Artificial hip replacement is a repair surgery to replace all (acetabulum and femoral head) or part (femoral head only) of the hip joint with an artificial hip prosthesis to rebuild the motion function of the hip joint. Compared with artificial knee, shoulder, elbow and ankle joint replacements, people’s awareness and acceptance of artificial hip joint replacement has improved compared to that of more than 10 years ago. However, there are still many patients who do not understand or even have misunderstandings about artificial hip joints. To address this situation, we invited Professor Wang Kun, Director of the Department of Joint and Trauma Surgery at the Third Affiliated Hospital of Sun Yat-sen University, to answer questions related to artificial hip replacement.
When it comes to joint replacement, the first reaction of many patients is often unbelievable, they feel mysterious and full of doubts about joint replacement. What is it like to have a joint replaced? Will walking be stiff and unnatural after joint replacement?
It is understandable that patients have such a mentality because our media such as radio, TV, newspapers and magazines do not have enough knowledge on this subject, for example, the Chinese network that I have seen has some introduction, but in general, it is not easy to understand.
The hip joint is made up of the femoral head and the acetabulum (Figure 1), with the femoral head being the round, smooth part and the acetabulum being the depressed part. When the surface of the joint breaks down, it could be on the acetabular side, on the femoral head side, or on both sides (Figure 2), and medication and injections don’t work, and it hurts when you walk. Then remove the painful part (Figure 3) and replace it with a man-made part and put it back together (Figure 4-1). The assembled joint will be as smooth as the original one (Figure 4-2) and will not cause any pain. Just like a broken tooth with braces, you won’t feel any pain when you bite again, and you won’t be able to tell which tooth has braces after a while.
Figure 1 Normal hip joint Figure 2 Diseased hip joint
Figure 3 Removal of the femoral head and a layer of the hip socket
Figure 4-1 The metal femoral head with stem is inserted into the femur and the plastic joint is placed into the acetabular socket
Figure 4-2 (left) Pre-operative diseased joint; (right) post-replacement joint
Patients often ask: How long will the artificial joint last? Will the metal in the body have a bad effect on the body? Can it cause infertility in young women?
The length of time an artificial joint lasts in the body depends on the material used in the joint and the surgical technique used to replace it, but it also depends on the patient. First of all, after more than 30 years of clinical practice, the technology of artificial hip joint replacement surgery has become quite mature. For example, our joint surgery department is one of the early hip replacement units in China and has successfully performed nearly 1000 hip replacements in the past 20 years, including not only the relatively simple initial replacement, which refers to the first joint replacement after the patient’s joint has broken down, but also the rather complicated revision replacement, which refers to the first hip replacement after the patient has used the broken artificial joint for 15-20 years and wants to replace it again with a new one (Figure 5). The first hip replacement is the first replacement after the joint has broken down. We have developed a relatively mature technical specification and a stable talent pool to ensure the success of the operation. In terms of the material of the joint prosthesis, in the past, it was mostly “metal head” to “plastic acetabulum”, which could last 15 to 20 years with no surgical errors. Theoretically, the “ceramic acetabulum” can be used for 30 years. Therefore, a mature surgical technique combined with good materials can ensure the use of the artificial joint for up to 30 years. However, it is also important to note that the patients who undergo joint replacement play a key role here, such as young patients with high activity levels, obese patients, and patients with hemiplegia of the opposite limb, where the stress on the artificial joint is higher (obesity, hemiplegia of the opposite limb) or more frequent use (young patients) will accelerate the wear and tear on the artificial joint, resulting in a relatively short service life.
Figure 5a: (left) 82-year-old female with a loose prosthesis and painful walking after prosthetic joint surgery more than 10 years ago; (right) review photo one year after revision surgery in our hospital
Figure 5a: (left) A 74-year-old female who had left hip artificial joint surgery 10 years ago and had walking pain in her left hip in the past year.
After careful X-ray reading and clinical examination, the pain was considered to be caused by the loosening of the left acetabular prosthesis; (right) the patient was able to walk on the ground without pain the day after the acetabular revision only was performed in our department.
The adverse effects of the artificial joint in the body are minimal. In the past, people were worried that these particles might cause side effects such as cancer and female infertility, but after years of international observation and research, there has not been any confirmed case of “particles” after joint replacement. There have been no cases of “carcinogenic” or “carcinogenic” side effects after joint replacement surgery.
However, after years of international observation and research, there has not been a single case of adverse reactions such as “cancer” or “infertility” after joint replacement. The “ceramic” artificial joints that are increasingly being used produce thousands of times fewer wear particles than other materials, and the harmful effects of ceramic particles are negligible.
After your introduction, we probably know how to replace the artificial hip joint, so what kind of disease should we replace the hip joint? I heard that it is appropriate to replace the joint for patients over 65 years old, is this true?
In the West, osteoarthritis is the most common reason for artificial hip replacement, while in China, the most common reasons for hip replacement are femoral head necrosis (Figure 6), femoral neck fracture (Figure 7), rheumatoid arthritis (Figure 8), hip dysplasia (Figure 9), ankylosing spondylitis (Figure 10), advanced hip osteoarthritis (Figure 11), benign and malignant bone tumors, etc. In conclusion, whenever there is hip joint destruction with moderate to severe persistent joint pain and dysfunction, and the disease cannot be relieved by various other non-surgical treatment methods, artificial hip replacement can be performed to restore joint function and improve quality of life.
Figure 6: (left) 60-year-old male with left femoral head necrosis and walking pain; (right) the affected hip can walk without pain after surgery
Figure 7: (Left) 79-year-old male with left femoral neck fracture caused by a fall, unable to walk; (Right) he got out of bed and practiced walking after the photo on the second day after surgery
Figure 8: (left) A 50-year-old woman with rheumatoid arthritis for 20 years, involving both hips, with painful walking on the left side; (right) walking on the ground on the third day after surgery
Figure 9: (left) 71-year-old woman with advanced bilateral hip dysplasia, unable to walk; (right) a double-layered hip replacement was performed once, and good walking function was restored after surgery
Figure 10: (left): 33-year-old male patient with ankylosing spondylitis to double-layered hip ankylosis, living with great inconvenience; (right) one double-layered hip replacement, post-operative use of a sitting toilet, and significant improvement in quality of life
Figure 11: (Left) 66-year-old woman with right hip walking pain gradually worsened for 3 years, diagnosed with primary hip osteoarthritis; (Right) the patient went down to the ground the next day after surgery
In the past, 60-75 years of age was considered the most appropriate age range for total hip and total knee arthroplasty. In the last decade, its indications have been expanded to include both elderly and younger patients. Older patients are most commonly seen with femoral neck fractures, and our department regularly replaces femoral neck fractures in the 80-100 year old range with a 100% success rate. Younger patients, mainly before the age of 55, may have to undergo a second or even a third joint replacement after surgery because of the high activity level of this age group, the long postoperative life span and the limited life span of the artificial joint.
Elderly patients often have comorbid diseases such as hypertension, heart disease, diabetes, and even cirrhosis of the liver and renal insufficiency, so the patients themselves and their families may think that joint replacement is a big operation, and the risk of surgery is even greater when combined with these chronic diseases, so they simply do not have surgery and lie down at home. Wang Kun, Department of Traumatology, Department of Joint Surgery, The Third Affiliated Hospital of Sun Yat-sen University
There are indeed elderly patients who think that they are already old and have a lot of diseases, and they can no longer afford such a major surgery as joint replacement. In fact, modern medicine is developing rapidly, and some combined chronic diseases can be well controlled, especially in large general hospitals like ours, in addition to our own set of proven experience in the management of elderly patients before and after surgery, there is also the consultation and collaboration of strong internal medicine departments, which can ensure the safe surgery and smooth recovery of elderly patients after surgery as soon as possible. Therefore, the combination of diabetes, hypertension and other common medical conditions is not a contraindication to surgery. In addition, I would like to emphasize that hip arthroplasty used to be considered a very large and complicated surgery, but after nearly 30 years of development, the surgical technique has become very mature. For example, in our hospital, a total hip replacement can be completed in an hour, or 30-40 minutes if it is just a replacement of the artificial femoral head. So even elderly patients aged 80-100 can get through the surgery quickly and safely.
I would like to emphasize again that for those patients who have one or more combined medical diseases, the more medical diseases they have, the more important it is to operate as soon as the medical diseases are basically stabilized in order to restore good walking function. Once an elderly person fails to walk normally, muscle atrophy, reduced limb coordination, rapid loss of bone calcium, reduced cardiopulmonary function, slow blood flow, reduced metabolism, and loss of appetite will soon occur, and these physiological changes will indicate that the elderly are more prone to falls, lung infections, chronic malnutrition, deep vein thrombosis, and pulmonary embolism, which is a very dangerous chain reaction and malignant. This is a very dangerous chain reaction and vicious circle. Getting an elderly hip patient back to walking as soon as possible means breaking the vicious circle that is irreversible and even irreversible.
It turns out that hip replacement surgery is not as mysterious as people think, and the results are so good. So, as the folk saying goes, “It takes 100 days to break a bone”, does it mean that the patient has to stay in bed for several months after surgery? What are the precautions to be taken after surgery?
This question is related to the functional rehabilitation after joint replacement. The “100 days of injury” is a backward medical practice in the past, when surgery was not possible. When an elderly person had a hip disease, such as a fractured femoral neck, the orthopedic surgeon would say, “I’m too old for surgery, go home and lie down. With that one sentence, the majority of elderly patients would never leave their beds and would be gone within a few months to a year. Now the situation has changed radically, as we routinely allow patients to come down and practice walking the day after the artificial hip surgery. Of course, the ability to walk after surgery is related to the patient’s preoperative physical condition and walking ability, and generally speaking, younger patients and patients with strong preoperative self-care ability will recover faster after surgery. In fact, post-operative rehabilitation of patients with artificial hip joints is one of the fastest and most effective post-operative orthopedic surgical procedures. Older fracture patients can basically return to their preoperative walking ability and functional status after surgery, and the quality of life of young bone patients after surgery is even more improved, and they can basically reach normal life such as walking around, visiting friends and relatives and traveling.
Of course, although artificial hip replacement has good efficacy and fast functional recovery, some matters should be noted after surgery, the main one is to prevent joint dislocation. For example, the seat or toilet should not be too low, prevent the hip joint from flexing and internally rotating when sleeping, and do not bend directly when picking up things. As long as patients pay attention to these habits and adapt to the new position after surgery, they can basically lead a normal and pain-free life. In addition, since a large proportion of hip replacement cases in China are elderly patients with osteoporotic falls to femoral neck fractures, these patients should be taught to perform muscle and limb coordination training after surgery to prevent further falls, in addition to being advised to routinely use calcium, vitamin D and other related anti-osteoporotic medications to prevent new fractures.
(Left) Incorrect: chair too low, no armrests (Right) Correct: proper seat height and armrests
(Left) Incorrect: Toilet is too low (Right) Need to raise the toilet seat
(Left) incorrect: no pillow between legs when lying on the side; (Right) correct: pillow between legs when lying on the side, or by
P to turn over to the side, should first clip the pillow to maintain the hip
Bones and knees at the same level to avoid ren
(left) incorrect: bend to pick up something (middle) correct: should be good leg when picking up something (right) incorrect: can both legs cross
Bend, the affected leg straight behind or cross your legs
Well, Professor Wang has explained the problems related to hip replacement in such a detailed and popular way, so that we can understand the efficacy and safety of this surgery, and I think the majority of patients will understand hip replacement surgery more deeply after reading this article, and increase their confidence in the surgery. Thank you!