Hip Replacement

Hip replacement and hip revision
A hip replacement operation involves replacing your hip joint if it’s been damaged or worn away. This is usually caused by arthritis, but is sometimes the result of an injury. Hip revision (or repeat hip replacement) involves replacing your artificial hip joint if it’s become loose, infected or worn out.

Your hip is a ball and socket joint. Usually the ‘ball’ at the top of your thigh bone (femur) moves smoothly in the ‘socket’ of your pelvis, which has a lining of low friction cartilage. The cartilage stops your bones from rubbing together and has no feeling (like fingernails). If your cartilage is worn away, the underlying bone is exposed and your joint becomes painful and stiff, which makes walking and moving around painful. A new hip joint aims to help improve your mobility and reduce pain.

About Hip Replacement
If you have a total hip replacement, the parts of your bones that are rubbing together will be removed. Replacement pieces made from artificial materials will then be put in their place.

Hip replacements can be made of metal, ceramic or plastic. The most common combination is a metal head and a plastic cup. Hip joints can be fixed (‘cemented’) or pressed into place (‘uncemented’). If the hip is uncemented, the metal surfaces are often treated with a substance and roughened. This encourages your own bone to grow into the artificial joint and fix it in place. You may also have a hybrid replacement where only one piece is cemented in place.

Metal and ceramic parts tend to be more hard-wearing, but they may have other disadvantages. Metal-on-metal hip replacements, where both pieces are made from metal, are no longer routinely used for total hip replacement operations.

The Medicines and Healthcare products Regulatory Agency (MHRA) has released new guidelines that say certain types of metal-on-metal implants aren’t suitable for women. This is because research studies show that you may be more likely to need a revision operation if you have one.

There’s also some evidence to suggest that particles of metal may get into your blood. This type of replacement joint may increase the risk of inflammation or cancer but more research is needed to confirm this. Speak to your GP or surgeon if you have any questions about the type of replacement you’re having.

Some types of metal-on-metal implant need to be checked every year. If you have a metal-on-metal hip implant and are having any pain or difficulty moving the joint, see your GP for a check-up. You may need to have a blood test to check the level of metal in your blood and X-rays to check for damage to the implant.

Some common reasons why a hip joint can become damaged include:

Osteoarthritis – so-called "wear and tear arthritis", where the cartilage inside a hip joint becomes worn away, leading to the bones rubbing against each other

Rheumatoid arthritis – this is caused by the immune system (the body’s defence against infection) mistakenly attacking the lining of the joint, resulting in pain and stiffness

Hip fracture – if a hip joint becomes severely damaged during a fall or similar accident it may be necessary to replace it

Many of the conditions treated with a hip replacement are age-related so hip replacements are usually carried out in older adults aged between 60 and 80.

However, a hip replacement may occasionally be performed in younger people.

The purpose of a new hip joint is to:

• relieve pain
• improve the function of your hip
• improve your ability to move around
• improve your quality of life

Pros and cons of hip replacement

This information is intended to help you understand the advantages and disadvantages of hip replacement. Think about how important each particular issue is to you. You and your doctor can work together to make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.

Pros

• After a hip replacement most people don’t have hip pain any more.
• Hip replacement can improve your ability to move around.
• You can reduce or stop taking painkillers you have been taking for your hip pain.
• You should be able to walk without aids when you have recovered.

Cons

• You will need to stay in hospital for a few days after this operation.
• Your movement may be limited after the operation to prevent hip dislocation.
• There are risks linked to major surgery, including the risk of dying as a result of the operation.
• You may need a repeat operation after 10 to 20 years.

Preparing for hip replacement

If you smoke, you will be asked to stop. This is because smoking increases your risk of getting a chest and wound infection, which can slow your recovery. If you’re overweight, your surgeon will discuss the benefits of losing excess weight. This will help reduce the strain on your hip and may mean you’re less at risk from complications of surgery.

The operation may be done under spinal or epidural anaesthesia. This completely blocks feeling from below your waist but you will stay awake during the operation. Alternatively, you may have surgery under general anaesthesia. This means you will be asleep during the operation. Your surgeon will advise you which type of anaesthesia is most suitable for you.

If you're having a general anaesthetic, you will be asked to follow fasting instructions for about six hours beforehand. It's important to follow your anaesthetist's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure. This is your chance to make sure you understand what will happen. You may find it useful to prepare some questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to give your informed consent for the procedure to go ahead.

You may also be asked to give your consent to have your name on the National Joint Register. This is used to follow up the safety, durability and effectiveness of joint replacements and implants.

To help prevent blood clots forming in the veins in your legs (deep vein thrombosis, DVT), you may be asked to wear compression stockings.

What are the alternatives to hip replacement?

You will usually only be recommended surgery if non-surgical treatments no longer help to reduce your pain or improve your mobility. For example, taking over-the-counter painkillers or using physical aids like a walking stick.

It’s possible that you may be able to have a hip resurfacing operation rather than a conventional hip replacement. This involves removing the damaged bone and covering the surfaces of the ball and socket with metal caps. This surgery may be an option if you’re 65 or younger with strong bones.

What happens during hip replacement?

A hip replacement operation usually takes around one and half to two hours, and a hip revision about twice as long.

Your surgeon will make a cut (20 to 30cm long) over your hip and thigh. They will then divide the hip muscles and separate (dislocate) your ball and socket joint.

The ball at the top end of your thigh bone will be removed and a replacement ball on a stem will be inserted into your thigh bone. Your hip socket will be hollowed out to make a shallow cup and an artificial socket placed into it. The hip joint is then put back together (the ball is put into the socket).

Your surgeon will close the cut in your skin with stitches and cover it with a dressing.

Alternatively, it may be possible for you to have the operation done making one or two smaller cuts (about 10cm) over your hip and thigh. This means that there may be less damage to your hip muscles. This type of operation (minimally invasive hip replacement) is carried out using specially designed surgical instruments. It isn't suitable for everyone.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic. You may need pain relief to help with any discomfort as the anaesthetic wears off.

A special pillow may be placed between your legs to hold your hip joint still and stop it from dislocating.

You may be given medicine as injections or tablets to prevent DVT. You will be given this shortly after your surgery and you may need to carry on taking it for a few weeks.

A physiotherapist will usually visit you after your operation and at regular intervals afterwards. They will give you exercises to do and it’s important that you do these as often as your physiotherapist tells you. Normally three times a day. These are designed to help your recovery by restoring movement and strength in your hip.

You will stay in hospital until you're able to walk safely with the aid of walking sticks or crutches. This is usually between three and five days after your operation. But it can be anything from one to eight days depending on your recovery. When you're ready to go home, you will need to arrange for someone to drive you. Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment.

Your stitches may need to be removed after 12 to 14 days. Dissolvable stitches don't need to be removed.

Recovering from hip replacement

You will probably be prescribed painkillers to take home when you leave hospital. If you need further pain relief, you can take over-the-counter painkillers (eg paracetamol). Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them when you’re home.

There are certain movements that you shouldn't do in the first six weeks. For example, don't cross your legs or twist your hip inwards and outwards. This is to reduce strain on your scar and also the risk of a dislocation.

You should be able to move around your home and manage stairs. However, you may find some routine activities, such as shopping, difficult for a few weeks. You will need to use sticks or crutches for about four to six weeks.

You can usually return to light work after about six weeks. If your work involves a lot of standing or lifting, you may need to stay off for longer.

Follow your surgeon's advice about driving. The length of time before you're fit to drive will depend on several factors. These include which leg has been operated on and whether your car is manual or automatic.

What are the risks?

As with every procedure, there are some risks associated with hip replacement or hip revision surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Your hip will feel sore for several weeks and you may have some temporary pain and swelling in your thigh and also in your ankle. This is normal and may last for several months.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or DVT. Specific complications of hip replacement are uncommon, but can include the following.

• Infection. You will be given antibiotics during and after surgery to help prevent this.
• Joint dislocation. This is most likely to happen in the early weeks and months after your surgery and you may need another operation to treat it. 
• Difference in leg length. Your leg may be slightly shorter or longer and you may need to wear a raised shoe to correct your balance.
• Hip fracture. Tiny cracks can occur in your bone while fitting the new joint. These usually heal, but sometimes your bone can fracture and require further surgery.
• Loosening of the joint. The hip joint may become loose and you may need further surgery to correct this.
• Nerve damage. This can result in numbness around your scar. Rarely the sciatic nerve may be stretched and this can lead to loss of movement and sensation in your foot (this is usually temporary).

More information

Plan your knee or hip replacement with MedWorld India

For FREE Case evaluation

visit : www.medworldindia.com

send your reports at : medworldindia.enquiry@gmail.com

or Call us / whatsApp : +91-98-11-188077

Knee replacement

Knee replacement

Introduction

Knee replacement, also called arthroplasty, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.

Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee.

The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments.

Anatomy of the knee

Joints are the areas where 2 or more bones meet. Most joints are mobile, allowing the bones to move. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons. Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee.

There are 2 groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of connective tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments of the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

The knee consists of the following:

Tibia. This is the shin bone or larger bone of the lower leg.

Femur. This is the thighbone or upper leg bone.

Patella. This is the kneecap.

Cartilage.  A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.

Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.

Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.

Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.

Meniscus. A curved part of cartilage in the knees and other joints that acts as a shock absorber, increases contact area, and deepens the knee joint.

Types of surgery

There are two main types of surgery, depending on the condition of the knee:

• total knee replacement (TKR) – both sides of your knee joint are replaced

• partial (half) knee replacement (PKR) – only one side of your joint is replaced in a smaller operation with a shorter hospital stay and recovery period

Why is knee replacement surgery needed?

The most common reason for knee replacement surgery is osteoarthritis. Other conditions that cause knee damage include:

• rheumatoid arthritis
• haemophilia
• gout
• knee injury

A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, haven't helped reduce pain or improve mobility.

You may be offered knee replacement surgery if:

• you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
• your knee pain is so severe that it interferes with your quality of life and sleep
• everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
• you cannot work or have a normal social life

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

• Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

• If you are pregnant or suspect that you are pregnant, you should notify your doctor.

• You will be asked to fast for eight hours before the procedure, generally after midnight.

• You may receive a sedative prior to the procedure to help you relax.

• You may meet with a physical therapist prior to your surgery to discuss rehabilitation.

• Arrange for someone to help around the house for a week or two after you are discharged from the hospital.

• Based on your medical condition, your doctor may request other specific preparation.

What happens during knee replacement surgery?

• A knee replacement is normally performed under general anaesthetic
• During the operation your whole existing knee joint is replaced with a new prosthetic knee joint
• This takes between one and two hours
• Your surgeon will make an incision (cut) at the front of your knee where the replacement will be inserted
• Usually, you will stay in hospital for 2-4  days, but you may have to stay longer if necessary.

Most total knee replacement operations involve replacing the joint surfaces at the end of your thigh bone (femur) and at the top of your shin bone (tibia).

A total knee replacement may also involve replacing the under-surface of your kneecap (patella) with a smooth plastic dome. Some surgeons prefer to preserve the natural patella if possible, but sometimes the decision will need to be made during the operation.

If you’ve had a previous operation to remove the patella altogether (patellectomy), this won’t stop you having a knee replacement, but it may affect the type of replacement part (prosthesis) your surgeon uses.

The new parts are normally cemented in place. If cement is not used then the surface of the component facing the bone is textured or coated to encourage bone to grow onto it, forming a natural bond.

Exercises after knee replacement : 

The following exercises should be performed three times per day for at least 12 weeks and supervision by a therapist may be useful. These exercises will help knee range and strength and should be performed pre and post-operatively.

Please note: these exercises may worsen your pain initially.

Pain following a knee replacement remains for many weeks and is normal for everyone. Take pain killers before you exercise to try and reduce the after-effects.

Sit on a chair with a towel under one foot. Slide the foot under the chair as far as you can. Move your knee forward keeping the sole of your foot in contact with the floor. Hold for approximately 10 seconds.

Repeat 10 times.

Sit on the floor with your legs straight out in front of you. Put a band around your foot. Bend your knee as far as possible. Gently pull the band to bend your knee a little more. Hold for approximately 10 seconds.

Repeat 10 times.

Sitting on a chair, with the leg to be exercised supported on a chair as shown, let your leg straighten in this position. Hold for approximately 15 seconds.

Repeat 10 times, three times per day.

Sit on a chair with one leg straight in front of you. Place your hand on your thigh just above the knee cap. Lean forward keeping your back straight. Straighten your knee, assisting the stretch with your hands. Hold for approximately 15 seconds.

Repeat three times, three times per day.

Sit on a chair. Pull your toes up, tighten your thigh muscle and straighten your knee. Hold for approximately five seconds and slowly relax your leg.

Repeat 10 times.

Lie on your back. Bend your leg, place a cushion under your knee and keep your other leg straight on the bed. Exercise your straight leg by pulling your foot and toes up, tightening your thigh muscle and straightening the knee (keep your knee on the cushion). Hold for approximately five seconds and slowly relax. To make the exercise harder, put a small weight around your ankle.

Repeat 10 times.

Risks specific to knee replacement surgery are:

Knee replacement surgery is a common operation and most people do not experience complications. However, as with any operation, there are risks as well as benefits.

Complications are rare but can include:

• stiffness of the knee
• infection of the wound
• deep infection of the joint replacement, needing further surgery
• unexpected bleeding into the knee joint
• ligament, artery or nerve damage in the area around the knee joint
• blood clots or deep vein thrombosis (DVT)
• persistent pain the in the knee

In some cases, the new knee joint may not be completely stable and further surgery may be needed to correct it.

More information

Plan your knee or hip replacement with MedWorld India

For FREE Case evaluation

visit : www.medworldindia.com

send your reports at : medworldindia.enquiry@gmail.com

or Call us +91-9811058159 / whatsApp : +91-98-11-188077