Total hip arthroplasty
Total hip arthroplasty – total hip replacement, cemented / uncemented hip prosthesis
The hip joint is a ball joint that allows motion with high degree of freedom in a weight-bearing joint. Hip joint is susceptible to cartilage wear and as a result the movements will be restricted and become painful. Several alternatives are known that can alleviate the pain and improve function. Once the patient reaches the stage when pain effects his normal activities of daily living, interferes with night sleeps and conservative measures fail, total hip arthroplasty might be indicated. During joint arthroplasty in the hip the degenerated joint surfaces are removed and a new artificial ball joint is implanted that helps restoring the motion and alleviating the pain. . Prostheses are made of special alloys and durable plastic or ceramic. Generally, if the bone quality is normal cementless prosthesis is used, however if the bone quality is poor cemented prosthesis might be necessary.
The surgery is performed under strictly sterile circumstances. The surgeon makes a skin incision. The location and length of the skin incision depends on the surgeon’s preferences and the patients anatomy. Several distinct approaches are known but basically in all cases the joint is accessed through soft tissue and muscle layers that surround the hip joint. The femoral head and neck is then removed. The acetabular cup is accessed, reamed to a certain size and an artificial cup seated into the pelvis. The femoral canal is accessed next. Using specific brooches the femoral canal is prepared and the artificial femoral stem is seated into the femoral canal. The properly sized ball is put on the stem and the joint offset and leg length is restored All layers are closed meticulously, the skin closure is up to the patient’s and the surgeon’s preferences.
In the postoperative period pain around the hip joint is expected, some swelling in the thigh is often seen and it is a general consequence of the procedure. From the very first day motion, sitting and walking is encouraged and physiotherapists and nurses will help patients in that. After a few days in hospital patients will be well mobilized and usually patients feel comfortable walking using walking aids and able to take care of themselves at a basic level. In the first 3 months restrictions of motions will apply and patients are discouraged to do certain movements Patients have to keep in mind that complete recovery can only be expected after 3 to 6 months after surgery.