Indications for Total Hip Replacement

Diagnosis

The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).

Indications

THR is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatment.
You should consider a THR when you have:

Arthritis confirmed on X-ray
Pain not responding to analgesics or anti-inflammatories
Limitations of activities of daily living including your leisure activities, sport or work
Pain keeping you awake at night
Stiffness in the hip making mobility difficult

Benefits

Prior to surgery you will usually have tried some simple treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, walking sticks, physiotherapy. The decision to proceed with THR surgery is a cooperative one between you, your surgeon, family and your local doctor. Benefits of surgery include.

Reduced hip pain
Increased mobility and movement
Correction of deformity
Equalization of leg length (not guaranteed)
Increased leg strength
Improved quality of life, ability to return to normal activities
Enables you to sleep without pain

Pre- operation

Your surgeon will send you for routine blood tests and any other investigations required prior to your surgerysuch as ECG, 2D ECHO
You will asked to undertake a general medical check-up with a physician
You should have any other medical, surgical or dental problems attended to prior to your surgery
Make arrangements around the house prior to surgery
Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
Cease any naturopathic or herbal medications 10 days before surgery
Stop smoking as long as possible prior to surgery.

Post- operation

When you wake, you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder and a number of other monitors to check your vital observations. You will usually have a button to press for pain medication through a machine called a PCA machine (Patient Controlled Analgesia).
Drain comes out next day evening. Sit out of bed and start moving your knee same day evening and walking starts same day evening or second day morning . Dresssing reduced on second day evening.
To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.
Your Orthopaedic Surgeon will use one or more measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings and injections into your abdomen to thin the blood clots or DVT's, which will be discussed in detail in the complications section.
A lot of the long term results of knee replacements depend on how much work you put into it following your operation.
Discharge is on 3rd day morning. Discharge on walker progressed on stick on or around 6th or 7th day post op. Stair climbing starts on or around 10th day post op.
You will be discharged on a walker and usually progress to a tripod or quadripod stick in 15 days time.
Your sutures are removed at approximately 15 days.
Bending your knee is variable, but by 6 weeks should bend to 110-130 degrees. Bending range depends upon the pre operative range of patient. The goal is to obtain full functional degrees of movement in total 6-8 weeks.
Once the wound is healed, you may shower from next day of stich removal. You can drive at about 6 -7weeks, once you have regained control of your leg. You should be going for a walk reasonably comfortably by 6 weeks.
More physical activities, such as sports previously discussed, may take 3 months to do comfortably.
When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your sleeping arrangements, especially if they are up a lot of stairs. Basically whatever you sit on should b 22 inches of height for 6-12 weeks
You will usually have a 2 week check up with your surgeon who will assess your progress.and later at completion of month . You should continue to see your surgeon once a year to check your knee and take X-rays.
You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the blood stream and find their way to your knee.
If you ever have any unexplained pain, swelling or redness or if you feel generally poor, you should see your doctor as soon as possible.

Steps of Hip Replacement Surgery

Step 1 : Excision of femoral head

Step 2 : Reaming of worn out acetabulum (cup)

Step 3 : Implantation of cup

Step 4 : Preparation of femoral canal

Step 5 : Implantation of femoral prosthesis

Step 6 : Implantation of femoral head

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