Total hip replacement surgery involves the comprehensive restoration of the hip joint by replacing the worn-out components, including the femoral head (ball) and the acetabulum (socket). This procedure utilizes a metal stem inserted into the thigh bone (femur), a metal cup fitted into the socket, a polyethylene liner within the cup, and a ceramic head affixed to the metal stem. Typically lasting between one to one and a half hours, patients often begin walking on the same day as the surgery, with recovery ranging from one to two months.
The primary objective of total hip replacement is to restore function and alleviate the majority of the pain associated with hip arthritis. Candidates for this procedure are individuals experiencing significant hip pain due to arthritis, who have exhausted non-operative treatments without relief. Ultimately, the decision to undergo hip replacement lies with the patient, weighing the impact of pain against available treatment options.
Revision Hip Surgery
Revision hip surgery, involving the replacement of a previously implanted prosthesis, presents greater complexity and uncertainty compared to the initial procedure. Each case presents unique challenges and risks, with outcomes less predictable than primary surgeries. Revision surgeries often require specialized implants and bone graft materials to reconstruct the hip joint adequately.
Major indications for revision hip replacement include hip instability, infection, component failure due to wear, and persistent hip pain. Access to operative notes and implant information significantly aids in diagnosing and addressing issues related to existing hip replacements.
Pre-operative Preparation and Education
Pre-operative education significantly enhances patient outcomes following joint replacement surgery. Our hospital offers a complimentary pre-operative instructional class, mandatory for all patients undergoing joint replacement. During this session, patients meet with nursing staff to discuss post-surgery expectations, necessary preparations, and arrangements for post-operative care, including the possibility of home health services.
Medical Clearance and Medication Management
Patients must obtain medical clearance from their primary care physician or relevant specialists before surgery. Discontinuation of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) seven days prior to surgery is advised. Patients taking blood thinners such as coumadin or Plavix must consult their physicians regarding safe discontinuation. All other medications should generally be continued unless advised otherwise by medical professionals.
Day of Surgery Protocol
Patients are instructed to fast for eight hours before surgery, with allowances for water intake up to two hours prior. Most routine medications are taken on the morning of surgery with a small sip of water, with specific guidance provided by the anesthesiologist during the pre-operative visit. Patients meet with the surgeon before the operation, and family members receive updates on the patient’s status post-surgery.
Wound Closure and Post-operative Care
Ensuring meticulous wound closure is paramount to successful outcomes. Surgical incisions are closed with both interrupted and running sutures to evenly distribute force on the skin edges. Sutures dissolve over approximately six weeks, with the application of Dermabond for additional wound protection. The hospital stay typically ranges from one to two days, during which pain management, IV antibiotics, and blood thinners are administered as needed.
Post-operative Follow-up and Risks
Patients undergo regular follow-up appointments, typically at two to six weeks and six weeks after the initial visit, with subsequent visits scheduled every four to five years. Regular monitoring via X-rays helps identify potential issues early, minimizing the need for further intervention. Complications, although rare, may include blood clots, dislocation, infection, unequal leg lengths, component loosening, nerve injury, bleeding, limp, fractures, and the need for further surgery.
In conclusion, while total hip replacement surgery presents potential risks, it remains one of the most successful orthopedic procedures. Patient education, thorough pre-operative assessment, meticulous surgical technique, and comprehensive post-operative care contribute to optimal outcomes and patient satisfaction.