Hip replacement

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1. What is hip replacement surgery?
 

Hip replacement surgery involves removing a damaged or diseased hip joint and replacing it with an artificial prosthesis. This surgery is most commonly performed to treat pain and disability caused by osteoarthritis, rheumatoid arthritis, hip fractures, or other hip joint conditions. There are several types of hip replacement surgeries, including primary hip replacement, revision hip replacement, and in more complex cases, mega-prostheses.

 

2. What are the different types of hip replacement surgery?

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• Primary Hip Replacement: This is the most common type of hip replacement, where the entire hip joint (both the femoral head and the acetabulum or hip socket) is replaced with an artificial prosthesis. It is typically recommended for patients suffering from arthritis or degenerative joint disease that affects the hip joint.

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• Hip Replacement for Fracture: In cases where a patient suffers from a hip fracture, typically due to trauma or a fall (especially in elderly patients), hip replacement may be required. This is because of the tenuous blood supply to the femoral head, which is often disrupted by fracture and causes problems with healing when fixation is attempted.

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• Revision Hip Replacement: Revision hip replacement is performed when a previously implanted prosthesis fails or wears out. This could happen due to factors like implant loosening, infection, fracture, or wear of the prosthetic components. In revision surgeries, the old hip implant is removed and replaced with a new one.

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• Mega-Prostheses and custom implants): Mega-prostheses and custom implants are used in more complex primary or revision cases, where there has been significant bone loss, such as in tumour resection or severe fractures. These implants are larger and can accommodate large amounts of bone loss, providing stability and improving function in these complex cases.

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3. What is the difference between cemented and uncemented components?
 

In hip replacement surgery, there are two main types of fixation methods for the prosthetic components: cemented and uncemented.

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• Cemented hip replacement: In this approach, the prosthetic components (either the femoral stem or the acetabular cup) are fixed into place using a special medical cement (bone cement). This method is often used in older patients or those with poorer bone quality, as the cement helps bond the implant to the bone directly. It typically allows for a quicker initial fixation and is associated with a lower risk of early implant loosening.

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• Uncemented Hip Replacement: In uncemented hip replacements, the prosthetic components are designed with a rough surface that allows the bone to grow into the implant over time, providing a natural bond. This approach is often preferred for younger, active individuals with strong bone quality, as it may provide a more durable long-term result. Over time, the bone heals into the implant, improving stability.

 

Some surgeries may use a combination of both cemented and uncemented components, depending on the individual patient anatomy.

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4. When is hip replacement surgery recommended?

Hip replacement surgery is typically recommended when conservative treatments, such as medications, physical therapy, and injections, are no longer effective in controlling hip pain or improving function. It is also an option for patients who experience severe pain or difficulty walking, or those whose quality of life has been significantly impacted by hip arthritis, fractures, or other joint disorders.

 

5. How do I know if I need revision hip replacement surgery?

Revision hip replacement surgery may be required if:

• Pain or discomfort persists after a primary hip replacement.

• Implant loosening or wear occurs, causing instability or poor alignment.

• There is a fracture or infection affecting the hip joint.

• The implant components become misaligned, resulting in reduced function or movement.

 

If any of these issues arise, your surgeon will use imaging techniques (such as X-rays or MRI scans) to assess the condition of the implant and determine whether revision surgery is necessary.

 

6. What are mega-prostheses, and when are they used?
 

Mega-prostheses are large prosthetic implants designed for patients with severe bone loss or complex conditions such as tumours or severe fractures around the hip. These prostheses are used in primary or revision surgeries where traditional hip implants cannot provide the required stability due to significant damage to the bone. Mega-prostheses can provide better alignment, stability, and function, in cases where the femur or pelvis has been severely compromised.

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They are typically reserved for complex cases and are customised to fit the patient’s unique anatomy.

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7. How long does hip replacement surgery take?

A primary hip replacement typically takes 1 to 2 hours to complete, depending on the surgical approach and any complications that may arise. Revision surgeries and surgeries involving mega-prostheses may take longer, up to 3 to 4 hours, as they are more complex and may require additional steps, such as removing old implants or reconstructing bone.

 

8. What is the recovery time after hip replacement surgery?
 

Recovery times after hip replacement surgery can vary depending on several factors, including the type of procedure and the patient’s overall health.

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• Primary hip replacement: Most patients stay in the hospital for 1-4 days and are encouraged to begin walking with a walker or crutches within the first day or two. Full recovery typically takes 3-6 months, although patients can often return to normal daily activities, such as walking, in 4-6 weeks.

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• Revision hip replacement: Recovery after revision surgery is typically longer, often taking 6-12 months for full recovery. This is due to the complexity of the surgery, the possible need for bone grafting, and the presence of scar tissue from previous surgery.

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Physical therapy plays a crucial role in both primary and revision hip replacements to restore range of motion, strength, and mobility.

 

9. What are the risks and complications of hip replacement surgery?

While hip replacement surgery is generally safe, there are some risks and potential complications, including:

• Infection at the surgical site

• Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism)

• Dislocation of the new hip joint

• Implant loosening or wear (particularly in revision surgeries)

• Fractures of the femur or pelvis during surgery, especially in complex revision cases

• Nerve or blood vessel damage

 

Your surgeon will take steps to minimise these risks and discuss how to prevent them during your recovery.

 

10. How long will my hip replacement last?
 

A primary hip replacement typically lasts 15-20 years or longer, although the lifespan can vary depending on your activity level, weight, and the type of implant used. However, higher activity levels or certain lifestyle factors can cause the prosthetic components to wear out more quickly.

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Revision hip replacements may not last as long as primary implants due to the additional complexities of the surgery. Mega-prostheses may also have a different longevity, depending on the individual’s condition and the nature of the bone reconstruction.

 

11. Will I be able to return to sports after hip replacement surgery?

After a primary hip replacement, most patients are able to return to low-impact activities like walking, swimming, and cycling. High-impact activities such as running, jumping, or contact sports are generally not recommended as they can place excessive stress on the implant.

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For those with a revision hip replacement or mega-prostheses, the surgeon will provide guidance on what activities are appropriate, as recovery may involve more limitations. Patients are encouraged to engage in low-impact activities to preserve the longevity of the implant.

 

12. How do I prepare for hip replacement surgery?

Before surgery, you will undergo a series of evaluations, including physical exams, blood tests, and imaging studies like X-rays or CT scans to assess your hip joint. Your surgeon will provide instructions on how to prepare for surgery, which may include:

• Pre-operative exercises to strengthen muscles around the hip.

• Arranging post-surgery help at home for mobility support.

• Stopping certain medications, such as blood thinners, a week or two before surgery.

 

13. Will I need physical therapy after hip replacement surgery?
 

Yes, physical therapy is a vital part of recovery after hip replacement surgery. It begins within a day or two after the procedure and continues throughout the recovery period. A tailored rehabilitation program will help restore mobility, strength, and flexibility, which is essential for a successful long-term outcome.