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Hip Replacement


  What is a hip joint replacement?     Who needs a new hip?     Kinds of Implants or Prostheses     What does a normal hip comprise of?
  Types of Hip Replacement     Total Hip Replacement Surgery Procedure     Post Operative Management     Typical Home Exercises after a Total Hip Replacement (THR)
  Advanced Exercise     Post-operative Complications     Life After a Hip Replacement



Total Hip Replacement Surgery Procedure
The hip replacement surgery begins with an incision to expose the hip joint. Once the hip joint is exposed to the surgeon, he removes the head and neck of the femur (the bone that extends from hip into thigh). Next, the shaft of the femur is reamed so that the metal component (comprising of head, neck and stem of the prosthesis) can fit into it. Then the acetabulum or the pelvis socket is scraped off to fit the plastic cup into it. Finally, the ball and the socket are placed in the normal position. This set of implants can be fixed into the bone with or without the bone cement.

Cemented Procedure
It is the most preferred choice of surgeon while performing a hip replacement surgery. During surgery, a chemical polymer substance, Polymethylmethacrylate, more commonly known as bone cement, is introduced between the prosthesis and the bone. This type of joint fixation depends on the health and bone density of the individual. It is mostly done for people aged 60 years and above.

Non-Cemented Procedure
Cementless total hip replacement or non-cemented hip replacement surgery is mostly done for people of younger age. In younger people, the metal component gets impacted to the bone as the bone tissue grows into the metal. In this case, a tight bond of scar tissue fixes the metal firmly to the bone. The acetabular component is either press fitted or fixed with screws to the pelvic bones.

Blood is often required for transfusion during the surgery. Usually, one to two units of whole blood is needed. However, the amount of the blood required depends on the pre-operative haemoglobin percentage.



Post Operative Management
Normally a plastic drainage tube is inserted at the operative site for the first 48- 72 hours. Patient is allowed to do bed side sitting and side turning with pillows between two thighs from the first post operative day. Quadriceps exercises and pelvic lift exercises are started immediately. After cemented THR, patient is made to do walker aided walking from the second post operative day. After three weeks, stick is given for walking for the next three to six weeks. But walking is delayed for two to three months after noncemented THR.



Typical Home Exercises after a Total Hip Replacement (THR)
Post-surgery, you will be required to follow a home recovery exercise program. Some typical home exercises are as follows:

1 Quadriceps Sets - Pushing the knee down, tighten the thigh muscles. Hold it for 6 seconds.
2 Gluteal Squeeze - Squeeze your buttocks and hold it for 6 seconds. Relax for a couple of seconds and do it again.
3 Ankle Pump - Lie down on your back and move the ankles up and down.
4 Isometric Hip Abduction - Lean straight against a wall and push your hips outwards. Retain the posture for 6 seconds.
5 Leg rotation - Lie down on your back and roll your operated leg inwards, the foot pointing towards the ceiling.
6 Heel Slides - Lying on your back, bend your operated hip and knee to around 40-45 degrees. Hold the posture for 6 seconds.

Quadriceps Sets or Quad Sets
1 Quadriceps Sets
Heel Slides
3 Ankle Pump
Straight Leg Raises
5 Leg rotation
Knee Extensions
6 Heel Slides



Advanced Exercise
To achieve your long term goals post-surgery, you will be suggested to follow a set of advanced exercise. The routine exercise will begin after your first post-operative visit to the surgeon. These exercises will help you build up strength in your thigh and hip muscles and will increase your joint range.

Straight Leg Raise - Lie down on the bed, tighten your knee and raise your leg upwards, keeping the knee straight. Maintain the position for 2 seconds and then lower the leg slowly.
Side Leg Raise - Lie down on your non-operated side and lift the operated leg off the bed. Hold it for a span of 2 seconds and relax. The same exercise can also be done while standing. Stand erect and move your operated leg to one side and then bring it back.
After the post-operated rehabilitation is complete, you can easily enjoy daily activities like walking, cycling, swimming, golfing, playing table tennis etc.



Post-operative Complications
Dislocation of the hip joint
Infection
Bleeding
Deep Vein Thrombosis
Peri prosthetic fractures etc.



Life After a Hip Replacement
New technology in the field of orthopaedic science and advancements in surgical procedures have improved the long-term result of a hip replacement surgery. Usually, artificial hips can last as long as a lifetime. However, in younger people the plastic components can wear out after a span of 15-20 years. In this case, the worn out socket implant can be easily replaced with the new one. It can be done without even removing the other parts of the hip joint. After a hip replacement surgery, the person can be able to enjoy and participate in physical activities that he was unable to do before the surgery. The surgeon will also provide you with some additional tips and precautions so that the life of the implant is not affected.

 
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