Hip Replacement Guide English

Are you a candidate for total Hip Replacement ?

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Total hip replacement is not an emergency operation but a plannedoperation. This operation is usually done for a damaged or adiseased hip joint for various reasons. It should be considered onlywhen no alternative solutions are available. Some of the indicationswhen you can consider this operation are as follows:-

  1. Severe pain: you must have been taking anti- inflammatory medicines (pain killers), doing physiotherapy or walking with help of waling aids (stick). But if the pain is getting worse or interferes with your sleep, perhaps time has come to consider yourself for this surgery.
  2. Significant stiffness of the hip joint restricting your mobility, including daily routine activities.
  3. Fractures around the hip joint with damage to the cup.
  4. Some diseases where you will require this operation are: Advanced Osteoarthritis; Rheumatoid Arthritis; Ankylosing Spondylitis; Avascular necrosis of hip joint;Failed prior surgery of hip, Tumors around hip etc.

Total hip replacement is not ideal for paralytic or other extreme conditions but exceptions do exist.You beside your doctor are the best judge to decide the right timefor the surgery.Consider yourself ready for the surgery when your pain becomeschronic and constantly debilitating to the extent of restricting yourdaily activities severely, and when medicationdoes not help you much.

What are the types of artificial hip joints?

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Artificial hip joints are broadly categorized by:

  1. How the implants are fixed to bone
  2. The type of material used for the ball and inner lining of the socket (Bearing Surface).

Fixation:

The socket and the stem are the only parts that are in direct contactwith the bone. The ball is mounted on the stem and fits perfectly intothe socket. The effectiveness of the surgery depends on how wellthe stem and the socket fit into the bone.Medical research and clinical studies have shown that pressfit oruncemented fixation gives better results as the bone can grow overthe implants. However, there are limitations and every total hipreplacement is unique.In certain cases, your surgeon will recommend a cemented total hipwhich means that both the socket and stem will be fixed to the boneusing bone cement. In other cases, the surgeon may recommend ahybrid total hip in which one implant is attached using bone cement,and the other pressfit or uncemented.The type implants differ based on whether fixation is Cemented,Uncemented or Hybrid.

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Materials used (Bearing Surface):

The ball and the inner lining of the implant are in direct contactwhich creates some friction every time a person moves his hip. As aresult, the type of material used for the ball and the inner lining ofthe socket can affect the wear and tear to the artificial hip.Typically, in a total hip replacement, the surgeon will opt for a metalball and a special plastic inner liner. This is the most commonoption in elderly patients because the wear and tear of the innerlining is very little and the patient can walk comfortably with his hipfor at least 15 years.

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In younger patients who require total hip replacement, the surgeonmay opt for using a ceramic head and ceramic liner as this givesmore range of motion and results in almost negligible wear and tearallowing the younger patient to use his hip for a longer period oftime.The surgeon may choose any combination of the above such as aceramic ball and plastic liner, or a metal ball and ceramic linerdepending on your specific condition.

What is an artificial hip joint ?

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An artificial hip joint is the prosthesis which consists of a Socket, aBall and a Stem. This prosthesis is used to replace the damaged hipjoint.

  1. Socket (or Cup) is usually made up of two parts, an outer metalshell and inner smooth surface called a liner. The entire socket mayalso be made of plastic. The socket is press fit into the bone usingscrews or fixed using specialized bone cement.
  2. Ball (or Head of femur) is made of stainless steel alloy or ceramic material and fits perfectly into the Socket / Cup.
  3. The Stem is also made of stainless steel alloy and fixed into the thigh bone (Femur) which could either be cemented or press fit without cement. The stem mounts the Ball / Head on top of it.

Hip implants

Revision Hip Surgery can be Complex

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At Delhi Institute of Trauma & Orthopaedics, in Sant Parmamand Hospital, we perform very complex knee and hip replacement surgery. One of the most complicated types of joint replacement surgery is revision hip replacement surgery. This surgery involves removing a previous implant that was in the hip joint that has become damaged due to injury or wear and tear and replacing it with new more advanced hip implants. This requires extremely high surgical technique and the surgery can often last many hours as the surgeon has to take many factors into consideration such as the age of the patient, the type of bone quality he observes in the patient, and the extent of damage found inside the joint or adjacent areas.

As an example, a 53 year old gentleman was presented to our hospital with pain in the right hip following a road traffic accident. He had a total hip replacement done 10 years prior to the accident and was walking comfortably before the accident. X-rays revealed a fracture of the pelvic bone (acetabulum) with posterior dislocation of the acetabular component. Fixation of the acetabulum fracture with screws followed by revision of the acetabular component with an uncemented cup was performed. As the femoral component was well fixed, it was not revised.

Essentially in this patient, we had to revise one component of the hip implant, and add screws in the pelvic area to give support to that area so that the bone unites where fractured. Post operatively, the patient is walking comfortably.

Delhi Institute of Trauma & Orthopaedics is one of the leading orthopaedic hospitals in India. Our teams of surgeons are dedicated to learning and practicing the most advanced surgical techniques and handling the most complex surgical cases.