Total Hip Replacement
Total hip replacement is an operation performed to replace a hip joint that has been damaged for various reasons and has developed severe arthrosis (calcification). There is no upper age limit for this surgery, which is mainly performed after middle age.
The most important criterion in patient selection is pain and limitation of movement. The primary goal of this surgery is to relieve pain and improve functions.
Non-surgical (conservative) treatment methods should be tried before surgical treatment. Although these treatment methods have been applied, total hip prosthesis is suitable in patients whose hip pain is uncontrollable, daily life activities such as walking and climbing stairs are severely restricted, and who have advanced damage to the articular cartilage. It should be kept in mind that the person who will make the final decision about whether his condition is serious enough to require hip replacement is always sick.
Prosthesis Components and Types
Almost all modern prostheses consist of 4 main parts that are fixed to the bones and move to these fixed parts to make the movements of the joint.
Shell; This part is squeezed into the slot after being prepared by carving the slot called acetabulum. Today, almost all of them are titanium and cementless. The porous structure and hydroxyapatite coating on the surface of the prostheses facing the bone ensure that the prosthesis and the bone stick together and fix the prosthesisas a part of the body.
Stem; This part is the part that enters the femur. Today, in all prostheses, this part is titanium. In some patients, bone cement with polymethacrylate active ingredient is adhered to the bone and this is called cemented prosthesis. If there is no bone loss, cementless prostheses are almost always used. The porous structure and hydroxyapatite coating on these prostheses ensure that the prosthesis and the bone are firmly attached to each other, fixing the prosthesis as a part of the body.
Liner; It is placed by locking into the shell called Shell in the acetabulum. The diameter varies according to the brand of prosthesis, the material it is made of and, most importantly, the diameter of the socket. It is made of plastic or ceramic called polyethylene.
Head; It is fixed by squeezing on the handle. The diameter should be the same as the diameter of the liner. However, their height varies depending on the shortness in the hip. 8 - 12 mm extension can be achieved with head selection. The materials from which the head is made can be metal, ceramic, oxinium.
Frequently asked questions
How long is the life of the hip prosthesis?
Although it depends on many factors, a properly placed prosthesis is expected to last at least 15 years. There are also patients with this period of time of 30 years or more. In patients who have been followed up at regular intervals in the long term; when the prosthesis completes its life, it is possible to replace only the spacers instead of replacing the entire prosthesis. In some cases where the prosthesis completes its life, the entire prosthesis, including the main parts that fit the bone, can also be replaced.
Planning at home after hip replacement surgery
Before going home, patients are explained and shown how to walk with crutches or walker, how to climb and descend the ladder with detailed applications. At first, chairs and armchairs with supports that the patient can hold are preferred while sitting and standing. Care should be taken to ensure that the chairs are not too low. When seated, the knees should not be higher than the hips. Situations that may pose a risk of slipping at home should be avoided. Elevators for the toilet should be used with a high shower chair when bathing, or care should be taken to shower with standing support.
Walking after hip replacement surgery
If there is no situation that requires otherwise after hip replacement surgery, patients are carried out immediately the next day. In order to be controlled, patients are first carried out with a walker. Depending on the patient's condition, the walker or crutch is abandoned within 3-6 weeks.
Duration of hospital stay after hip replacement surgery
Patients are hospitalized for an average of 3 to 5 days after surgery. In this process, follow-up of a possible superficial infection that may develop in the surgical site and physiotherapy are applied. Long-term hospital stay also has a negative effect on hospital-acquired infections.
Admission position after hip replacement surgery
There are multiple surgical techniques for hip replacement. Postoperative recommendations may also vary depending on the technique used. In general, patients are asked to lie on their backs for a certain period of time after surgery. The time required to lie on the side on the operated side or the other side varies depending on the type of surgery.
Physiotherapists teach patients how to lie on their sides.
Driving after hip replacement surgery
Although it varies according to the physical progress capacity of the patient after total hip replacement surgery, patients can start driving after an average of 6-9 weeks. After 3 months, patients can ride bicycles.
What are the complications after hip replacement surgery?
All surgical interventions without exception carry risks, and hip replacement is no exception. Risks vary according to the general health status of the patient. Serious complications seen after total hip replacement surgery occur at a very low rate.
The main risks are:
Infection: After total hip replacement, infection, that is, inflammation of the prosthesis, occurs between 0.1% and 2%. In another part of the body (eg. Infection in the urinary tract, teeth), diabetes, excessive smoking and alcohol consumption, and the presence of other chronic diseases may increase this risk. .
Treatment of infections that may occur elsewhere in the body is necessary before surgery. Preventive antibiotic treatment is performed during surgery and the risk of infection is reduced by taking special precautions during surgery. If an infection develops in the prosthesis, repetitive surgeries, removal of the prosthesis and re-insertion after a certain period of time may be necessary.
Thrombosis: The most common problem is the formation of a clot in the veins due to the slowing of blood flow in the leg (deep vein thrombosis). In order to prevent this, preventive treatment with drugs that will dilute the blood after surgery and wearing varicose veins socks are applied. This treatment can be extended up to 30 days if necessary. Starting hip movement and walking in the early postoperative period and avoiding immobilization will reduce this risk. When thrombosis is suspected, the examinations should confirm this. Treatment will only begin after that.
Dislocation: It is one of the most important and common problems. In general, in the first 3 weeks, it is due to some involuntary or careless movements of the patient (crossing legs, not putting a pillow while turning sideways, squatting on the ground, etc.). Its treatment is to perform the hip joint under anesthesia and to detect or re-operate with a special breys applied externally.