Hip replacement surgery is a surgical procedure usually recommended in the presence of osteoarthritis of the joint (coxarthrosis), a condition that causes pain and subsequent functional limitation in everyday activities.
Today, that of hip replacement is the most performed orthopedic surgery in the world. In fact, the prestigious journal The Lancet called hip replacement “the surgery of the century” in 2000. This hints at how this type of operation has revolutionized our society, enabling people who would have been severely limited in their daily activities to lead nearly normal lives.
Hip arthroplasty? Absolutely.
In fact, hip replacement is the only solution that can guarantee functional recovery as well as the disappearance of joint pain when arthrosis has now consumed the cartilage. Moreover, thanks to improved prosthetic designs, increasingly biocompatible and durable materials, and minimally invasive surgical techniques, the short-, medium-, and long-term clinical results are, to date, truly excellent.
Despite this, patients often turn out to be very concerned about this type of surgery, both before and after the operation. To reassure those about to undergo this operation, I decided to answer the most frequently asked questions that patients ask us orthopedic surgeons.
When is hip replacement surgery necessary?
Surgery is necessary whencartilage wear is such that it causes severe pain and makes daily activities difficult. Hip replacement surgery, in fact, by going to replace the suffering and no longer functional joint, allows people to return to their activities without pain, regaining, thus, total mobility.
At what age is it advisable to undergo the surgery?
Improvements in materials and long-term clinical outcomes have made it possible to extend the surgical indication to young patients as well, especially those who have developed early cartilage wear due to childhood or adolescent pathology (e.g., congenital hip dysplasia or epiphysiolysis) or an outcome of joint fractures. There is, therefore, no inadvisable age to undergo the procedure. In fact, the prosthesis is implanted even in patients in their 20s.
Can hip arthroscopy replace hip replacement surgery?
Recent anatomic pathology defined as FAI (femoro-acetabular impingment) can be treated with conservative surgery such aship arthroscopy.
When osteoarthritis, however, is in an advanced state or such surgery has failed to provide lasting results, prosthetic replacement remains the only alternative.
How can I avoid hip replacement surgery?
As mentioned earlier, the primary cause of hip osteoarthritis is an anatomic, congenital or acquired alteration of the coxofemoral joint.
From this it follows that, unfortunately, cartilage wear in the hip, unlike that in the knee, is not affected by weight.
Therefore, changing one’s lifestyle (such as losing weight) or undergoing specific physical therapies does not help to manage cartilage wear and tear problems and relieve pain.
What is minimally invasive hip replacement surgery?
Operations using tissue-sparing techniques (minimally invasive surgery) have been performed in orthopedics for about ten years. Depending on the patient’s specific characteristics (particularly age and weight), the least invasive surgical approach will be chosen to avoid complications and reduce recovery time.
Hip replacement surgery: two minimally invasive approaches
There are two innovative approaches performed with minimally invasive techniques:
1. Minimally invasive anterior approach: the incision is made transversely or longitudinally, along the crease of the thigh, so as to be as unobtrusive as possible. This technique allows the hip joint to be reached and the prosthesis to be implanted without disrupting any muscles, following an internervous plane. Rehabilitation begins much earlier than with any other approach.
2. Minimally invasive lateral approach: this type of technique necessitates partial disconnection of the gluteal muscles with their subsequent selective suturing. This access allows excellent visualization of the joint, especially when subversion of the anatomy is present. Again we see rapid rehabilitation.
Minimally invasive surgical techniques for prosthetic hip replacement aim to decrease postoperative pain. They also allow faster rehabilitation (“fast track” rehabilitation) and, consequently, a reduction in hospitalization.
Finally, the tissues, if dissected, are sutured, making the prosthesis biologically stable and allowing ambulation as early as the day after surgery.
Are there minimally invasive hip replacements?
Yes! Over the decades, increasingly accurate analyses of the anatomy of the hip have enabled the production of prostheses that can adapt to the proximal femur while sparing bone: so-called short stems. These are specially designed to functionally adapt to the specific conformation of the proximal femur.
What materials ensure the most reliable joint coupling?
For more than 15 years, the most reliable articular coupling has been provided by 4th generation ceramics. This coupling has reduced material wear to zero, allowing the prosthesis to function optimally for entire decades and proving extremely resistant to trauma.
In contrast, the metal-to-metal joint coupling, which was widely used by Americans during the first decade of the 2000s, showed a serious problem of wear and joint reaction termed metallosis.
A special European Union committee produced a document in 2014 that strongly restricts the use of metal-on-metal bearing in hip joint replacements.
What are the risks of surgery?
Although almost all operations end without complications, it should be kept in mind that in some rare cases, complications such as infection or thrombophlebitis of the operated limb may occur. To prevent these, antibiotic and antithrombotic prophylaxis is administered during and after the operation.
As in any surgical procedure, there are, of course, also dangers associated withanesthesia. In this regard, anesthesiologists will evaluate, on a case-by-case basis, whether to perform spinal anesthesia, loco-regional anesthesia, or general anesthesia. Even in the case of non-general anesthesia, the anesthesiologist will administer mild medications so that the patient can sleep and not make him “worry” about what is happening around him.
What materials are used for the prostheses? Could I be allergic to them?
The hip prosthesis is made of titanium metal alloys with ceramic-ceramic joint bearings. These materials are extremely biocompatible, hypoallergenic , and have been used successfully for several decades.
THE EXISTENCE OF A HYPERSENSIVITY (allergy) TO METALS. prosthetics has been debated for many years. However, these materials are compatible even if the patient reports a history of intolerance or allergy to materials such as Nickel (e.g., skin reactions from costume jewelry).
What is the recovery time after hip replacement surgery?
As early as the day after surgery, it will be possible to mobilize the hip, beginning to take the first steps. To resume normal daily activities (without the use of crutches), however, it will be necessary to wait a period varying between three and five weeks. There we expect that, within 3-4 months, the patient can resume sports.
How to sleep with hip replacement?
It is possible to sleep in any position. You must, however, absolutely avoid crossing your legs in the first 4 weeks by placing a pillow between them. Rotational movements in bed will still be taught by physical therapists in the first few days after surgery.
Which sports are recommended and which should be avoided?
After surgery, it is recommended to perform activities such as walking, exercise biking and swimming that promote the resumption of movement without burdening the knee; contact sports (soccer, basketball) should be avoided.
Recent articles have documented that continuous ground-impact activities such as running, once discouraged, do not change the life of the hip replacement. Upon reaching full recovery, if the physique allows, sports such as skiing and tennis.
Can the hip replacement activate the airport warning system?
This is a possibility, depending on the calibration of airport detectors. After Sept. 11, 2001, documents attesting to implantation are no longer accepted at checkpoints as “passes.” But simple specific examination with the hand-held metal-detector will allow officials to understand the presence of an implanted synthetic medium.
How long does a hip replacement last?
It is safe to say that, to date, hip replacements have a survival rate of about 97 percent 15 years after surgery (from data from the Emilia-Romagna regional R.I.P.O. registry). Obviously, prostheses have a variable duration that depends on several factors such as the weight of the subject and the activities performed daily. In any case, after normal postoperative visits, it will be advisable to perform routine checkups every two years or so.
Do you have any other questions you would like to ask about hip replacement surgery? Please do not hesitate to contact me!
