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Hip Replacement

Welcome to the Center for Information of Hip Replacement

At Bone & Joint Center of Bangkok Hospital Phuket, we understand that as a patient thinking about orthopaedic procedures such as hip or knee replacement and hip fracture repair you have many questions. If you have additional questions, kindly contact us and we will be happy to find the right answer for you.

Below are some general information and FAQs about Hip Replacement:

About Hip Replacement

 

What is a hip replacement?

Hip Replacement

Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.

Who Should Have Hip Replacement Surgery?

Hip Replacement

People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.

Today, a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes.

 

What are alternatives to Hip Replacement?

Hip Replacement

Alternatives to Hip Replacement:

  • Conservative Treatment - Not having surgery is always an alternative. Patients who have severe arthritis of the hip, but function adequately, can choose to live with their condition. There are effective treatments for hip arthritis that may help patients avoid the need for a total hip replacement. Among these are physical therapy, walking aids, anti-inflammatory medications, cortisone injections, and joint supplements.
  • Hip Arthritis Treatments
  • Hip Resurfacing - Hip resurfacing surgery is an alternative to standard hip replacements for patients with severe arthritis. In a hip resurfacing surgery, the implant is smaller, and less normal bone is removed. Hip resurfacing is gaining interest, especially in younger patients. During the hip resurfacing procedure, only a small amount of bone is removed from the ball-and-socket hip joint, and a metal cap is placed on top of the ball. A metal socket is placed in the pelvis, similar to the hip replacement procedure. This hip resurfacing preserves much more normal bone than a standard hip replacement.
  • Hip Fusion (Arthrodesis) - Hip fusion is a seldom performed procedure now that hip replacement has become so successful. Hip fusion surgery eliminates all motion at the hip joint by having the bones of the femur and pelvis heal together. They are held in this position by a large metal plate and screws. Hip fusions are usually done in young patients who are heavy laborers. The hip fusion does not wear out like hip replacements would in these patients. The hip fusion allows the patient to perform physically demanding tasks that could lead to early wear on a total hip replacement. The problem with hip fusion is that patients will have no motion of the hip, they will walk with a limp, and may eventually need further surgery to convert to a hip replacement.
  • Resection Arthroplasty (Gridlestone Procedure) - A resection arthroplasty is a procedure where the bone around the hip joint is removed and the joint space is allowed to fill with scar tissue. This procedure is usually done in patients with severe infection that cannot be controlled, or in patients whose physical condition is such that they have little chance of normal walking. Patients who undergo a Girdlestone resection arthroplasty will likely need some assistive device for walking.
  • Hip Osteotomy - Hip osteotomy is a procedure that is done to realign the bones of the hip joint. The osteotomy can be performed on the thigh bone (femur), the pelvis, or both. Osteotomies are usually performed on patients with an underlying problem that has led to early arthritis of the hip joint. For example, developmental conditions such as hip dysplasia can lead to early hip arthritis. Hip dysplasia occurs in infants and leads to malaligned bones around the hip. The osteotomy helps to realign the bones and relieve the symptoms of early arthritis. These procedures must be done in carefully selected patients.

 

What does hip replacement surgery involve?

Hip Replacement

The hip joint is located where the upper end of the femur meets the acetabulum. The femur, or thigh bone, looks like a long stem with a ball on the end. The acetabulum is a socket or cup-like structure in the pelvis, or hip bone. This “ball and socket” arrangement allows a wide range of motion, including sitting, standing, walking, and other daily activities.

During hip replacement, the surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural, gliding motion of the joint. Hip replacement surgery usually lasts 2 to 3 hours.

Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a “cemented” procedure. In an uncemented procedure, the artificial parts are made of porous material that allows the patient’s own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a “hybrid” replacement, which consists of a cemented femur part and an uncemented acetabular part.

 

Is a cemented or uncemented prosthesis better?

Hip Replacement

Cemented prostheses were developed 40 years ago. Uncemented prostheses were developed about 20 years ago to try to avoid the possibility of loosening parts and the breaking off of cement particles, which sometimes happen in the cemented replacement. Because each person’s condition is unique, the doctor and patient must weigh the advantages and disadvantages to decide which type of prosthesis is bette.

For some people, an uncemented prosthesis may last longer than cemented replacements because there is no cement that can break away. And, if the patient needs an additional hip replacement (which is likely in younger people), also known as a revision, the surgery sometimes is easier if the person has an uncemented prosthesis.

The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, people with uncemented replacements must limit activities for up to 3 months to protect the hip joint. The process of natural bone growth also can cause thigh pain for several months after the surgery.

Research has proven the effectiveness of cemented prostheses to reduce pain and increase joint mobility. These results usually are noticeable immediately after surgery. Cemented replacements are more frequently used than cementless ones for older, less active people and people with weak bones, such as those who have osteoporosis.

 


Remark:

  • This information should not be used as a substitute to consultation from a physician. Always talk with your doctor about diagnosis and treatment information.
  • The service center is Bone & Joint Center of Bangkok Hospital Phuket.
  • For more information about our medical services, please contact us at info@phukethospital.com
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