeons will tell you if hip replacement surgery is the right fit for you. We will also provide you with the cost of the hip replacement surgery.

Hip Replacement Surgical Options

What is a total hip replacement surgery?

Total hip replacement surgery replaces both the head and neck of the femur and the acetabulum.

The surgeon will make an incision on the back or front of the hip to access the bone underneath. Then, he will remove the entire hip joint and replace it with an implant.

The round portion of the joint at the top of the thighbone is cut with a saw. Then, a metal stem is placed into the hollow center of the remaining thigh bone using special cement. It can also be “pressed fit” into the femur to allow your bone to grow onto the component.

Then, the surgeon places a metal or ceramic ball at the topmost part of the stem. Afterward, the surgeon prepares the surface of the acetabulum – free of damaged cartilage -and attaches the artificial socket to the hipbone. Screws or cement can be used to fix the metal socket in place.

A total hip implant is perfect for young patients who need good mobility due to their age and activity level. After all, a partial hip implant could limit mobility greatly.

This type of hip implant is also used if, besides the fracture, the patient has significant osteoarthritis of the hip.

Partial vs Resurfacing hip replacement surgery.

Partial hip replacement surgery only replaces the femoral head, leaving the pelvis intact.

Although partial hip replacement surgery is faster and has a lower risk of bleeding, it has worse functionality performance. A partial hip replacement surgery is ideal for elderly patients with low physical activity. Also, it is a less aggressive intervention than total hip replacement surgery.

The resurfacing (surface prosthesis) replaces the surface of the head of the femur and the acetabulum, covering them with metal material (metal-metal surface prosthesis or MoM).

This type of hip implant is ideal for younger patients. By preserving bone, the recovery is faster, and there is less risk of dislocation. Also, the material is more durable.

Over time, the surface prosthesis makes revision surgery easier. Indeed, a young patient may need at least a couple of hip replacement surgeries throughout his life, hence the importance of saving as much bone as possible.

Resurfacing implants are also perfect for patients who wish to engage in intense physical activity after the surgery, whether for work or pleasure. Although there have been reports of some cases of metal-on-metal hip replacements wearing out sooner, this is relative and happens on rare occasions.

HIP REPLACEMENT SURGERY WITH A MINIMALLY INVASIVE TECHNIQUE

Most hip replacement surgeries are performed following the standard technique with long incisions between 8 to 10 inches. However, more recently, some surgeons have been taking a minimally-invasive approach.

With this technique, your surgeon will perform the same procedure but use one or two small incisions along the side of the hip between 2 to 5 inches long. This translates into less blood loss, discomfort, pain following surgery, and a smaller hip replacement scar. Also, you will need minimal downtime, and the hospital stay is reduced to an average of 4 days.

However, you must put yourself in experienced hands with this technique. Otherwise, the results can be disastrous and far from ideal.

WHAT MATERIALS ARE USED IN TOTAL HIP REPLACEMENTS?

The material used to perform hip replacement surgery (arthroplasty) depends on many factors, including the patient’s age and activity level.

The most used materials are metal, stainless steel, cobalt, chrome, titanium alloys, polyethylene, and ceramic.

WHAT ARE THE RISKS OF HIP REPLACEMENT SURGERY?

As in all major surgical procedures, hip arthroplasty involves certain risks. However, many of them can be minimized by following the recommendations of your orthopaedic surgeon.

The main risks of hip replacement surgery (arthroplasty) are bleeding, infection, and DVT (deep vein thrombosis). However, the risk of serious complications is very low.

Other risks include hip implant loosening. It can be caused by the natural wear of the implant, an overload, being overweight, fractures, or an infection. In these cases, it will be necessary to replace the hip implant totally or partially.

Also, to avoid the risk of dislocation, you should avoid certain postures such as crossing your legs or sitting in very low chairs.

WHAT IS THE SUCCESS RATE OF HIP REPLACEMENT SURGERY?

Hip replacement surgery is one of the most common joint replacement procedures performed today by orthopaedic surgeons.

The success is very high. A small fraction of patients requires revision surgery to replace or repair the artificial joint. Complications, such as hip implant infection, occur in only 1% or 2% of cases.

Also, be aware that your new hip will reduce the pain you felt before your surgery and increase mobility in your joint. However, don’t expect to regain range of motion enough to do activities you used to do before your hip became stiff and painful.

Realistic expectations and good care are essential when having hip replacement surgery.

Before hip replacement surgery

You should try to keep active as much as possible in the weeks or even months before your surgery. After all, strengthening the muscles near your hip will later help your recovery.

Gentle activities, such as swimming and walking, are ideal. Also, if you are overweight, your doctor may put you on a special diet to help you lose some weight before surgery. This will diminish the stress on your new hip and decrease late complications.

Also, you must go to the Diagonal clinic facilities in Barcelona (Spain) to carry out a series of preoperative exams. You will have blood tests, telemetry, a profile and axial hip x-ray.

Is hip replacement surgery painful?

The patient will not experience pain or discomfort during the intervention.

Total hip arthroplasty is performed under epidural (you will be awake but numb from the waist down) or general anesthesia (completely asleep). It can last between 1 and 3 hours, being around an hour and a half in most cases.

How is hip replacement recovery?

After the surgery, you will be moved to the recovery room.

You are usually encouraged to start walking soon after the intervention to reduce the risk of blood clots in your legs. Indeed, most patients start physical therapy as soon as the same day or the next morning. The recovery time depends on each patient.

The Diagonal clinic team of physical therapists will instruct you in the rehabilitation and use of crutches. You will attend a couple of daily rehabilitation sessions throughout your six-day stay.

When discharged, you will leave the clinic on your own foot, only with the help of crutches. You will have to use them during the first 2 to 4 weeks after the intervention. Then, you will use a single crutch for about three more weeks.

When going back home, it is helpful to place your regular-use items at waist level so you don’t have to reach up or bend down. A raised toilet seat can be good for you too.

Remember that rehabilitation exercises are necessary to regain maximum mobility. You will be able to return to light activities or work within six weeks.

After one year, the checkups will be annual or every six months, depending on your doctor’s indications.

LIVING WITH A HIP IMPLANT

When having hip replacement surgery, you must have special considerations to extend the implant’s life.

First, you should keep an ideal weight and engage in moderate physical exercise so that your implant won’t wear out before expected. Also, you should maintain the mobility of your new hip, and a toned musculature will make the hip prosthesis work better.

Try to avoid falls and injuries. An impact on the hip prosthesis can dislodge some of its parts. It can also break the bone in which it is implanted, and you may require more surgery.

Other future considerations include telling your dentist that you have a hip implant before any dental procedure. A dental infection could migrate to the implant site. So, you may need to take antibiotics before dental procedures.

Finally, regular checkups and follow-up examinations are mandatory, even if it seems like your hip replacement is doing fine. This will allow future complications to be caught on time.

WILL I BE ABLE TO PLAY SPORTS AFTER HIP REPLACEMENT SURGERY?

Patients who want to play sports after the surgery must consider that contact sports can quickly deteriorate or displace the hip prosthesis.

Non-recommended high-impact sports include jogging, jumping, and soccer (even adapted for veterans).

However, each patient is unique, and you could be able to practice sports with caution between 6 and 9 months after the intervention. Indeed, the fact that a patient has previously practiced sport may reduce the probability of injury.

There is a long list of hip prosthesis-friendly sports, including steps, walking, swimming, golf, dancing, cycling, skiing, Pilates, and other low-impact sports.

To sum up, everything depends on your age, physical shape, and type of prosthesis used.

Whichever your case, the Diagonal clinic in Barcelona (Spain) has specialists in sports medicine. So, if your passion is playing sports, you can be sure that our experts will know how to give you the necessary guidelines to continue practicing your sport with caution.

HOW MUCH DOES HIP REPLACEMENT SURGERY COST?

The cost of private hip replacements depends on many factors. We would be delighted to answer your query.

Please, fill in the contact form. If you have any medical reports from other centers, we would appreciate it if you could send these tests to us by email to offer you the solution that best suits your needs. You can be sure that this information will always be treated with maximum confidentiality.

Qualified personnel is placed at your disposal, and they will advise you in your language and accompany you during the hospital process. If the doctor does not speak your language, a personal interpreter can accompany you throughout all your visits.

FAQ ABOUT HIP REPLACEMENT SURGERY

How long does a hip prosthesis last?

Even though prostheses have a limited life, current materials are increasingly endurable.

The average duration of a hip prosthesis is around 15 years, even when subjected to regular physical activity.

Some factors that affect its duration are the materials and type of fixation, the weight of the patient, and the level of physical activity.

A hip prosthesis can last less when a complication arises. But there are also cases where it can go up to 25 years.

Can I undergo hip replacement surgery if I am allergic to metals?

In the case of patients allergic to metals, orthopaedic surgeons will identify which metals the patient is allergic to and find the most suitable alloy.

Also, it is possible to use hypoallergenic materials.

How can I tell if the hip implant is loosening?

If the hip implant is severely worn or loosening, the patient will notice pain in the groin or the thigh.

Other symptoms may include an instability sensation and a hip clicking or noise when walking.

Can both hips be operated at the same time?

It is possible to operate both hips but not at the same time. Each intervention requires its own rehabilitation process. Therefore, the surgery will always be carried out in two stages.

Surgeons advise waiting 4-6 months between the first hip surgery and the second one.

How long after hip replacement can I tie my shoes?

You should be able to bend down to tie your shoes after 12 weeks or so. However, even after your hip has completely recovered, you should not try bending your hip more than 90 degrees.

Hip Specialists at Diagonal Clinic (Barcelona, Spain)

Doctor Martín Casola, Daniel

Doctor Martín Casola, Daniel

Hip replacement surgeon. Specialist in arthroplasty, hip and knee replacement, osteosynthesis, arthroscopy acromioplasty and stem cell transplantation
Doctor Aláez Penina, Jaume

Doctor Aláez Penina, Jaume

Hip replacement surgeon. Specialist in arthroplasty, hip, knee and shoulder replacement and treatment of scapulohumeral periarthritis
Doctor Norberto Bayona, Eduard

Doctor Norberto Bayona, Eduard

Hip replacement surgeon. Specialist in arthroplasty, hip and knee replacement and fracture surgery
Doctor Salvans Giralt, Xavier

Doctor Salvans Giralt, Xavier

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip and knee replacement, osteosynthesis and sports orthopedics and traumatology
Doctor Valls Elias, Artur

Doctor Valls Elias, Artur

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip, knee and shoulder replacements, osteosynthesis and sports orthopaedics and traumatology
Doctor Garcia Bonet, Jordi

Doctor Garcia Bonet, Jordi

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip and knee replacement, foot surgery (halux valgus, finger deformities) and pediatric orthopedics
Doctor González Navarro, Albert

Doctor González Navarro, Albert

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty, hip and knee replacement and osteosynthesis
Doctor Sánchez Navés, Rubén

Doctor Sánchez Navés, Rubén

Hip replacement surgeon. Specialist in upper limb surgery, arthroscopy and hip, knee, shoulder and elbow replacement surgery
Doctor Rios Torondell, Joan

Doctor Rios Torondell, Joan

Hip replacement surgeon. Specialist in arthroscopic surgery, arthroplasty and knee replacement

Other articles that may interest you – External links – Bibliography

Cement penetration in Hip resurfacing 2008 Aufranc Award, Hip Society: Beaulé; Matar; Poitras, Smit, May. Clin Orthop Relat January 2009

Hip Resurfacing versus Total Hip Arthroplasty: A Systematic Review Comparing Standardized Outcomes Deborah A. Marshall, Karen Pykerman, Jason Werle, Diane Lorenzetti, Tracy Wasylak, Tom Noseworthy, Donald A. Dick, Greg O’Connor, Aish Sundaram, Sanne Heintzbergen, Cy Frank. Clin Orthop Relat Res. 2014

How long does a hip replacement last? (16 févrrier 2019). Lancet (London, England) Evans; Walker; Blom; Whitehouse; Sayers

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    Diagonal Clinic - Barcelona Espain - traumatology and orthopedic surgery - Clínica Diagonal

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    Carrer de Sant Mateu 24, 08950 Esplugues de Llobregat (Barcelona, Spain)

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