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Total Hip Replacement

The hip joint has two parts: the upper end of the femur (thighbone) called the femoral head (the ball of the hip) and the acetabulum (hip socket). In a healthy hip, these components are covered with even, smooth cartilage that allows pain-free movement. If a joint is diseased, the cartilage breaks down and the patient feels pain, stiffness and functional limitation, which has a detrimental effect on quality of life. 

There are a number of diseases that can cause the joint to deteriorate, but the most common are osteoarthrosis, necrosis of the head of the femur, rheumatic diseases such as rheumatoid arthritis, ankylosing spondilitis and fracture of the femoral neck, etc. 

Total hip replacement consists of replacing a hip joint that has been damaged by any of these conditions with a prosthesis.   

Benefits of the Operation

A hip replacement allows the hip to move normally again, eliminating the severe pain suffered by these patients when walking and resting. Patients recover their quality of life and can walk normally again. 

Hip joint replacement has become one of the most successful procedures available and it is continuing to improve as a result of the work done by numerous researchers. During the last ten years, new materials, designs and hip surface replacements have been developed particularly quickly. 

The success of the surgery depends on the patient's efforts to do exercise, taking into account the precautions recommended for the hip and leading a healthy life.

Medical-technical description

Total hip replacement consists of replacing both parts of the joint, the femoral head and the acetabulum, by grafting a femoral stem and acetabular component. 

Nowadays there are numerous types of hip prostheses in different materials and with different designs. There are cemented and non-cemented components that are indicated according to the morphology of the hip to treat and the quality of the patient's bone mineral density, the patient's age, etc.  Each type of prostheses meets the needs of a specific type of patient, which is why each patient gets individualised treatment, receiving the best prosthesis for his or her requirements. Generally speaking, the different types of prostheses currently available are: 

  • "Traditional" total hip replacement: after removing the damaged femoral head, two components are implanted. One is cup-shaped and goes into the pelvis and a stem which is attached to the femur. There is a ball (replacement femoral head) that goes on the end of the femoral shaft. This fits into the cup, which forms the acetabular dome, giving the joint movement. This is the most common type of prosthesis used in active patients. The materials from which the prosthesis is made depends on the patient's age and lifestyle.
  • Hip resurfacing: Unlike traditional hip replacement, hip resurfacing does not replace the "ball" of the hip and leaves more of the patient's bone intact. This makes it suitable for young, active patients, especially men.
  • Mini-hip replacement: these prostheses are similar to conventional models but the femoral stem is smaller, meaning the material in contact with the acetabulum is metal or preferably ceramic.  With this technique, less of the ball of the hip is removed than in traditional hip replacement surgery. They are suitable for young, active patients, especially when we do not want to use a metal friction prosthesis.
  • Partial hip replacement: Only the femoral head (ball) is replaced, with a stem and large metal head which is goes directly into the socket in the pelvis. This technique is used in elderly patients with low functional requirements.  This is why they are used in subcapital hip fractures. These are usually cemented prostheses.

About the operation

Total hip replacement is performed in the operating theatre. The procedure usually takes one hour, although the patient is in theatre and recovery room for between three and five hours. Patients must stay in hospital for between three and five days.

Before the operation

  • The patient goes to the doctor's office for a prior consultation, when decisions are taken and the doctor explains the surgery in detail and gives the patient an informed consent.
  • The patient has a complete preoperative study with laboratory tests, ECG and x-rays.
  • You must cut your toenails, because you will not be able to do it for 12 weeks after the operation.
  • You should plan your convalescence at home for after the surgery. Get help from your family, friends and social services to do the shopping, wash you, make your meals, etc.
  • Get hold of a high stool or chair for the kitchen and bathroom, and a booster seat for the lavatory. You must sit on high chairs so that your knees are no higher than your hips.
  • Do not drink alcohol or smoke for 48 hours before the procedure.
  • If you are to have your surgery in the morning, you must not eat or drink anything that morning. If the surgery is to take place in the afternoon, have an early breakfast then do not eat or drink anything after 9 am.
  • You must remove all metal objects during the operation (rings, bracelets, earrings, body piercings, etc).

Post-operative care

  • An abduction cushion will be placed between your legs to stop you from closing them and dislocating your hip. You should use then while in bed for the first six weeks.
  • The drains will be removed on the day after surgery. You will wear a compression stocking to the hip for at least three months after the operation.
  • You will start moving on the first day. You should put no more than 50% of your weight on the hip for six weeks, until osteointegration commences in non-cemented joint replacements, or until complete osteointegration in cemented replacements. In any case, you must follow the instructions you will be given by your surgeon.
  • You will receive preventative anti-clotting medicines and antibiotics.
  • First you will need a walking frame and then some crutches.
  • You must not bend your hip beyond a 90 degree angle or cross your legs for the first six weeks.
  • After release, you should contact us if you suffer from chest pain or have breathing difficulties, swelling or reddening in a leg, sharp pain in the hip on which you have had the surgery, fever or shivering.
  • Correct rehabilitation is necessary, so on the first few days you must not travel or do any strenuous or violent movements.
  • After you have been released, you must avoid several movements and positions for three months to prevent injury and the risk of dislocation of your new hip.
    • Do not bend your hip beyond a 90 degree angle.
    • Make sure your knees are not higher than your hips when sitting.
    • Do now crouch down to pick things up from the floor.
    • Avoid twisting the leg in question inwards or outwards while sitting or lying down.
    • Avoid crossing your legs at the knees or ankles while sitting or lying down.
    • Do not lift weights.

The importance of immediate rehabilitation

  • Correct rehabilitation is essential after an operation of this type. Rehabilitation should start as soon as possible and on the first few days you must not travel or do any strenuous or violent movements. That is why we recommend that before you go back to your country you should spent at least eight days doing rehabilitation at our Casaverde rehabilitation centre.
  • This will help you to improve muscle tone and for the muscles affected by the surgery to gradually become stronger, which will reduce the risk of falling or complications.
  • This will optimise mobility of the joint affected and reduce any pain and/or discomfort that may appear after the surgery.
  • Improves trophism – nourishes the tissues around the operation site and encourages correct healing and closure of the surgical wound.
  • Recovers motor skills, giving the patient help, guidance and re-educating them adopt walking patterns that will soon have them on the road to recovery.

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