Total hip replacement

In principle, a radical procedure such as hip replacement is recommended when all conservative treatment methods have been exhausted. You should discuss this option with your doctor if:

• You have severe pain that prevents you from doing daily activities such as walking and bending over;
• You have pain even when there is no load;
• Medicines, physical therapy, and aids do not bring you adequate relief.

Your doctor will determine the necessary tests, but the following tests are most often required before hip replacement:

• A detailed medical history: through this, your doctor will receive information about various “hidden” problems, as well as the nature and extent of the issues due to which hip replacement is necessary;
• X-ray: it determines the size of damage and deformation of the hip joint;
• Other tests: sometimes (rarely), it is necessary to use additional tests such as a CT scan or MRI to determine the condition of the bone and soft tissue when it is unclear.

Once you have decided to undergo this procedure, it is necessary to carry out specific preparations to ensure that everything related to the system and the recovery afterward will go smoothly. Here are the measures you should take:

• Medical tests: do all the tests prescribed by your doctor. Some of these tests must be done in the hospital before the operation.
• Skin preparation: you mustn’t have any skin infections or irritations before surgery. If there is something like that, you need to share it and consult with your surgeon.
• Medicines: give your doctor a complete list of your drugs and nutritional supplements. He will make a plan for you to change or stop taking them before, during, and after the operation.
• Body weight: if you are overweight, your doctor may ask you to lose weight before surgery.
• Dental examination: hip replacement infections are sporadic, but such an infection can occur if pathogenic bacteria enter the bloodstream. One of the most familiar sources of pathogenic bacteria is the teeth and oral cavity. Any dental procedures treating inflammation and infection in the mouth must be fully completed before hip replacement. Postpone routine tartar cleaning for several months after surgery.
• Urological examination: urinary tract infections are also a common source of pathogenic bacteria. If you have symptoms or recently had a similar infection, you must ensure you are entirely cured. Men with prostate problems must address them before proceeding with hip replacement.
• Social planning: although walking is possible almost immediately after surgery, you will most likely have problems with activities such as shopping, cooking, laundry, etc., in the few weeks following surgery. It is best to plan who will help you with these activities.

• Anesthesia: Usually, this procedure is done with spinal anesthesia, but in some cases, your anesthetist may decide that a general anesthetic is necessary.
• Access: the standard surgical incision is lateral to the pelvis and about 10 cm long. In many cases, a minimally invasive technique can also be used, and this technique is chosen when possible. Its advantages are the smaller incision, less tissue trauma, and a faster and easier recovery.
• Procedure: During the hip replacement, the head of the femur is removed and replaced with a prosthetic head mounted on a shaft (stem). The joint surface of the acetabulum is lined with a bowl-shaped synthetic (polyethylene) joint surface. The charge is made of metal alloys or ceramics. The acetabular bearing is made of polyethylene or ceramics.

The patient spends the first five days in the hospital under observation for various post-operative problems. Rehabilitation begins the next day with verticalization and assisted walking training. If you are in pain, you will be given medication to relieve it.

Upon discharge from the hospital, you can travel independently and fly.

The sutures are removed after two weeks.

Walking aids are removed after the first month, depending on the individual progress of each patient. The rehabilitation program should be carried out progressively under the guidance of a competent physiotherapist.

After the first month, you can train on an ergometer. After the third month, you can drive. Sports activities can be resumed after six months at the earliest.

The complications with this procedure are at a meager rate. Suppose you follow all the instructions given to you by the doctor, not only in the days after the operation but also in general for life with an artificial joint. In that case, the probability of falling victim to a complication is minimal. However, some problems that may occur are:

• Infection: wound infection is not particularly dangerous. It is usually treated with antibiotics relatively easily. A deep infection around the prosthesis is a more serious complication that can occur even years after surgery. You should know that any infection in the body can spread to the artificial joint, so you should be careful. Such a condition in the joint area may require surgical treatment and the removal of the artificial joint.
• Blood clots (thrombi) are one of the most common complications of joint replacement. They can be life-threatening if they break off and reach your lungs or brain. That is why prevention is essential. This prevention includes medications such as anticoagulants (at the physician’s discretion) and measures such as compression stockings, ankle exercises, and early verticalization and mobilization.
• Dislocation of the joint: this is an infrequent complication. The risk of joint dislocation is most significant in the first months after surgery. In most cases, a joint realignment by an orthopedic specialist solves the problem, but surgery may be necessary if dislocations persist.
• Loosening of the implant: your artificial joint can loosen over time. This can happen simply because of the daily load or because of the physiological thinning of the bone. If the loosening is painful, surgery may be necessary.
• Limb length discrepancy: this complication is infrequent with modern joint replacement techniques. However, after surgery, your legs may feel differently long. This feeling is most often due to improved stability and lower limb biomechanics. Correcting with insoles or other orthotics in the shoes in some patients eliminates this problem.

If you follow the instructions strictly, you will minimize the risk of any damage. You will receive precise and detailed instructions on what to do in all recovery periods and how to modify your daily life, work, and hobbies so that your joint serves you for many years. It is essential to know that in the recovery period, working with a qualified physiotherapist significantly improves the outcome of the operation.