General Information About The Hip

  The Anatomy of the Hip

The hip joint creates the jointed connection between the trunk and the legs. It connects the pelvis and thigh bones. It is a ball-and- socket joint which, due to its shape, enables great freedom of movement. It consists of the socket of the hip bone (pelvic bone) and a ball (thigh bone), which is covered with a layer of cartilage.The joint itself is sealed off by a joint capsule. Within the joint capsule, a mucosa layer produces the synovial fuid, which on the one hand nourishes the cartilage, and on the other hand produces friction free sliding. The synovial fuid also serves as a sort of shock absorber which intercepts the powerful forces that impinge on the joint during a person's lifetime. The bones are connected by the ligaments which impart the necessary stability to the joint. The joint is moved by muscles and tendons.

  Diseases of the Hip

  • There are a number of causes that can lead to diseases of the hip joint. The most common ones are :
  • Osteoarthritis Pathological wear of the joint cartilage Secondary Osteoarthritis.
  • Accidents - resulting in injury to bones or joints part.s

  Symptoms :

Pain on walking Progressive reduction in the distance you can walk without pain Hardly any relief from pain even on resting or with pain killers Clear reduction in general mobility of the hip joint Diffculty in sitting on foor in cross legged positions, using Indian toilets & doing activities of daily living like wearing Shoes, stairs climbing etc.

 

What's Involved in a Total Hip Replacement - THR?

What is Total Hip Replacement?

In principle, Total Hip Replacement or THR is the replacement of the diseased joint by anctifcicl implant. Many decades ago, the relatively simple structure of the hip joint a ball-and-socket joint had inspired physicians and medical technicians to create an ortiliciol hip, and in the course of time Follow-up examinations and improvements in operative methods and materials have led to great progress, and the optimisation of total hip prosthesis.

Thus, we can view THR as a routine operation. Over time, normal wear and tear may cause cartilage to crack or wear away. When this happens, the bones making up the joint rub together. Stiffness and pain occur when the boll storts to grind in the socket.

A bad fall or below to the hip can break (fracture) the thigh bone, typically around the femoral neck region. If the broken bone does not heal properly. The joint may slowly wear down. Blood flow through the femorel head may be restricted or cut off, leading to the joint.

The hip prosthesis is designed to simulate the human anatomy and is comprised of a hip socket and a hip shaft. The ball head may be a ceramic or metal head running against a polyethylene socket. The socket can also be entirely of ceramic. The materials used in the joints have been specially developed for medical purpose with good tissue tolerance and allow the function to be as painless and lasting as possible.

Having your hip replaced?

The hip is a simple ball-and-socket joint where the high bone joins with the pelvis. When these point surfaces become roughened, causing severe pain and stiffness, the ball-and-socket have to be replaced.

Total hip replacement is when a cup is inserted into the pelvis and fixed into place and a stem with a head attached is inserted into the shaft of the femur. The artificial ball-and-socket then fitted together to function normal hip joint. For each prosthesis there as a type, is wide range of models, manufactured in different sizes. Selection of the prosthesis is dictated by the bone condition and the weight and physical activities of the patient. The surgeon will prepare for the operation on your hip with a graphic plan compiled on the basis of X- rays and will thus determine the model, size and position of the prosthesis parts.

What are artifcial hip joints made up of?

Materials used for artifcial joints are highly developed. They provide maximum tolerance and long-term acceptance by the human body, which is called bio-compatibility. For decades, Stryker had been a leader in material development and fundamental know-how in metallurgy, material, research and testing. In general, there are three different types of material employed for orthopaedic purposes: Metals, Polymers, Ceramics.

When is total hip replacement required?

  •   Persistent pain in the joint requiring regular pain killers, affecting activities of daily living and compromising your quality of life.
  •   When other treatments like medicines, physiotherapy etc have failed and no other alternative treatment is likely to help.
  •   X-ray confrming advanced arthritic changes in the joint.

  Before Surgery - Getting yourself ready

Having decided to perform the total hip replacement surgery for you, various members of the staff will help you to prepare for the surgery as well as your recovery. At any time, if you have any doubts or require any clarification, please feel free to call on your surgeon anytime.

  • An anaesthetist will visit you for pre-operative examination and assessment, if it has not been done before.
  • An orthopaedic team will again visit you to give a final check and be available for any last minute questions.
  • Please make sure you inform about all the medicines you are taking at the moment for Hypertension, Diabetes etc. to the visiting physician.

  The Surgery

During the operation, the diseased joint will be replaced by an artifcial joint.

The procedure of implanting an artifcial hip joint is a routine operation. For this reason, possible complications should not be a cause of concern; rather, they should be seen as part of careful patient information. The possible risks and / or complications should be discussed with your doctor.

  After the Surgery

Upon completion of surgery, you will be transferred to the recovery room, where your condition will be monitored carefully. You may feel discomfort in the region of your hip. Your pain will be managed as discussed before the surgery with an anaesthetist and nursing staff. When the general condition and pain is well controlled, you will be transferred to your room.

  Hospital Stay

Usually, over the first 48 hours following the surgery, there is pain which can be well controlled as per the discussions had with you before the surgery.

Additionally, you leg will be immobilized and compressed with stockings or elastic bandage in order to prevent :

  •   Dislocation of the joint.
  •   Pain.
  •   Danger of thrombosis.

Body and muscle-tensioning exercise begins in accordance with the goals set by your surgeon and physical therapist. A personal rehabilitation program will help you to practice:

  • Moving with confidence.
  • To get out of the bed.
  • Sitting down correctly and standing - up again.
  • Getting in and out of the car.
  • Walking up and down the stairs.
  • Other necessary functions for day-to-day life.

The objective is to train your femoral and pelvic muscles so as to benefit in full from your regained mobility. The more actively you participate, the quicker you will reach your goal. The crucial points of post-surgery and rehabilitation are designed to your personal needs. It is essential to continue the rehabilitation exercise at home. After leaving the hospital, you will be soon able to pursue your professional and private activities again. But please be careful not to overdo your regained freedom of movement.

Your activities determine the loads to which your artifcial joint is subjected and thus influence its durability.

In subsequent years, do take the opportunity of regular follow-up examinations by your doctor, even if your have no complaints so that the doctor is able to recognize complications at an early stage which otherwise might emerge after several years.

  Precautions

There are four basic movements which must always be avoided. These precautions apply in all positions including sitting, standing and whilst getting in and out of bed or a chair.

  1. Don't move your hip into more than a 90 degree fexion (this is a right angle). The increased motion may cause dislocations. This means no sitting on low stools, low chairs, low toilets etc.
  2. Don't cross your legs: the operated leg must always be kept out to the side, away from the midline of the body.
  3. Do not pivot or twist on the operated leg, or roll operated leg in or out. The toes and the knee cap should always point straight ahead not to the side.
  4. Do not lie on either side until you have permission from your doctor. When lying on your side, you need at least one pillow between your legs.

  Sitting

Keep your knee lower than your hip when sitting: check the height of your chair. Sit in a firm chair with arms, no a swivel or rocking chair. Arm are needed to aid in rising to a standing position.

When getting up, move to the front of the chair, place your operated leg forward. Your unoperated leg should be bent under the chair. Push up with your arms and unoperated leg until standing.

Remember not to lean too far forward.

  Toileting:

  •    You will need to use a toilet seat "raiser".
  •   To prevent hip dislocation, you will need to use extra care when using a toilet without a raiser
  •   Get up the same way as for sitting.

   In bed:

Avoid sitting on a low bed. Also make sure that your bed is firm.

  •   To avoid dislocating your new hip:
  •   Don't roll onto your side without a pillow.
  •   Don't learn forward to pull up the blankets.
  •   Don't cross your ankles or legs.

  Getting in an out of bed :

Remember the precautions - keep your legs well apart and lean back to avoid excessive bending of your hip. Once your unoperated leg touches the floor, bend it well back and push down through your hands on the bee to stand up straight. Keep the operated leg out in front until you are standing. Whilst you are in hospital, you will be assisted as necessary, and prior to discharge you will be taught to perform this independently.

  Picking up objects :

  •   When bending, stretch operated leg out behind you.
  •   When kneeling, kneel onto operated leg.

  Dressing and washing :

When dressing and washing, use lon-handled equipment or call for assistance from your carer. You cannot touch your operated leg below the knee without being at risk of dislocating your hip.

  Physiotherapy :

Physiotherapy is an essential part of your recovery following hip replacement.

Physiotherapy aims to :

  •   Keep your chest clear.
  •   Provide and exercise program to improve the joint movement, strength and flexibility.
  •   Improve mobilisation and confidence with an appropriate walking aid.
  •   Educate you on how to protect your new hip.

Physiotherapist will initially review you at the Orthopaedic Clinic and assess your hip movement and strength. You will be provided with an appropriate walking aid and exercise program. Please practice both prior to your admission, as tis will assist your recovery.

  What's new in THR :

  1. Minimal Invasive Surgery
  2. Computer Assisted Surgery (Navigation)
  3. New joints
    •   Resurfacing Hip.
    •   Ceramic on Ceremic Hips.
    •   Newer durable plastics (highly cross linked poly & X3 poly.
    •   Special implants for difficult situations.