Total Hip Replacement Surgery

Dr Priya Sharma

Dr Priya Sharma

BDS (Bachelor of Dental Surgery), 6 years of experience

December 21, 2021 Bone Health 573 Views

English हिन्दी Bengali

What is Total Hip Replacement (THR) Surgery? 

Hip replacement / Total Hip Replacement (THR) Surgery is a surgical procedure in which the damaged hip is replaced with an artificial implant. Total Hip Replacement (THR) Surgery is also known as total hip arthroplasty. This procedure helps relieve hip pain caused by a fracture, trauma, or injury when medications or physiotherapy fail to provide pain relief. Also, if a person is over 60 or 65 years of age and has severe hip pain while sitting or sleeping, it is advisable to get hip replacement surgery.

Let us tell you about Total Hip Replacement Surgery in detail through this article.

  • What are the causes for Total  Hip Replacement Surgery?
  • What are the symptoms that require Total Hip Replacement Surgery?
  • What are the prostheses used for Total Hip Replacement Surgery? 
  • What are the diagnostic medical procedures done before Total Hip Replacement Surgery?
  • What are the tests done before Total Hip Replacement Surgery?
  • What are the steps of care taken before a Total Hip Replacement Surgery to reduce the complications?
  • What is the procedure of Total Hip Replacement Surgery?
  • What is the care to be taken after Total Hip Replacement Surgery?
  • What are the risks and complications of Total Hip Replacement Surgery?
  • What are the alternative treatments for Total Hip Replacement Surgery?
  • What is the cost of Total Hip Replacement Surgery in India?

What are the causes for Total  Hip Replacement Surgery?

Depending upon the severity of the symptoms, a Total Hip Replacement Surgery is recommended. Some of the conditions that make hip replacement necessary include: 

  • Arthritis: Arthritis is the inflammation of the joint that leads to pain, swelling, and a decrease in the range of motion

Types of Arthritis are:

  • Osteoarthritis: Degenerative joint disease that affects older patients
  • Rheumatoid Arthritis: Chronic non-infectious inflammation  
  • Post-Traumatic Arthritis: A type of arthritis that occurs after an injury  ( Know more about- What are the home remedies for Arthritis? )
  • Fractures of the hip- This is a serious injury or breaks to the upper part of the thigh bone. This occurs mostly in elderly people due to weak bones (osteoporosis), due to long-term medications that weaken the bones, due to deficiency of calcium and Vitamin D, chronic medical conditions like thyroid disorders, etc. 
  • Bone cancers- The primary bone tumors of the hip occur rarely. The most common bone cancer associated with the hip joint is Chondrosarcoma that may require hip joint replacement surgery. (Know more about- Bone Cancer)

What are the symptoms that require Total Hip Replacement Surgery?

Patients experience a number of symptoms when their hip joint is either infected or damaged due to trauma. Common symptoms experienced are as follows:

  • Hip joint stiffness
  • Intense chronic pain in the hip joint or groin region.
  • Inability to do regular everyday activities such as walking or bending
  • Inability to move or lift the leg
  • Inability to put body weight on the leg present at the side of injured hip
  • Swelling and bruising around the injured hip
  • Pain that doesn’t go away even after the use of anti-inflammatory medicines or therapy.

What are the prostheses used for Total Hip Replacement Surgery? 

During Total Hip Replacement surgery, the surgeon removes the damaged or diseased parts of the hip joint and replaces them with artificial components to improve the function and reduce pain. These artificial components consist of metal, ceramic, or very hard plastic. For a Total Hip Replacement surgery, two components of the hip joint are replaced. The prostheses used for both these parts are as follows:

  • A cup made with high-density polyethylene is used to replace the Cup-shaped depression of the hip bone called the acetabulum.
  • Metal alloys like Cobalt-Chromium are used to replace the head of the long bone of the thigh bone called the femur.

What are the diagnostic medical procedures done before Total Hip Replacement Surgery ?

When a patient complaining of symptoms like pain and immobility in the hip joint goes to the doctor, a set of procedures are followed by the doctor along with the hospital staff. The initial formalities that are vital for diagnosis and treatment are as follows:

  1. Medical history: Upon arrival, the doctor takes a complete medical history of the patient starting with chief complaints of the condition. This is followed by an interrogation of the onset, duration, progression to better understand the correlation between the symptoms and the disease. The most common symptoms include- pain and restriction of movement. This also includes questions about the patient’s general health, addictions- alcohol, smoking, relevant genetic history, and previous surgical and medical history. 
  2. Physical examination: This will assess mobility, strength, and alignment of the hip.
  3. Provisional Diagnosis is formulated based on the doctor’s initial assessment of the patient.
  4. X-rays are used to assess the extent of damage or deformity by looking for structural changes, signs of joint erosion, loss of cartilage, etc. 
  5. Other Investigations like Magnetic Resonance Imaging (MRI) scans are used to assess the condition of the bone and soft tissues of the hip.

What are the tests done before Total Hip Replacement Surgery ?

Once the final diagnosis has been interpreted from the reports, a treatment plan is made by the doctor. If the treatment plan includes a surgery, a fixed set of tests have to be conducted before performing Total Hip Replacement Surgery. Some of those tests include:

  1. Electrocardiogram (ECG)
  2. Complete Blood Count (CBC)
  3. Urinalysis
  4. Coagulation studies (PT/PTT).

Additional tests may be performed to rule out other health conditions or/ comorbidities.    

What are the steps of care taken before a Total Hip Replacement Surgery to reduce the complications ?

Total Hip Replacement Surgery is a major surgery performed to decrease pain and improve function. It involves the largest joint in the body and one that is responsible for our daily mobility.

 Certain things are recommended to ensure a better recovery experience. They include: 

  • Lifestyle modifications: Depending upon the habits of the patient, lifestyle modifications are advised. They include eating a balanced diet, reducing intake of fatty food, consuming food rich in iron and protein, and regular physical activity. 
  • Pre-hab or prehabilitation: Physical therapy is the exercise regimen before the surgical intervention so that patients can bounce back post-surgery with minimum downtime. It also improves overall health, increases metabolism, and reduces the risk of complications
  • Abstinence from usage of narcotics, alcohol, and smoking: Smoking sets off a cascade of effects on the body starting with constriction of blood vessels, resulting in delayed healing and slow recovery. Narcotics and other drugs can also cause complications. 

What is the procedure of Total Hip Replacement Surgery?

For the success of this operation, good quality artificial joints are imported. 

In addition to importing the joints, training of the surgeon, ensuring good standard of the operation theatre and postoperative care are of paramount importance for early recovery and rehabilitation.

The entire surgical procedure takes a few hours. The steps of the procedure are-

  • Before performing Total Hip Replacement surgery, general or local anesthesia (numbing agent) is given to the patient. For general anesthesia, the drug is injected using the IV attached to the vein in the hand. In local anesthesia, the drug is injected at the site of the surgery.  The objective of the anesthesia is to numb the body so that the patient does not experience any pain during the surgery. 
  • A catheter is passed through the urinary bladder before the surgery and kept there for the collection of urine.
  • During the surgery, an incision ( cut in the skin ) is made by the surgeon to expose the hip joint. 
  • Once the incision is made, the diseased or damaged bone and cartilage are removed, leaving the healthy bone intact. 
  • To replace the damaged parts of the bone, the surgeon fits prosthetic components to the bone. In Total Hip Replacement surgery, both the components of the hip joint are replaced. The two components include the opening in the hip bone called the acetabulum and the head of the long bone that is connected to the acetabulum. Both the components are placed either with or without the use of bone cement. A decision has to be made as to whether cemented or uncemented joint replacement is to be used. Normally, in the elderly with an expected life of 10-15 years, cemented arthroplasty is used, while in the younger generation, uncemented joint replacement is used.

What is the care to be taken after Total Hip Replacement Surgery ?

After hip replacement surgery, the patient is taken to the recovery room where his vitals are monitored on a regular basis. Depending upon the condition, the patient may get discharged from the hospital in three to four days. The doctor recommends the following tips for quick recovery at home:

  • Prevent the wound from getting wet 
  • Include iron-rich foods in your diet
  • Indulge in mild physical therapy that usually starts on the first day and gradually progresses to activities such as walking and climbing. ( Know more about- Physiotherapy )
  • Practice slow and gradual movements of the leg to prevent the formation of blood clots
  • Prevent falls in the house, keep the chair, table, or long wire out of your way
  • Do not perform high-intensity exercises unless your doctor says so.
  • Take medications as prescribed on time.
  • Visit the doctor for the follow up appointments as scheduled by your doctor.

What are the risks and complications of Total Hip Replacement Surgery?

Total Hip Replacement Surgery involves some amount of risk. They include:

  1. Formation of blood clots in the hip joint space
  2. Infection at the site of incision
  3. Excessive Bleeding
  4. Severe reaction to anesthesia (rare) 

Few complications specific to Total Hip Replacement Surgery are as follows-

  • Deep Vein Thrombosis– This consists of blood clots in the deep veins of the limb (legs) due to inadvertent manipulation of the thigh during surgery and stasis (blockage) of blood in the veins due to immobility. (Know more about- What is Deep Vein Thrombosis? )
  • Nerve palsies– This occurs due to injury to the nerve causing partial weakness or paralysis of the surrounding area. The sciatic nerve is the most common nerve that is affected.
  • Injury to a blood vessel- This may lead to uncontrolled blood loss (internal or external ).
  • Fracture– Occurs while the prosthesis is being placed during the surgery. ( Know more about- What is Bone Fracture? )
  • Dislocation– Occurs due to malposition of the limb (leg) during the postoperative period.
  • Infection- This may occur at the site of incision or implant placed.
  • Heterotrophic or New bone formation around the components placed.
  • Pulmonary thromboembolism- This occurs when the blood clots travel to the lungs from the deep veins in the leg.

What are the alternative treatments for Total Hip Replacement Surgery ?

Before deciding on total hip replacement surgery, other non-invasive treatments are tried, which include medications and physiotherapy. If these treatment modalities fail to show promising results, the doctor resorts to other recommended procedures, some of which include-

  • Osteotomy, wherein the part of the thigh bone that is connected to the hip bone or the hip bone is cut, realigned, and fixed into proper position.
  • Joint debridement, in which torn or worn out parts of the bone are removed. 
  • Hemiarthroplasty, which consists of replacement of only one side of the joint as against total hip replacement surgery.
  • Arthrodesis, which is a procedure to surgically fuse the joint surfaces to strengthen and stabilize the joint

 On failure of these procedures, the surgeon resorts to total hip replacement surgery.

What is the cost of Total Hip Replacement Surgery in India?

The total cost of total hip replacement surgery in India can range from around INR 2,30,000 to INR 3,80,000.  There are many large hospitals and experienced doctors for hip replacement surgery in India.  The cost of total hip replacement surgery varies across different hospitals.

If you are coming to India from abroad, apart from the cost of total hip replacement surgery, there will be some additional expenses, such as the cost of the hotel stay and local travel. Apart from this, after the surgery, the patient has to stay in the hospital for 8-10 days and in the hotel for around 14 days for recovery. So, the total cost of hip replacement surgery comes to a total of INR 6,00,000 – INR 7,00,000.

We hope that we could answer your questions regarding Total Hip Replacement Surgery through this article.

For more information and treatment about hip replacement surgery, you can contact an Orthopedic Surgeon.

We only aim to give you information through the article. We do not advise medication or treatment. Only a doctor can give you the best advice and correct treatment plan. 

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