Hip replacements, Total Hip Replacement, Hip Arthroplasty
Hip replacement, hip arthroplasty or total hip replacement is a surgical procedure which replaces your arthritic or damaged hip joint with a new, artificial version. Hip replacements provide long-term relief from the pain and disability of osteoarthritis or hip trauma such as fracture, both of which can be very limiting in day to day life. It is one of the most successful medical treatments, with the highest increases of quality of life of all medical interventions, along with knee replacement which has similar results. It is a very good treatment, providing a high level of hip pain relief.
The hip joint is a large ball and socket joint, with both the original socket and the ball of the top of the thigh bone replaced with artificial components which imitate closely the natural movements of the normal hip.
The National Joint Registry collects statistics about all the joint replacements performed in England and Wales. In 2010 there were over 52,000 hip replacements performed in the NHS and over 23,000 in independent hospitals, with the large majority being people over sixty five years old and with a higher proportion of women requiring this joint replacement.
Hip resurfacing is an alternative strategy for hip arthritis, with a much smaller removal of bone allowing future hip replacement options to be maintained. A hemispherical insert is placed in the socket, with a similarly shaped part pressed onto the femoral head so the metal-on-metal hemispheres articulate with very low friction. The advantages of hip resurfacing surgery is that a large amount of bone is preserved, people can go back to their normal activities and dislocation is not likely.
This metal on metal hip resurfacing technique means that the plastic wear problems of standard hip replacement are avoided, although concentrations of metal ions in the body have been recorded, without any evidence of harm. While private operations account for many instances of hip resurfacing, NHS hospitals units do provide this surgery in specialised areas.
The long term reliability and durability of hip resurfacing is a present unclear as they have not been studied for long enough, however they are expected to last ten years.
Why Hip Replacement is done
Hip replacement is typically performed for arthritis of the hip with the commonest reason being osteoarthritis. Osteoarthritis gives hip pain, limitation of range of movement, walking restrictions and reduction in functional abilities, as well as thigh pain in many cases. Other hip symptoms can be lateral hip pain at the side of the hip and lower back pain can refer pain round to the hip, with a physiotherapist able to distinguish the various parts.
Physiotherapy examination may also turn up bursitis, an inflammation of the lubricating sacs which make movement easier between parts of the body, with hip bursitis a cause of hip pain. Patients may present in these cases with hip pain running.
A replacement hip is also sometimes used in the management of a broken hip or fractured neck of femur, especially those that are managed late on or have a very high fracture which may compromise the blood supply to the head of the thigh bone (avascular necrosis). Orthopaedic surgeons assess each patient and decide the optimal treatment.
Other reasons for performing a hip replacement are rheumatoid arthritis (a more generalised body wide arthritis caused by the immune system attacking the joints), septic arthritis (infection), Paget's disease of bone, bone tumours and abnormal hips from birth (developmental dysplasia of the hip or DDH.
You might want to consider asking about hip replacement if your pain is severe enough to interfere strongly with day to day life, the pain is preventing or interrupting sleep, your medications or stick are less effective, your walking ability is reducing, you are unable to manage activities of daily living, the pain is making you feel down or you have a very limited social life due to your hip.
How Hip Replacement is Done
In hip replacement the surgical techniques vary with the types of hip replacement used to manage the particular problems of the patient. You are usually given a general anaesthetic where you will be completely asleep and unaware during the whole operation. If there are medical reasons you may be given a spinal anaesthetic to numb the lower body but you will be sedated to reduce or eliminate your awareness of what is going on.
Total hip replacement involves the removal of bone from the hip socket to accommodate the new socket and removal of the ball and neck of the upper femur (thigh bone) to accept the femoral part of the hip prosthesis. A plastic or ceramic socket is press fitted or cemented into the prepared socket and an angled metal component with a ball on the top is inserted into the prepared central canal of the thigh bone. A large amount of bone is removed and hip replacements are often cemented in with acrylic cement, although uncemented techniques are used in younger people. Problems with these replacements include dislocation, loosening and wear.
Choosing Your Hip Replacement
There are a large number of different hip replacement systems on the market, over 60 overall, but a much smaller number are suitable for standard hip replacement. The National Institute for Clinical Excellence (NICE) has recommended that the hip components used should have a 90% chance of lasting for ten years and there are a group of replacements with very good published long term results. The National Joint Registry again collects data about the performance of hip replacements and is a good source of information.
You will want to choose a hip specialist who regularly performs the type of hip replacement which is suitable for you. They should be very happy to answer your questions and justify their choices for you with their own results.
While the technology is very successful, there are hip replacement risks and hip replacement complications which need considering before committing to surgery. People of 80 years old or older are very likely to suffer from at least one complication although most are readily treatable and cause no long term problems. However, surgery does not go well for everyone and some people develop infections or dislocation problems which may require repeat surgery or medical treatment.
This is particularly important to consider if you are thinking about having hip replacement abroad as there are potential financial and legal risks if you have hip replacement surgery in a foreign country as well as the surgical and medical risks. You may want to do some hip replacement cost comparisons to ensure you are getting a balance of skilled treatment along with a good saving from having it done in the UK.
Physiotherapists typically manage the post-operative period after hip surgery, prescribing hip replacement exercises as appropriate to progress the rehabilitation towards normal gait and function. A new hip joint should allow a person to go back to full functional activity except for vigorous activities like running or crouching in low positions.