I. What is total hip arthroplasty?
Total hip arthroplasty is the replacement of a diseased joint with a material that simulates the structure of the human joint, in order to eliminate joint pain and restore joint function.
There are two types of artificial hip prostheses: cemented and biologic, which will be selected according to the patient’s age, quality of bone tissue and anatomical shape of bone structure. Xuesong Dai, Department of Orthopedics, The Second Hospital of Zhejiang University School of Medicine
At present, more than one million hip replacements are performed each year worldwide. With the improvement of people’s living standard, more and more patients are willing to undergo total hip replacement surgery in order to pursue a better quality of life.
Second, total hip replacement is suitable for people.
The effect of total hip replacement surgery has a certain time limit, so elderly patients are the best treatment group, and for certain systemic and multi-joint diseases (such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing crestitis, etc.), the age of surgery can be relaxed.
Common indications.
1.Primary or secondary osteoarthritis
2, hip dysplasia secondary to osteoarthritis
3.Rheumatoid arthritis
4.Ankylosing crestitis
5.Femoral neck fracture
6.Traumatic osteoarthritis
7.Aseptic necrosis of femoral head
8.Hemophilic arthritis
9.Some types of bone tumors
IV. Pre-operative conditions of patients
In good physical condition, but for diabetes, heart disease or hypertension, the patient should undergo systematic medical treatment and be operated only after the condition is stabilized.
If the patient is suffering from immune diseases (such as rheumatoid arthritis, systemic lupus erythematosus, etc.), the condition must be stable.
Discontinue non-steroidal drugs [such as aspirin, ibuprofen (Fenbendazole), diclofenac (Fotaralin), etc.], anticoagulant drugs such as warfarin, blood pressure lowering drugs such as Bolivar, and immunosuppressive drugs (such as methotrexate, etc.) two weeks before surgery to avoid intraoperative and postoperative bleeding, impairing renal function or affecting wound healing. If you have hidden infections (such as dental caries, otitis media, sinusitis, etc.), you should treat your chronic diseases before arthroplasty.
V. Treatment process
The surgeon will ask you about your condition in detail and ask you to give a detailed history of your previous drug application and drug allergy.
1.Prepare for blood transfusion during and after the operation. During your admission to the hospital for the operation, the nurse will instruct you to learn to relieve your bowels in a flat position on the bed. You will need to complete the relevant procedures before the operation, including reading and signing the notification form, the operation consent form, the preoperative talk form and the anesthesia notification form.
2. On the night before surgery, sleeping pills may be given before going to bed to eliminate preoperative tension. Also, no food, including water, should be consumed after 8 p.m. until 6 hours after surgery.
3.Before entering the operating room, please hand over your valuables and dentures and other items to your family for safekeeping.
4.After you enter the operating room, the anesthesiologist will insert an intravenous line into your arm for the use of medication during the operation. A catheter will be left in place during the operation and will be kept for several days after the operation.
5.You should shower before surgery to try to keep your whole body, especially the skin near the incision, clean.
6.After the surgery, you will be taken to the resuscitation room and gradually regain consciousness. The anesthesiologist will be by your side to encourage coughing or deep whistling to clean the lungs.
VI. Post-operative recovery
1.The correct resting position
For 1 day after surgery, you should lie flat. Put a thin pillow under the knee to keep the knee joint flexed 10°-15°, with the toes up, and place a sponge triangle pad between the lower limbs to make the affected limbs abducted.
After 1 day of surgery, semi-recumbent position is recommended, but the head of the bed should not be elevated more than 30° to avoid backward dislocation of the hip joint.
1 week after surgery, the head of the bed can be raised 45°-60°, but should not exceed 90°.
2 weeks after surgery, lateral lying to the healthy side is allowed, and pillows should be placed between the single and double lower limbs to keep the affected limb out of the booth (the affected limb is prone to dislocation by inversion).
2 – 3 months after surgery, lateral lying to the affected side is allowed.
When the patient uses the commode, the upper body is allowed to be slightly elevated and the hip is slightly flexed, and the escort is asked to hold the whole hip up. Remember to over-extend the hip joint when lying down to prevent forward dislocation of the hip joint.
2.Standing exercises in bed
3–4 days after surgery, the patient can get out of bed under the appropriate use of walker and axillary cane.
Before starting to walk, first learn the correct standing posture, under the protection of the walker, hold the chest and waist up, and look straight ahead with both eyes. The two lower limbs are separated, the distance between the two feet is 20 – 30 cm, the toes are aligned with the front, and the affected limb is allowed to partially bear weight.
Gradual hip flexion up to 90° can be allowed within 2 weeks after surgery Allow the patient to get out of bed and sit in a rigid seat with high back and armrests (the seat should be at a certain height so as to keep the hip joint flexion from exceeding 90°).
Usually use double crutches at 4 – 6 weeks postoperatively; single crutches at the second 4 – 6 weeks; walking distance should be gradually increased, even if fully recovered, a single long distance (1 – 2 km) should never be allowed uninterrupted walking.
3.How to use the walker
The walker is suitable for the initial walking training, especially for the elderly, after moving forward with both hands holding the walker, take the healthy limb, and then move the affected limb to follow.
4.Walking gait with cane
Suitable for patients 2 – 3 months after surgery, to reduce the weight of the joint, cane held on the healthy side, cane and the affected limb swing at the same time.
Seven, hip joint exercises
In the early stage, passive exercise is the main exercise, after the muscles around the hip joint are repaired, then gradually transition to active exercise as the main exercise, the frequency and intensity of the exercise also gradually increase, no matter which exercise, some movements are discouraged or contraindicated, such as flexion of the hip internal rotation position; some movements are encouraged, such as extension and flexion of the hip joint and abduction exercises within the normal range of activity, any exercise should not cause excessive pain.
Eight, new behavior norms
After total hip replacement, it is recommended to re-regulate the behavior of daily life and living.
1. The majority of patients can flex their hips up to 90°, which can basically meet the requirements of daily life; individual patients can exceed 90°, but do not force it. Avoid crossing legs or lower limbs, and do not bend and flex the hip to pick up objects to prevent dislocation of the hip joint.
2, Reduce or control weight gain, the best time for functional exercise is within 6 months of surgery; gait improvement can continue until 1 – 2 years after surgery.
3.Minimize the frequency of going up and down stairs every day and the height of the stairs; it is recommended to go up 2–3 floors every day, i.e. stand for a moment to rest, and it is advisable to use handrails to go up and down stairs.
4.Control the single walking distance (about 1 kilometer); long distance walking must use a cane.
5.Visit the hospital on time for follow-up (1 month, 3 months, 6 months, 9 months and 1 year after surgery, and every 1 year thereafter).
6.If the following conditions occur after discharge: distension and pain in the affected hip, abnormal limb position, limb deformity or abnormal pain in the hip joint, redness, swelling, heat and pain in the local incision, you should seek medical consultation in time
7. Continuous sitting time: it is appropriate not to cause discomfort or pain in the hip. Within the initial 2 months after surgery, the single sitting time should be limited to 30 minutes, and gradually extend the time.
8.When getting up, first move your body forward to the side of the seat, i.e., increase the angle of knee flexion, use the armrest of the seat to hold your body up with both hands, and then stand. In the early postoperative period, while moving the body forward, the affected limb can be stretched forward a little, which helps to stand up.
9. Advice.
After total hip replacement, if you need any surgery, even minor surgery (tooth extraction, dental installation or catheterization, etc.), you must tell your attending physician that you have an artificial joint.