What is a total hip joint replacement?
A total hip joint replacement, total hip replacement or total hip arthroplasty (THA) is a surgical procedure performed by an orthopaedic surgeon and performed under general anaesthesia or in some cases spinal anaesthesia. The aim of the total hip joint replacement is to completely replace a damaged and painful hip joint with an implant. This is done via an incision of between 8 to 25 centimetres, most commonly along the outer side of the damaged hip, which allows surgeons to remove the entire ball-and-socket hip joint and measure and place the correct size of metal prosthetic. A minimally invasive hip replacement alternative involves a smaller incision of between 8 and 12 centimetres resulting in less tissue trauma and postoperative pain, and a more rapid recovery. However, larger incisions may be necessary for easier surgical access. Your eligibility for either hip arthroplasty type – minimally invasive or traditional - can be discussed during a free Remedazo e-consultation.
Total hip joint replacement surgery requires a hospital stay of between 2 to 4 days. Patients may usually fly home within 7 to 10 days. Long haul flights are not recommended in the first 3 months after hip replacement surgery and these should ideally be split into shorter journeys. It is also worth booking seats with extra legroom for your own comfort.
Why do I need total hip joint replacement?
A total hip joint replacement is the recommended procedure for individuals suffering from chronic hip pain or lack of mobility caused by osteoarthritis, rheumatoid arthritis and hip joint injury. During the total hip joint arthroplasty procedure, uneven, thin and inefficient cartilage is removed and replaced with a smooth-gliding metal ball-and-socket prosthesis. Hip arthroplasty is a therapeutic surgical treatment.
Can I prevent needing a total hip joint replacement?
Most total hip replacements are carried out in the over-50s age group. This is because cartilage degeneration takes time. If you are already experiencing pain and loss of mobility in one or both hips, losing weight may significantly alleviate the symptoms of osteoarthritis in the limbs as the force you place on the joints of the lower body can be up to six times your weight. Strengthening muscle groups such as the gluteal muscles in the buttocks and flexors in the pelvis are also important for hip strength and flexibility. The combination of weight loss and strength-building exercise may be enough to postpone total hip joint replacement for months to years. Chondroitin and glucosamine supplements have been shown to help cartilage repair but are insufficient to prevent hip replacement surgery once symptoms have started to appear.
How do I prepare for a total hip joint replacement? What can I expect?
Pre-travel total hip joint replacement preparation
Approximately 1 month before your total hip replacement procedure you may be asked to lower your food intake if you are clinically overweight. This will lower future stress on the hip joint. During this period it is worth looking around your home for potential access problems and remedy access or mobility issues such as the placement of a rail beside the bath, shower or toilet and the relocation of a sleeping area to avoid stairs and allow easy access to the bathroom; these hip replacement tips will help during your revalidation. In addition, it is extremely helpful to strengthen the muscles of the back and upper body well before the surgery takes place. You can ask your local physician or physical therapist for hip surgery exercise advice. Naturally, stopping smoking is always recommended. You will also need a recent hip X-ray.
Approximately 2 weeks before your total hip joint replacement procedure your doctor will need to take blood for a preoperative blood test. Remedazo will inform you well beforehand which tests your home-based physician will need to carry out. Depending on your age, an electrocardiogram may be required. Some blood-thinning medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.
Total hip joint replacement preparation in the hospital
You will be admitted to your chosen clinic on the day of your total hip joint replacement surgery. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting.Â
From midnight of the day before the total hip joint arthroplasty procedure, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during anaesthesia. If you have planned a spinal anaesthetic, these rules still apply as there is always a small chance that you will need to be sedated or fully anaesthetised. Smokers should stop smoking at least 24-hours before an operation. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the six hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medications with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted.
Approximately thirty minutes to one hour before the planned procedure time you will be collected from your room and brought to the operating department either in your bed, on a gurney, in a wheelchair or on foot.
Preoperative total hip joint replacement preparation requires:
An intravenous line
A blood pressure cuff placed on the upper arm
The completely painless placement of electrodes to the chest to measure heart activity
A finger or ear sensor to measure oxygen levels in the blood
A spinal or general anaesthetic
At the surgeon’s signal, you will be anaesthetised.Â
What happens during a total hip joint replacement operation?
A minimally invasive total hip arthroscopy takes approximately 60 minutes and is carried out in a supine position. The surgical site is broadly disinfected and sterile drapes placed so that only the hip area is visible. If, for personal reasons, you prefer a single-gender surgical team this can be arranged, although all staff from our carefully-selected clinics are extremely professional and respectful individuals.
During minimally invasive or traditional total hip arthroplasty, single vertical incisions of between 8 and 12 or 12 and 25 centimetres respectively are made along the outer side of the hip. This allows your orthopaedic surgeon to remove the damaged cartilage and the thin layers of cartilage-producing bone from the surface of the pelvis as well as the entire femur head (top of the thigh bone). The orthopaedic surgeon makes careful measurements so the correct implant sizes can be selected from immediately available stock. These metal or ceramic implants are shaped to mimic the natural, healthy cartilage of your hip joint. The femur head prosthesis includes an angled stem that is inserted through the middle of the long femur bone and a screw-on ball that replaces the damaged femur head and will fit into the cup-shaped pelvic joint known as the acetabulum. The acetabulum prosthesis is of a semi-circular shape. Both prostheses are temporarily fitted into place and tested for mobility before being permanently fixed into place. Finally, a plastic, ceramic or metal spacer is fitted between both sections of the prosthesis. The spacer creates a very smooth, gliding surface between acetabulum and femoral head and restores pain-free mobility of the joint.Â
At the end of the procedure a hollow and sterile soft, plastic tube with a collecting bottle called a drain may be placed through the incision.
What happens after total hip joint replacement? What can I expect?Â
You will be woken by the anaesthesiologist immediately after surgery if you have undergone a general anaesthetic and transported from the operating theatre to the recovery room. Spinal anaesthesia requires that the patient remains in the recovery room until both legs regain sensation and mobility. It is possible that you experience an itching sensation as the products within the spinal anaesthetic wear away. This sensation ends as lower limb mobility returns. During your stay in the recovery room you will be carefully monitored. Total hip joint replacement patients remain in the recovery ward until they are fully responsive and any pain is well under control.Â
When the anaesthesiologist is satisfied with your recovery from the effects of the anaesthetic you will be brought to a surgical ward. Remedazo patients continue to be carefully monitored for a minimum of 24 hours after surgery. Pain medication is given at regular intervals according to your personal doctor’s prescription. Gradually decreasing but regular doses of pain medication will need to be taken for up to three months after your total hip replacement surgery. Arterial lines are usually removed within 12 hours after your transfer to a surgical ward and your intravenous catheter will remain in place until you are able to drink and take medication by mouth. Blood-thinning injections will be administered to the stomach area for approximately 12 days. These injections lower the risk of blood clot formation. The intravenous catheter will continue to administer fluids for approximately 48 hours and, if applicable, your drain will be removed by a trained nurse or doctor approximately 24 hours after your arrival in the surgical ward.
The majority of total hip joint replacement patients are out of bed within 24 hours of exiting the recovery room. Rehabilitation begins immediately under the guidance and care of a trained physical therapist. Your physical therapist will teach you how to get in and out of bed, and how to manoeuvre during the six-month revalidation period. In the hospital, nursing staff, crutches and walkers will assist you when getting out of bed and moving around. A pain medication regime will be prescribed and patients are advised to take the advised doses at the advised intervals during the first weeks, even if they feel little to no pain.
The average hospital stay for a total hip joint replacement is 3 days. By this time you should be able to move around with assistance. You will be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home. We will ensure anticoagulant injections are administered during your stay, including the day of your flight home.
Long-term postoperative care includes the removal of stitches after 10 to 14 days. This can be done by your general practitioner at home. You will require crutches or similar support for at least 2 weeks after surgery. A revalidation plan needs to be followed for the best outcome. You will need to recover for least 6 weeks before returning to work, depending on your profession.
Benefits of total hip joint replacement
Total hip joint replacement surgery will help you regain painless mobility in the hip joint, enabling you to enjoy non-contact sports and an outdoor lifestyle, to climb stairs and enjoy a full range of previously painful activities. However, you will need to adapt certain movements such as no longer crossing your legs. Total hip joint replacement procedures are counted as one of the most successful surgery types. A hip prosthesis will last for between 15 and 20 years.
Disadvantages of total hip joint replacement
During any surgery the chance of postoperative infection is a potential risk; all patients fitted with implants are administered antibiotics as a preventive measure before surgery commences. Your chosen clinic’s doctors and nurses are trained to recognise the symptoms of infection very early on. Other short-term risks include bleeding, adverse reactions to anaesthesia, blood clots and breathing problems. It is important you continue to receive your anticoagulant therapy for the full term as recommended by your surgeon and wear compression stockings until you are moving around on a regular basis.
Long-term complications of THA are the loosening of one or both implants and the dislocation of the hip joint. We recommend you heed advice concerning which types of movement are not recommended after this surgery, keep at a healthy weight and visit your local orthopaedic surgeon should you notice any instability or pain in the operated hip.Â
A total hip joint replacement requires you to make temporary and, in some cases, permanent lifestyle changes. Only low-impact sports are recommended after this type of surgery. However, the painless range of activities and increased mobility experienced after a total hip arthroplasty more than make up for the restrictions.
Total hip joint replacement alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
Total hip joint replacement alternatives are few – one option is hip resurfacing. The use of corticosteroid injections, mobility aids and painkillers do not treat the degeneration of cartilage and are therefore short-term solutions. Stem cell regeneration of damaged cartilage may be an option.Â
Of course, there is no alternative for professional medical advice. Please call us to arrange your free e-consult and the opportunity to speak personally with specialist orthopaedic surgeons. You can discuss the total hip joint replacement and any alternatives that interest you with them, ask for second and third opinions, and take the first step towards your personalised Remedazo holistic care package.
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