Total Hip Replacement Surgery (THR)
Total hip replacement (THR) is a treatment option for late-stage degenerative hip disease, also known as osteoarthritis or degenerative arthritis. THR is one of the most successful and common surgical procedures in orthopedic surgery. In addition to marked reduction in pain and improvement in sleep, most people regain range of motion, physical ability, and quality of life.
• The hip joint is composed of a ball and socket, with the surface of each covered by cartilage.
• A number of conditions and diseases can cause the cartilage surfaces to degenerate, which in turn leads to pain, stiffness, loss of hip joint range of motion, and disability.
• Surgeons replace both the ball (femoral head) and socket (acetabulum) during total hip replacement surgery
When is it recommended?
Total Hip Replacement is recommended when the patient is suffering from Rheumatoid Arthritis, Osteonecrosis, Injury of the hip joint, or some bone tumors have been diagnosed that are adversely affecting the hip joint. Additionally, if the patient has any of the following conditions then hip replacement is required:
• Hip arthritis (Primary osteoarthritis)
• Secondary osteoarthritis (more common in India)
• Femoral neck fractures with preexisting osteoarthritis
• Femoral neck fracture, Non unions
• Malunited hip socket and ball fractures
• Avascular necrosis(AVN)
• Protrusio acetabuli (deep socket)
• Slipped upper femoral epiphysis
• Perthes disease
• Rheumatoid arthritis
• Ankylosing spondylitis
There are specifically two types of Hip replacement surgeries, one that is most commonly used is the Total hip replacement surgery and the other one is the semi (half) hip replacement surgery. The surgeons adopt various techniques to do these surgeries.
Anterior Hip Replacement Surgery/Operation:
Anterior hip replacement technique is also known as mini anterior approach towards hip replacement. It provides similar results as the traditional hip replacement procedure of replacing worn out bones of the hip joints with prosthetic implants. The only difference in anterior technique is that the method of opening the body to reach for hip joint. It has emerged as a feasible substitute of posterior or traditional approach.
While undergoing the anterior hip replacement operation the orthopedic surgeon uses a small incision that’s approximately 4 inches long; which is located in front of the leg or hip portion, through this approach the surgeon can easily push the muscle aside instead of cutting and making passage through them to reach the hip joint and again reattaching the muscle. This method is considered best because it causes less trauma and damage to the soft tissue, risk of dislocation of new prosthetic implant is lesser and it also allows quick recovery.
Partial Hip replacement surgery
This surgery is also known as semi Arthroplasty. In this procedure the ball that is scientifically called ‘femoral head’ of the worn out or damaged joint is replaced with the prosthetic implant. During this procedure, the socket i.e. the acetabulum is not replaced. Partial hip replacement operations are usually conducted when the patient has fractured or broken his hips or had a traumatic hip injury. This type of hip replacement surgery is not recommended for degenerative arthritis in hip joint. It is also a good technique of semi hip replacement surgery.
Minimally Invasive Hip Replacement surgery
Minimally invasive hip replacement technique is a process through which the orthopedic surgeon can implant the prosthetic components through one or two smaller incisions. Operation using such technique means that there will be a very small scar, less post-operative pain,less loss of blood during surgery and shorter recovery time. Tough the time taken for the surgery may be more. For operation the surgeon may also require some special equipment that may not be available everywhere
Bilateral Hip Replacement Surgery
Bilateral hip joint replacement surgery is a surgery where the surgeons replace and resurfaces both the hips at the same time because of excessive stiffness and arthritic pain. This type of surgery is not common, because arthritis in hips do not usually advances at a same rate. But occasionally, such situations may appear. If there is any major damage along with severe pain because of arthritis in both the hips, then the candidate may be advised to undergo bilateral hip replacement operation.
• The best of hip replacement surgeons in India have acquired super specialisation and training in the UK, USA, etc
• The low cost of Total or Partial Hip Replacement surgery in India is offered without any compromise on quality or
• The success rate in India for Total & Partial Hip Joint Replacement surgery at India's best hospitals is a phenomenal 99%
• Success rate, which is as high as 99% at the best orthopaedic hospitals in India
• The cost of Hip Replacement surgery in India is amongst the lowest anywhere in the world
If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting. If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
The most common forms of arthritis which affect the hip joint are the following:
• Osteoarthritis : This condition is primarily age-related and generally occurs in individuals over the age of 50, who have a family history of this condition. Osteoarthritis causes the cartilage cushion in the hip to wear away, leading to bone friction and hip pain
• Rheumatoid arthritis : This condition causes inflammation of the synovial membrane, which produces the lubricating fluid for the hip joint.
• Hip disease during childhood : Some hip diseases suffered during infancy or childhood can result in arthritis in adult life even if the diseases were treated and cured during childhood
• Arthritis caused by hip fracture/trauma : Fracture of the hip or severe damage to the ligaments in the hip joint can cause degeneration of the cartilage, resulting in hip pain.
There are two major types of artificial hip replacements - Cemented Prosthesis and the Uncemented Prosthesis. Both types of prosthesis are widely used.
Each prosthesis is made up of two parts :
• The acetabular component, or socket portion, which replaces the acetabulum.
• The femoral component or stem portion, which replaces te femoral head.
The femoral component is made of a metal stem with a metal ball on the end. Some prosthesis have a ceramic ball attached to the metal stem. The acetabular component is a metal shell with a plastic inner socket liner that acts like a bearing. The type of plastic used is highly cross linked ultra high molecule weight Polyethylene which is wear resistant.
A cemented prosthesis is held in place by Poly Metha Acrylate (PMMA) cement that attaches the metal to the bone. An uncemented prosthesis has a fine mesh of holes on the surface area that touches the bone. The mesh allows the bone to grow into the mesh and "become part of" the bone. The lofe of uncemented prosthesis is three times as that of cemented hip prosthesis.
Orthopaedic surgeons may use computer assisted surgery (CAS) technology, also known as surgical navigation, during total hip replacement procedures to help ensure that the implants are properly aligned to the patient’s unique anatomy. Accurate alignment of the hip components is crucial to the overall function of the new hip joint. Proper alignment may also help the new joint feel more natural, and enable it to potentially last longer. Hip replacement surgery involves replacing the femur (head of the thighbone) and the acetabulum (hip socket) with an artificial prosthesis consisting of three parts: a cup (replacing the hip socket), a metal stem (replacing the neck of the thighbone) and a metal or ceramic ball (replacing the damaged head of the thigh bone and linking the cup and stem together).
CAS technology offers a hip replacement patient several benefits including: -
• With CAS technology, surgeons are able to make precise adjustments to ensure the optimal implant fit, range of motion and joint stability. This may help to reduce joint wear and extend the life of the implant.
• CAS may allow for less invasive techniques which have other potential advantages including: smaller incisions with reduced muscle disruption and decreased rehabilitation time.
• Provides your surgeon with comprehensive data about your anatomy which may help determine proper placement of your joint replacement
• Ability to plan for surgery with a computer generated model of your hip .
• Provides the surgeon with feedback and the ability to correct potential misalignment during the surgery
• Allows for better visualization of anatomy, which is particularly important when minimally-invasive techniques are used.
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