Hip Replacement: What is it, Surgery, Life After Surgery

Hip replacement surgery, also called hip arthroplasty, is the process of replacing damaged or worn parts of the hip joint with an artificial implant.

Hip replacement surgery, also called hip arthroplasty, is the process of replacing damaged or worn parts of the hip joint with an artificial implant. If you have a hip fracture or are experiencing severe hip pain, hip replacement surgery may be recommended. Diseases such as osteoarthritis or rheumatoid arthritis are also among the reasons for these conditions. Hip replacement surgery can help improve range of motion, reduce pain, increase strength and improve quality of life.

What is Hip Prosthesis?

The hip is a joint that connects the thigh bone to the pelvis. It has a ball-shaped tip at the top of the thigh and fits into a socket. The hip is the most flexible and freely moving joint in the body and can move forward, backward and sideways. Hip prostheses are artificial medical materials that replace the hip part of the person that needs to be replaced. When other treatments have not helped, a hip replacement is usually recommended if the person has severe hip damage that interferes with their life.

Hip prostheses can be manufactured in metal or plastic. The parts that need to be replaced for hip replacement surgery are separated from the joint and removed. A prosthesis is placed instead of the removed part. There are different types of hip replacement, partial and total.

• Total hip replacement: Total hip replacement is the most common hip surgery. This prosthesis uses a prosthesis to replace the entire hip. During the procedure, surgeons insert a stem into the patient’s femur, or thighbone. They replace the head of the femur with a ball and the natural socket in the hip joint with an artificial cup.
• Partial Hip Replacement: A partial hip replacement removes and replaces the femoral head, or thigh bone. A ceramic or metal ball is attached to the top of a stem that is placed in the center of the femur. Surgeons typically perform this surgery to repair certain types of hip fractures.

Who is Hip Replacement Surgery Suitable for?

Not everyone with hip pain needs hip replacement surgery. However, if pain interferes with performing daily tasks or walking independently, a hip replacement can often help improve quality of life. Total hip replacement involves implanting the hip without cement and replacing the ball-shaped part on the hip. Different conditions and factors that can occur throughout life, such as excessive wear and tear, can affect the hip, causing increasing pain and difficulty walking. Hip replacement surgery is generally preferred because the person’s mobility decreases as a result of damage to the hip joint. Apart from this, feeling pain in the hip area even during rest is also a reason for surgery. The most common reason for hip replacement surgery is osteoarthritis, also known as osteoarthritis. Situations where hip parts need to be replaced with prosthetics are as follows:

• Limitation in physical activities due to hip pain
• Hip pain that persists at rest
• Pain in the anterior hip and groin
• Calcification
• Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis)
• Femoroacetabular impingement
• hip fracture
• hip dislocation
• Legg-Calvé-Perthes disease
• Slipped capital femoral epiphysis
• Childhood hip disorders

Pain relief is the biggest benefit and main reason for hip replacement surgery. Possible benefits of hip replacement use include:

• Improved movement
• Relieving pain due to hip injury
• Improved coordination of trunk and leg
• Facilitating physical activities in daily life

How is Hip Replacement Surgery Performed?

Before surgery, it is important to learn as much as possible about what the surgery involves. The doctor makes recommendations for prostheses according to the person’s age, activity level, and bone quality. To prepare for surgery, the person undergoes various examinations. With these tests, the person’s medical risk is evaluated before surgery. Preoperative examinations performed by healthcare professionals are as follows:

• Measuring the strength of the hip muscles with muscle testing
• Learning medical history
• Physical examination
• Assessment of body weight
• Cardiovascular disease control
• Electrocardiogram (ECG)

There are various surgical methods available for hip replacement. Minimally invasive hip replacement surgery is a surgery used for any type of surgery that is less invasive than traditional or open surgery. Minimally invasive hip replacements use fewer, smaller incisions around the hip joint. The best candidates for minimally invasive hip replacements are typically people with minimal or moderate deformity. However, in cases where large parts of the hip need to be replaced, open surgery is preferred. Open surgeries are standard surgeries performed with large incisions.

When total hip arthroplasty is planned, a surgeon replaces necessary parts of the hip with a sturdy implant made of plastic and metal. The femoral head is also replaced during this surgery. Hip replacement can be performed under general anesthesia or epidural anesthesia. Epidural anesthesia is a method of anesthesia in which the lower part of the body is numbed. This method can be used in people who do not need to be under general anesthesia. When performing hip replacement surgery, surgeons use procedures that can be performed by making an incision from the back or the front. The surgery usually takes about 60-90 minutes to complete. The surgery stages are:

• The person is given anesthesia before the surgery.
• The surgeon makes an incision above the hip.
• Problematic hip parts are removed through an incision.
• The femoral head, acetabulum and other necessary parts are replaced with implants.
• The incision areas are stitched.

After the surgery, a dressing is applied to keep the hip in place for 1 week. The stitches covering the incision are removed approximately 10-14 days after surgery and can be replaced with sterile strips. If your surgeon used glue to close the wound, the end stitches will gradually fall off after about 1 month.

Life After Hip Replacement Surgery

Everyone recovers differently from hip replacement or revision surgery. The important thing is to keep moving, but to pace yourself and gradually encourage becoming more active.

It may be necessary to stay in the hospital for a few days after the surgery. For the first 4 to 6 weeks after surgery, the use of crutches may be necessary to facilitate walking and reduce pressure on the hip. Most people are encouraged to walk with the help of a walking aid immediately after surgery. On average, recovery occurs within 2 to 3 months, allowing the patient to continue normal activities. However, it may take up to a year for the whole body to return to normal activity after the implant. The patient should avoid sitting on low chairs, running, squatting and jumping for the first 3 months.

Additionally, the person may need to start an exercise program under the supervision of a doctor to get used to the hip implant. The surgeon informs you about what activities the person can do after the surgery and prescribes medications to be used after the surgery. Things to consider after hip prosthesis installation are:

• Correct use of prescribed medications
• Avoiding gaining too much weight
• Using walking aids
• Physical activity practice under doctor supervision
• Receiving therapeutic exercise support
• Starting physical therapy
• Use of toilet seat risers
• Installing a handle for use in the bathroom
• Getting help from a seat in the shower
• Preferring shoes with a design that does not require bending for long periods of time
• Keeping the wound area clean and dry
• Contacting the doctor when necessary

The patient should realize that the healing process is time-consuming. During this process, it can usually take at least 4-6 months for the patient to feel like they have returned to their pre-operative activity level. People with desk jobs may need to take at least 4 weeks off work and may take longer if complications arise. The duration of leave a person must take is decided by the doctor, taking into account the patient’s health condition.