What is total hip arthroplasty?
Total hip arthroplasty is an operation to replace the hip joint, which consists of two parts: the acetabulum (the cup-shaped bone in the pelvis) and the head of the femur. During the procedure, these two parts are removed and replaced by an artificial prosthesis, consisting of a polymer material for the acetabulum and a thick alloy material for the femoral head and the attached stem. These artificial components are placed within the normal pelvis and femoral tissue.
Non-cemented total hip replacement
Non-cemented total hip prostheses have the potential to grow bone in and are more durable than cemented prostheses. These prostheses are designed primarily for younger patients, and in some cases, only one or two components are cemented and the remaining components are not cemented; the prosthesis is called a hybrid hip prosthesis.
When do we consider a total hip replacement?
1.Severe pain that not only limits work and recreation, but also affects daily living activities.
2.The pain is not effective with anti-arthritic drugs and restricts activities.
3.Significant hip stiffness.
4.X-ray shows arthritis or other diseases.
Expected purpose of total hip arthroplasty
Total hip arthroplasty provides complete or substantial pain relief in 90-95% of patients, allows patients to perform many of the movements of daily life, and allows you to perform vigorous exercise or heavy work under the direction of a rehabilitator. Many patients with hip stiffness regain near normal mobility after surgery, and almost all patients show improvement.
Risks of total hip arthroplasty
Total hip replacement is major surgery and the results of various complications can be attributed to a prolonged hospital stay for the patient. The most common complications that are not directly related to the hip and do not affect the outcome of the surgery include: blood clots in the lower leg, cerebral blood clots, urinary tract infections or urinary retention. Complications affecting the total hip joint are rare, but in these cases the surgery can be unsuccessful: lower limb inequality, joint stiffness, hip dislocation (ball coming out of the socket), hip infection. Some complications such as infection or dislocation may require reoperation, the infected hip prosthesis sometimes has to be removed, and the residual limb is shortened (about 1-3 inches) and is the affected limb, but this makes the patient more comfortable and supported by a cane or crutches when walking.
How durable the hip prosthesis is
According to our early observations, 90-95% of hip prostheses last successfully for more than 10 years, with the main long-term problem being loosening or wear, which can be triggered either by cement fracture or by bone resorption. In the last 10 years, 25% of all prostheses were visible as loosening on radiographs. Less than half of these patients experience pain and require revision, and after several years the plastic socket can wear away. Small wear particles can cause inflammation, leading to bone thickening and an increased risk of fracture. Loosening and wear are related to your weight and exercise level, so we do not operate on overweight, over-active young patients. Loose, painful hip prostheses are often replaced, and the results of the second surgery are not as good as the first and the risk of complications becomes greater.
Preparation for surgery
Preparation for total hip arthroplasty begins several weeks before the date set for surgery. It is important to maintain good physical condition prior to surgery, and strength exercises for the upper extremities will help with the ability to apply crutches after surgery. There are several ways to address blood loss during and after surgery. Day-of-op blood work is required, and the workup will help you make the best choice for blood control. You can become a post-op autologous blood returner, and in the early post-op period the wound drains blood that can be filtered back to the patient, and the physician will help you make a conclusion.
The physician will perform preoperative blood and urine tests to determine if there is a urinary tract infection. Urinary tract infections are common, especially in older women, and often go undetected. If you have seen a dentist in recent years, please make an appointment with your dentist as infected teeth or gums can cause infection of the hip prosthesis. When preparing for surgery, you will want to consider the post-operative recovery time. Total hip replacement patients need help at home for the first few weeks after surgery; dressing and eating is a must. Bowel movements are common 4-6 days after surgery. You will want to consider being there for companionship if you are not recovering physically and if you cannot get help from family members.
Pre-operative Visits
Due to varying levels of health insurance coverage, insurance will visit most patients, a few days before the day. This visit usually lasts several hours to determine the maximum cost at the time of surgery. The visit takes place at the hospital and involves previous medications and a record of current medications. You will be asked to stop taking NSAIDs or anticoagulants (aspirin, Relifen) 1 week prior to surgery. You will have plenty of time for questions and discussion. It is a good idea to bring information about previous surgeries and the names and doses of medications you take by mouth on a daily basis at home.
Diet
You should eat your daily diet before surgery, abstain from water after midnight, and you may brush your teeth and rinse your mouth on the day of surgery. Do not swallow mouthwash.
Bathing
Showers, baths and scrubs are allowed every evening and in the morning of surgery. It is necessary to scrub the brush with antiseptic and scrub the hip with the side of the sponge for 5 minutes, which can be obtained with the help of family members. The brush contains a special liquid to reduce the risk of infection. Tell the nurse if you are allergic to iodine or fluids. If possible you should shampoo your hair, smooth your nails and remove makeup.
Deep Breathing Exercises
You will be asked to perform deep breathing exercises to reduce postoperative pulmonary complications and to remove excessive secretions from the lungs under intraoperative anesthesia. These exercises are mandatory. These exercises will be performed every 1-2 hours postoperatively. A stimulant lung ventilator can be applied and this device can help you with this exercise.
Prevention of blood clots
You can wear elastic exercise stockings to help improve blood circulation in the foot and lower leg in the morning of surgery to reduce the risk of blood clots.
Anesthesia
You will be scheduled to meet with an anesthesiologist to discuss how to keep you under anesthesia during surgery. The anesthesiologist will advise you on routine medications to be applied on the day of surgery.
Pain control
Read this brochure for the section on the pain pump, which is a common method of analgesia for 2-3 days after surgery. When the pain pump is discontinued, your physician will prescribe oral analgesics, and it is important to continue taking them because it is easier to stop the pain. If the pain is not relieved after taking the medication, we recommend that you notify your healthcare provider to change your pain medication.
Your physician will review your medication history and the medications you are using. He or she will give you a thorough physical examination, including cardiopulmonary auscultation, to check for the presence of various infections. Blisters, abrasions and boils should be told to the physician. If an infection is found, surgery should be postponed until the infection subsides. At the pre-operative visit, you will have blood taken and laboratory tests performed to make sure you are in a healthy state and X-rays are mandatory. An electrocardiogram should be performed if it has not been done within 6 months or if there are other indications. After all tests and labs are completed, the anesthesiologist will talk to you to determine which type of anesthesia is best for you. After you have seen the anesthesiologist, your preoperative evaluation has usually been passed. Before you leave the hospital, make sure that all your questions are answered. If you inadvertently become ill, such as a cold or flu, you should see your physician. Remember, we want you to be in the best of health.
Night before surgery
1. Shower
2. Fasting from water after midnight
3. Revisit the pamphlet and exercise
Day of surgery 1
1. Regular oral medication
2. Second shower and brushing
Operation day 2
You should arrive at the pre-operative assessment unit at the prescribed time for a hip scrub. The nurse will take a few minutes to make sure you are in good health and ready for surgery. The nurse will have a correct determination for you when you need to stay in the hospital. However, it is difficult to predict how long the surgery will last, so there will be some waiting time to do something to pass.
You will be asked to change into a hospital gown and be taken to the operating room on a stretcher. A family member will accompany you to the elevator. Then you will wait in the waiting room. Your physician will communicate with your family after the surgery. A debriefing of the surgery will take place. You will be taken to the pre-operative care room to establish intravenous access for intra-operative and post-operative fluid medications. From here, the anesthesiologist will take you to the operating room. The actual surgical procedure takes 2-4 hours, however the preoperative preparation will keep you in the operating room and the awake room for a long time as well as the awake time.
After surgery
Your blood pressure, pulse, breathing and temperature will be checked frequently after surgery. The sensation and blood flow in the lower leg and foot will be closely monitored. Tell the nurse promptly when you feel numbness, tingling sensation or pain. Once you are awake and stable, you will be returned to your room.
Although every patient’s situation is different, you may experience a variety of conditions as follows.
1. You will find a dressing covering the wound in order to keep it clean and dry. This dressing is usually changed by the physician 2-4 days after surgery.
2. You will find a drainage tube in the wound and the nursing staff will record the flow of drainage. It will be removed 2-3 days after surgery.
3. Intravenous access is established preoperatively and continues to be applied until you can take in enough fluids by mouth. When rehydration is complete, the intravenous access is closed by heparin. A sterile indwelling needle ensures antibiotic input and easy mobility. Antibiotics are administered every 8 hours for 2-3 days to reduce the chance of infection.
4. Anti-inflammatory: A side effect of anesthesia is difficulty in urination after surgery. Therefore, intraoperative urinary catheters are routinely placed to ensure a patent urinary tract. It is usually kept for 2-3 days postoperatively.
5. The drainage tube is removed and a plantar IV pump is applied. The wrapping tape is wrapped around the foot and connected to a pressure device to promote blood return and reduce the occurrence of thrombosis. Postoperatively, through medication and foot exercise, all help to prevent thrombosis.
6. Due to anesthesia and drugs, there may be temporary nausea and vomiting after surgery. To reduce the symptoms, anti-nausea drugs can be used.
7. Diet: You will be asked to increase your diet when the situation allows. You can start with ice cream and clean water drinking gradually increase.
8. Coughing and deep breathing: To prevent complications such as constipation and lung infections, deep breathing and coughing exercises are important. Inhale deeply through the nose, then exhale deeply by the mouth. Repeat 3 times and cough 2 times, which can be assisted by applying a respiratory stimulator.
Movement
Some patients will experience postoperative discomfort in the hip, which may be caused by hip pain. A small number are related to the lack of exercise before and after surgery. Changing the position regularly can relieve postoperative discomfort and prevent skin compression and breakage.
In the first few days after surgery, the head of the bed should not be elevated more than 700, and sitting or standing can make the ball head prolapse from the acetabulum. There is a greater chance of dislocation 6-8 weeks after surgery, and the following points should be noted.
1. Put 2-3 pillows between the calves and do not do cross-legged movements.
2. Do not bend more than 90.
3. Use a high toilet seat.
Early recovery
On the first post-operative day, you will be helped to reach the recliner and physical therapy can begin, such as gradual steps, walking and stair climbing with the help of a brace or crutches. Early recovery usually takes 4-6 days, during which time walking or practicing may be uncomfortable. Pain medication will be required if necessary. Many patients experience pain relief after surgery.
Treatment as well as rehabilitation plan
Your physical therapist will work with you after surgery to help you practice independent walking, walking up and down stairs, getting in and out of bed, and improving hip range of motion and strength. The physical therapist will develop an appropriate home exercise program for you. Do home exercise 2-3 times a day and keep exercising. Walking is not a substitute for exercise. If the exercise causes persistent pain, reduce the intensity of the exercise. If pain continues, contact your physical therapist or physician promptly.
Home Exercise
Range of motion exercises.
Active hip and knee flexion: Lie flat on your back with your lower extremities straight, toes pointing upward, arms on either side of your body, and heels against the bed. Flex the hip and knee joints. Return to the starting position and repeat 20 times, twice a day.
Effective internal and external rotation: Start with the legs straight and moderately apart. Rotate the legs internally so that the patella is opposite each other and maintain for 5 seconds, and externally rotate the legs for 5 seconds. Repeat 20 times, 3 times a day.
Effective abduction: Lower the legs to the plank, start with the legs together, then separate them as far as possible, maintain for 5 seconds, return to the starting position, repeat 20 times, 3 times a day.
Strength exercises
Quadriceps exercises: Tense the thighs as much as possible. At the same time, press the knee joint down toward the bed. This will strengthen the legs, maintain for 5 seconds, relax for 5 seconds, repeat 20 times, 3 times a day.
Gluteus Maximus Exercise: Lie on the bed with the same leg against the bed, tense the glutes in a contracted manner, hold the isometric contraction for 5 seconds, relax for 5 seconds, repeat 20 times, 3 times a day.
Isometric hip abduction: both legs straight and together against the bed, place a circular band around the thigh and try to separate the legs, hold this position for 5 seconds, relax for 5 seconds, repeat 20 times, 3 times a day.
Straight leg raise: keeping the foot flat on the bed, raise the knee joint, flex the healthy leg and raise the affected leg straight, 6-10 feet, then slowly place the leg on the bed. Repeat 20 times, 3 times daily.
If you have hip contracture (difficulty straightening the hip joint), your physician and physical therapist will recommend that you lie in a prone position and place your feet on the side of the bed for 15-30 minutes, 2-3 times per day. When doing this exercise after surgery, it is important to be careful when lying prone and to position the affected hip well. As required for total hip replacement, do not pronate, internally rotate or flex the leg more than 300 when prone.
Hip extension: lift the straight leg off the bed in the prone position and keep the hip against the bed. In slowly lowering, repeat 10 times, avoiding overextension of the back. Repeat the above actions for the affected leg, 10 times for each leg, 3 times a day.
Daily activities
Hip prostheses are designed to eliminate pain and improve function. Certain movements can place abnormal weight on the prosthesis and should be avoided for safety reasons. In particular, during the first few months after surgery, care should be taken to.
1. Do not flex the affected hip more than 90°.
2. Do not sit in a chair without arm support
3.You should grab the armrest of the chair and stand up safely to the standing position. Put a pillow or cushion in the chair to avoid flexing the hip more than 900
4, do not stand with both feet parallel, should make the affected leg in front when standing up.
5.Use a chair with armrests. Put the affected leg in front. The healthy leg should be placed below. Do not sit too low on the commode or chair.
6.Should stand up from the toilet seat under the guidance of the physical therapist, and apply the liftable toilet seat.
7.Can’t overflex the hip joint and pull the blanket.
8.Apply the pick-up device with long handle to pull the bed sheet, blanket or under the guidance of physical therapist.
9.Do not bend and walk
10.Do not rotate the hip bone internally while sitting or standing and walking
11.Do not try to wear shoes and socks in the conventional way
12.Do the above actions are not normal, will be over flexion or internal contraction of the affected leg, should do the above actions under the guidance of physical therapist.
13.Do not internalize the affected leg over the midline
14.Pillows should be placed between the legs when lying down
15.When turning over to a comfortable position, a pillow should be placed between the legs. This can prevent the affected leg from crossing the midline.
Home Guide
What happens when you go home
After discharge from the hospital, you should walk with crutches or braces, walk up and down stairs, get in and out of bed, and sit in a chair to gain some degree of freedom. In some patients, help is still needed at home for 6 weeks or until physical condition is restored.
Medication
1. Continue to take the medication prescribed by the physician
2. Continue antithrombotic therapy. The physician will decide whether to administer oral medication (such as bicoumarol or aspirin) or intramuscular injection of low molecular heparin. If intramuscular injection is needed, the physician will discuss this with you in detail. The nurse will teach you or a family member how to administer the intramuscular injection.
3. Pain medication. Oral pain medication should be taken 30 minutes prior to exercise and if pain relief is not effective, contact your physician.
Exercise
1. Continue to walk with crutches or braces under the guidance of a physical therapist
2. The physician will determine the amount of weight you can bear on the affected leg.
3. Walking is a good way to restore muscle strength
4. However, walking is not a substitute for the exercise program you learned in the hospital, and the success of the surgery will depend heavily on the degree of exercise and muscle strengthening.
5. If significant swelling and pain occur, the intensity of the exercise should be reduced.
Sitting
Sitting and standing for more than an hour at a time should be avoided, do not tuck your legs in, in fact you should spread your knees 12-18 inches apart, and should always sit in a chair with upper body support, with your upper arms providing the leverage to lift you when you stand up. High kitchen facilities or chairs with guard rails are beneficial for movement in the kitchen. Avoid sitting in chairs that are too low, as standing up requires excessive hip flexion. Sitting in a chair, do not bend forward more than 90° for the next 8 weeks with a potty elevation device to avoid hyperflexion of the hip.
Flexion
For the first 8 weeks, you should not dorsiflex to pick up anything on the floor, you can wear slippers with a longer heel to avoid dorsiflexion.
Other precautions.
Do not drive for 6 weeks after surgery and keep your knees 12 inches apart when getting in and out of the car from a seated position and moving through the seat to the car. The plastic cushion on the seat will help you get in and out of the car safely. Avoid sexual intercourse for the following 4-6 weeks and resume sexual intercourse after 2 months with no abnormalities at follow-up. You may return to work at 3-6 months insisting on wearing compression stockings until you pass the follow-up visit. Do not shower until the stitches are removed, you can shower two days after the stitches are removed
Wound
Keep the wound clean and dry and be alert to certain specific signs when you go home. Notify physician immediately if swelling and pain increase, wound oozing, periwound redness, or fever.
Prevent infection
Notify your physician whenever an infection such as strep throat, pharyngitis, or pneumonia develops. Antibiotics should be administered immediately to prevent rare complications that are distant or lead to hip involvement. As with tooth extraction or dental treatment, tell your physician that you have had a hip replacement. You will be given a medical alert card to keep in your wallet, which will provide valid information on the use of antibiotics in the event of dental or oral surgery or increased bacterial infection.
When to follow up
In addition to wound removal, the first follow-up appointment is 6 weeks after discharge, at which you will be carefully examined and x-rays will be taken. Subsequent follow-ups are 6 months, 1 year, 2 years after surgery, and every 3 years thereafter.
Should I have a total hip replacement?
Total hip replacement is an elective surgery, it is not a matter of dying, there is an option not to have the surgery, the decision to have the surgery is not up to the physician but up to you as you have to take all the risks and complications. Your physician may recommend surgery, and your decision should be based on a weighing of the benefits and risks of surgery, which you may discuss with your own physician, and an opinion on surgery or other treatment. All questions should be answered prior to surgery. To make the decision easy, feel free to ask all your questions. Remember that your physicians and nurses are working hard to help you have a pain-free, functional hip, and that the true success of your surgery will depend in part on how carefully you exercise and follow the principles of home care self-discipline.