Hip arthroplasty is a recommended surgery if cartilage wear has reached the bone and the Patient manifests severe pain and subsequent functional limitation in daily activities such as walking or climbing and descending stairs.
Thus, hip replacement is the treatment of coxarthrosis.
types of hip prosthesis
Hip arthroplasty involves replacing the femoral head with a small stem and head positioned in the proximal part of the femur. They articulate with the prosthetic cup, housed in the acetabulum (lateral socket deputed to house the femoral head). This allows geometric stability of the implant.
What tests should I perform?
Normally, an X-ray of the pelvis with an antero-posterior projection and an axillary projection of the diseased hip is sufficient.
In cases of altered joint anatomy such that prosthesis implantation is difficult, such as outcomes of congenital hip dysplasia or epiphysiolysis or post-traumatic outcomes, it becomes essential to complete the diagnostic procedure with a C.T. of the pelvis. At the Rizzoli Institute we perform a C.T. according to a special protocol called Hip-Op©, in which images are transferred to a software with which we perform three-dimensional planning of the components to be implanted.
The surgical procedure
Once the decision to undergo surgery has been made, the patient should undergo anesthesiological preoperative evaluation before admission.
Today, the anterior surgical approach can greatly reduce postoperative pain and recovery time.
This access route, the most innovative surgical approach existing in hip prosthesis today, is done through a transverse (the so-called “bikini”) or longitudinal incision, on the thigh crease, so that it is as little visible as possible. This technique allows the hip joint to be reached and the prosthesis to be implanted without any muscle being disengaged following an internervous plane. Rehabilitation will be extremely early compared to any other access route practiced.
Minimally invasive surgical techniques for arthroplasty hip are aimed at decreasing postoperative pain compared with “traditional” techniques by avoiding muscle section; in this way we also achieve “fast track” rehabilitation and thus reduced hospitalization.
Finally, the tissues, which are not dissected, also make the prosthesis biologically stable and allow ambulation as early as the day after surgery, without any restriction of movement.
What benefits can I get from a hip replacement?
The greatest prospect of benefit given by hip arthroplasty is definitely the disappearance of arthrosis joint pain. From this follows a marked improvement in joint function and gait as well as recovery of the physiological arc of hip motion.
the post-operative
As early as the first day after surgery, verticalization and walking are started with the help of crutches, giving as much load on the operated limb as the Patient can tolerate.
Over the next few days, one learns, with the support of a physical therapist, to walk up/down stairs with crutches. Loading is allowed immediately, and about 15-20 days after surgery, the patient is encouraged to abandon the first crutch.
Free ambulation without crutches is usually achieved at one month after surgery.
Discharge from the hospital depends on the patient’s general condition: it occurs, generally, 3-4 days after surgery for younger patients; elderly patients who require more attention due to concomitant diseases remain hospitalized until general parameters stabilize.
rehabilitation
After hip replacement surgery, it will be sufficient to continue the exercises learned during hospitalization for the first few weeks after surgery.
A patient with no concomitant problems limiting movement and travel, with supportive friends or family, and living in a barrier-free home can safely return home, possibly repeating exercises biweekly with a physical therapist.
What materials are hip replacements made of?
Since 2000, hip replacement materials have achieved such high reliability and biocompatibility that it can be said that the “golden standard” has been achieved.
Femoral prosthesis stems are made of titanium and increasingly short to find stability while sparing femoral bone. They are implanted in “press fit” (“press fit”) and without cement in almost all Patients. This is to allow biological osseointegration of the prosthesis; in cases of elderly Patients with osteoporotic bone, it is to achieve rapid fixation of the femoral component with cement.
Acetabular cups, on the other hand, are always fixed without cement. In the last 10 years, the possibility of creating 3D porous prosthetic surfaces with Titanium and/or Tantalum alloys has further increased the already optimal primary bonding to bone and also the subsequent osseointegration, making, even in technically difficult cases, the placement and stability of the prosthesis easier.
Joint coupling has been ensured for more than 15 years by 4th generation ceramics. This coupling has reduced material wear to zero, allowing the prosthesis to function excellently for many decades.
duration of a hip replacement
Survival of hip and knee arthroplasty has been studied for several decades, and the results are entered into national prosthesis registries. The first to introduce these registries were the Scandinavians in the late 1970s, while, since 1990, a pilot registry project started within theRizzoli Orthopedic Institute.
In 2000, the following was born in Emilia-Romagna. R.I.P.O.(Register of Orthopedic Prosthetic Implantology), which allows the precise monitoring of all hip and knee prosthesis implanted in the region.
Each year the registry produces a report in which the success of each type of prosthesis is analyzed, including in relation to patient characteristics (age, gender, diseases).
To date, hip replacements have a survival of about 90% at 18 years after implantation, while more modern models have a survival of 97% at 15 years.
Surgeons can now use this report to guide their choices, implanting the type of prosthesis that has provided the best results over time.
In addition, the registry (which is based at the Rizzoli Institute’s Medical Technology Laboratory) provides patients with the assurance that they can be promptly tracked in case extraordinary checks of implanted prostheses are needed.
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