Anatomy           

The hip is one of the body's largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.
            
The bone surfaces of the ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.

A thin, smooth tissue called synovial membrane covers all remaining surfaces of the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint.

Common Causes of Hip Pain and Loss of Hip Mobility

The most common cause of  hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

• Osteoarthritis usually occurs in people 50 years of age and older and often individuals with a family history of arthritis. It may be caused or accelerated by subtle irregularities in how the hip developed. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.

• Rheumatoid arthritis is an autoimmune disease in which the synovial membrane becomes inflamed, produces too much synovial fluid, and damages the articular cartilage, leading to pain and stiffness.

• Traumatic arthritis can follow a serious hip injury or fracture. A hip fracture can cause a condition known as osteonecrosis. The articular cartilage becomes damaged and, over time, causes hip pain and stiffness.

Whether to have hip replacement surgery should be a cooperative decision made by you, your family,& your orthopaedic surgeon at A+ clinic.

Although many patients who undergo hip replacement surgery are 60 to 80 years of age, orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability, and general health status-not solely on age.

           Hip replacement surgery may benefit you if: if: if:

• Hip pain limits your everyday activities such as walking or bending.

• Hip pain continues while resting, either day or night.

• Stiffness in a hip limits your ability to move or lift your leg.

• You have little pain relief from anti-inflammatory drugs or glucosamine sulfate. 

• Other treatments such as physical therapy or the use of a gait aid such as a cane do not relieve hip pain.

The Orthopaedic Evaluation

•  Your orthopaedic surgeon at A+ clinic ask you about your general health the extent of your hip pain and how it affects your ability to perform every day activities.

• A physical examination to assess hip mobility, strength, and alignment.

• X-rays (radiographs) to determine the extent of damage or deformity in your hip.

• Occasionally, blood tests or other tests such as MRI (magnetic resonance imaging or bone scanning may be needed to determine the condition of the bone and soft tissues of your hip.

What to Expect From Hip Replacement Surgery

· An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do.

·         Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. However, hip replacement surgery will not enable you to do more than you could before your hip problem developed.

·         Following surgery, you will be advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life. You may be asked to avoid specific positions of the joint that could lead to dislocation.

·         Even with normal use and activities, an artificial joint (prosthesis) develops some wear over time. If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.

Surgery

The surgical procedure takes a few hours. The orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic joint surfaces to restore the alignment and function of your hip.

Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal or ceramic material) and the socket component (a durable cup made of plastic, ceramic or metal, which may have an outer metal shell).

Special surgical cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint.

A noncemented prosthesis has also been developed and is used most often in younger, more active patients with strong bone. The prosthesis may be coated with textured metal or a special bone-like substance, which allows bone to grow into the prosthesis.

You will usually stay in the hospital for a few days. After surgery, you will feel pain in your hip. Pain medication will be given to make you as comfortable as possible.

To avoid lung congestion after surgery, you will be asked to breathe deeply and cough frequently.

To protect your hip during early recovery, a positioning splint, or a pillow is placed between your legs.

Walking and light activity are important to your recovery and will begin a day after your surgery. Most patients who undergo total hip replacement begin standing and walking with the help of a walking support and a physical therapist the day after surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.  

Recovery

The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.

Avoid getting the wound wet until it has thoroughly sealed and dried. A bandage may be placed over the wound.

Diet

 A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Drink plenty of fluids.

Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.

Your activity program should include:

• A graduated walking program, initially in your home and later outside

• A walking program to slowly increase your mobility and endurance

• Resuming other normal household activities

• Resuming sitting, standing, and walking up and down stairs

• Specific exercises several times a day to restore movement

• Specific exercises several times a day to strengthen your hip joint

• You may wish to have a physical therapist help you at home.

Other precautionary measures

• Avoiding Falls

·        A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs climbing is avoided until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.

·        Your orthopaedic surgeon and physical therapist at A+ clinic will decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

Special  Precautions:

• Do not cross your legs.

• Do not bend your hips more than a right angle (90°).

• Do not turn your feet excessively inward or outward.

• Use a pillow between your legs at night when sleeping until you are advised by your orthopaedic surgeon that you can remove it.

   What changes at home will help a patient with THR

The following is a list of home modifications that will make your return home easier during your recovery:

• Securely fastened safety bars or handrails in your shower or bath

• Secure handrails along all stairways

• A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms

• A raised toilet seat

• A stable shower bench or chair for bathing

• A long-handled sponge and shower hose

• A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip

• A reacher that will allow you to grab objects without excessive bending of your hips

• Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips

• Removal of all loose carpets and electrical cords from the areas where you walk in your home