To understand total hip arthroplasty, you must first be familiar with the structure of the hip joint. The hip joint is a ball and socket joint with the “ball” (femoral head) attached to the top of the femur (the long bone of the thigh). The “socket” (acetabulum) is part of the pelvis. The ball rotates within the socket allowing your leg to move forward, backward and to the side at will, accomplishing movement in a variety of planes.
In a healthy hip joint, smooth cartilage covers the surface of the femoral head and acetabulum, allowing the head of the femur to glide easily within the socket.
When problems occur in the hip joint, the worn cartilage surfaces of the hip joint lose their padding. As the diseased and damaged bones rub against each other, they will gradually become rough and the ensuing pain will make walking increasingly difficult. Aseptic necrosis of the femoral head, on the other hand, is a hip disease of unknown etiology in which osteonecrosis and fractures occur in the weight-bearing area of the femoral head and gradually lead to structural changes in the femoral head, collapse and deformation of the femoral head, joint inflammation, and functional impairment.
Total hip arthroplasty involves the replacement of a worn out acetabulum using a cup (titanium shell) made of wear-resistant polyethylene or ceramic. And the femoral head will be replaced by a femoral head made of chrome cobalt alloy or ceramic with a metal stem underneath.
Why do I need a total hip replacement? To relieve or reduce pain, improve hip motion and function, and improve quality of life.
Risks and benefits of total hip replacement.
When you decide to have a total hip replacement, you will have fully discussed the risks and benefits of the procedure with your supervising physician. To date, tens of millions of hip replacements have been performed worldwide. The artificial joints have all proven to be very safe and reliable, with a general success rate of 90-95% over 10-20 years of follow-up.
Your rehabilitation program will begin as soon as you are stabilized, at which time you will have various orders from your surgeon to begin post-operative activities. Some patients’ rehabilitation will begin on the day of surgery, while others will generally begin on the first day after surgery. For all patients, rehabilitation will begin within 24 hours of surgery. The most critical thing to understand is that being active and participating in a rehabilitation program is a decisive factor in a successful, full recovery from surgery. You must play an active role in your recovery and rehabilitation exercises from the very beginning.
The doctor/nurse will assist you with the following activities: sitting with your legs dangling over the edge of the bed, safely getting in and out of bed, walking with the help of a walker or cane climbing stairs to begin walking.
The doctor/nurse will assist you to sit up on the edge of the bed (with your legs in the air). You will then need to use a cane or stand up with the help of the doctor/nurse. As time goes on, you will need to increase the distance and frequency of your walking. The vast majority of patients will be able to walk using a cane or crutches for a few days after surgery.
Looking ahead before you leave the hospital, there will be someone available to guide you through a rehabilitation exercise program at home. Remember, the results are up to you! Being extremely involved in the physical therapy program is a crucial point to the success of your surgery. The harder and more enthusiastic you are, the faster your progress will be. Tips for a smooth recovery during hospitalization
Physical Therapy: Participate in physical therapy daily. Physical therapy needs to be scheduled by 9:00 p.m. each day. You can ask the nurse when your physical therapy appointment is scheduled to arrive so that you can prepare to attend in advance.
Patient safety and fall prevention, please call for help before leaving your bed, and take your pain medication regularly during the day, not just before physical therapy. Your doctor does not want you to do rehabilitation exercises while in pain, so please speak up whenever you feel pain. use cold packs once every 3-4 hours.
Use the bathroom, safely with assistance, as long as you can tolerate being out of bed for at least 20 minutes. Please use the bathroom prior to physical therapy so that you can improve your functional flexibility during treatment. Please have a commode available for use when you are unable to get out of bed.
There are some precautions you must follow after total hip replacement to protect your new hip joint. Following these precautions will allow your new hip to recover from surgery while strengthening the tissues and muscles around the joint. If your new hip moves beyond the limits described below, it will increase the risk of hip dislocation. You must take these precautions until your follow-up visit with your surgeon 6-8 weeks after surgery. Your surgeon will tell you at your follow-up appointment when you can exceed these limits.
Do not flex your hip more than 90°, do not sit with your legs crossed, do not lean forward so that your shoulders are in front of your hip, do not bend over to pick up objects on or near the floor level, and do not rotate your leg externally after surgery. Do not keep your post-operative feet “figure eight” apart. Do not use your post-operative leg to rotate on its axis, either while walking or turning. Do not cross your feet or ankles. When lying on the healthy side, put 2 pillows between the legs and avoid sitting on low, soft stools, such as sofas and recliners. Sit on a sturdy stool (preferably with armrests) with two pillows to raise the height of the stool. Plan ahead and place the stools at home in the right place. Your bed at home should be higher than 45cm, so that when you sit on the bed, your thighs are tilted down. However, the exact height will depend on your height.
How to ride in a car, choose the front seat and sit on the two cushions. Before getting into the car, make sure the seat is adjusted to the very back and tilted back appropriately. For regular cars, get in directly from the road to prevent your hips from flexing excessively. For SUVs, because of their high chassis, it is much easier for you to get in the car from the curb. The amount of weight you can carry on your leg after surgery will depend on your surgery. Your surgeon will tell you how you should weight-bear.