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  Dr. Harsh Shah
 
• Knee
• Hip
 
:: Faq - Hip

• Which are the commonest hip problems in India?
• Why is hip fracture a problem?
• Which are the ways to treat a hip fracture?
• What can be done to preserve hip function after a fracture?
• Total Hip Replacement
  a) What are the risks involved in this surgery?
  d) Should I delay the surgery and wait till the symptoms     get worse?
  c) How long can I expect my new hip to last?
  d) How long before I can take bath of shower?
  e) How long would I have to stay in the hospital?
  f) When would I be able to walk after the surgery?
  g) Would there be any restriction of activities?
  h) How long would I have to use walking support?
  i) How long does it take to replace hip joint?
  j) Who should be operating on me?
  k) How much would I be able to walk with the new hip?
 
Which are the commonest hip problems in India?

Osteoporosis in the hip joint (weakening of the bone structure) in the later years of life is one of the commonest problems affecting elderly in India. This condition leads to increased risk of fracture in the hip and in this situation, the fractures are also difficult to treat. The best way to avoid this is to keep your level of activity including daily exercises up. There are medicines available to combat the condition. In elderly females, HRT (Hormone Replacement Therapy) has shown to be very effective in prevention and treatment of this condition.

Arthritis of the hip joint (as arthritis of the knee joint) is quite common in Western countries but this form is unknown in India. There are cases of hip arthritis due to an underlying condition like rheumatoid arthritis, birth defects, fractures, ankylosing spondylitis (a condition where joints of the body get stiff) and avascular necrosis (see below) but not due to excess wear and tear (as in the knee joint).

Other problem quite commonly seen is the Avascular Necrosis of the Femoral Head. This is the condition where due to various reasons the blood supply stops to the ball part of the femur (head) which in turn becomes soft and deforms. This deformed head then leads to arthritis of the hip joint. Unscrupulous use of steroids is one of the commonest factors causing this wide spread problem.

The main problem in osteoarthritis is degeneration of the articular cartilage that covers the joint. This results in areas of the joint where bone rubs against bone. Bone spurs may form around the joint as the body's response.

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Why is hip fracture a problem?

Hip fracture can be a problem in two particular ways. If the fracture is too close to the hip joint, there is a traumatic loss of blood supply to the femoral head, leading to its softening and then later arthritis. This incidence is about 25% to 33% (i.e. in one fourth to one third of the cases). Secondly, as these fractures are commonest in the elderly, there are medical problems associated with it together with osteoporosis (soft bones). This makes treatment of the hip fracture in this group of people most difficult. Furthermore, when the elderly are confined to bed for even a short duration, their lung condition can rapidly deteriorate.

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Which are the ways to treat a hip fracture?

Treatment of hip fractures depend mainly on two factors, the site and geometry of the fracture and the age of the patient. If the fracture is too displaced, likelihood of its successful healing becomes remote, especially in the elderly. In this situation, the femoral head is replaced immediately with an artificial hip joint to enable the patient to start walking on second or third day of the operation and thus avoiding long confinements to bed with its medical and social problems. These operations for a fracture in an otherwise normal hips are either half hip replacement (i.e., only the ball of the joint is changed and not the cup side) or Bipolar hip replacement. In Bipolar hips replacement, the cup in not changed but a mobile head intervenes between a small metal head and the bony cup (acetabulum). Minimally displaced fractures in the elderly can be treated with fixation of the fracture with a reasonable chance of success and a short confinement to bed. In younger individuals, most fractures are initially treated with reduction and fixation with some sort of fixation device.

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What can be done to preserve hip function after a fracture?

Nothing is as good as the natural hip. Hence, in cases with small displacement type fractures and in younger individuals, the treatment options are designed to preserve the natural head. Once the fracture heals successfully, the hip function returns to near normal. On the other hand, if the fracture treatment is unlikely to have a high success rate, replacement of the hip (either half or full) preserves the hip function.

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TOTAL HIP REPLACEMENT

What are the risks involved in this surgery?

Nothing in this world is as safe as one would like to be, may it be driving on the roads, flying in an aircraft, going for a walk or undergoing seemingly a minor surgery. Total Hip Replacement is no exception. Though the risks involved are very small, the fact of the matter is that they are there. There are general risks associated such as heart problems, lung problems, infection and blood clots which can occur with any operation.

With hip replacement the most serious problem is developing infection. Special operation theatre set-up, which are used solely for joint replacement operations can bring this risk down to less than 1%, i.e, making it safe in more than 99 patients out of 100. Infections can be treated with antibiotics but at times require additional surgery to remove infected material.

There are some risk factors specific to Total Hip Replacement such as dislocation, loosening, nerve injury or blood vessel injury. Efforts are made to correct any leg length difference although a small difference may still be noticeable after surgery.

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Should I delay the surgery and wait until the symptoms are worse?

We will not recommend hip replacement surgery unless we feel the surgery is indicated and that by having the procedure your life can be significantly improved. Delaying surgery can lead to the development of other problems brought on by the inability to remain active. It is possible that the worsening condition of the bones may make the surgery more difficult to perform. There is good rationale for having the surgery while you're healthy so that after surgery you can resume an active healthy lifestyle and avoid problems related to inactivity and having to undergo major surgery in an unhealthy state with all its associated problems.

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How long can I expect my new hip to last?

Current studies show that 5-10% of hip replacement patients are reoperated after 15 years for a variety of reasons, such as infection, loosening or fracture. With current technology it is extremely rare for a hip replacement to "wear out". We would expect you to have a 95% chance of being satisfied with your hip in 10 years and a 90% chance of being satisfied in 20 years.

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How long will it be before I can take a shower or bath?

Your incision must be kept clean and dry while the skin staples are still in place. You may shower or bathe after the staples have been removed and there is no seepage from the incision. This is usually 2-3 days after the staples have been removed. A clean light dressing should be placed over the incision daily until it is healed.

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How long would I have to stay in the hospital?

The hospital stay depends of the complexity of the operation, health of the individual and age. In a routine first time hip replacement surgery, if there are no other problems, you will have to stay in the hospital for less than 5 days. Complex surgery, revision surgery and elderly patients generally require to stay in the hospital between a week and ten days.

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When would I be able to walk after the surgery?

Generally you are out of the bed on the second or the third day. Few steps are tried on the first day out of the bed and gradually increased to small walks in the room initially and then in the corridor and eventually in the hospital compound. If the progress is quick and satisfactory, stair climbing is started on the fourth day. It may be purposefully delayed in some cases. We encourage our patients to walk back to their car when going home from the hospital.

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Would there be any restriction of activities?

The artificial hip is made of metal (super alloy of Cobalt-Chromium-Molybdenum) and plastic (Ultra High Molecular Weight Poly Ethylene). These elements are not capable of regeneration or healing unlike the tissue of the body. Hence it is necessary to protect the artificial hip from excessive wear and loads. Activities like swimming, walking, cycling etc are encouraged for physical fitness. Activities like running, jumping, playing cricket or football and dancing are discouraged. The common Indian customs of cross leg sitting and squatting, though possible after the surgery are strongly discouraged to increase the longevity of the artificial hip joint.

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How long would I have to use walking support?

Although the skin heals in about a week to ten days' time and the muscles within in about three weeks, the bone take a lot longer to return to near normal state. For this reason the initial fixation of the artificial components should be protected. We generally advise out patients to use some sort of support for all the time during the first six weeks and then partially for next six weeks. This is just a precautionary measure and can help to make your artificial hip last longer.

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How long does it take to replace hip joint?

Routinely a hip replacement takes about 60 to 90 minutes in an uncomplicated case. However the preparations for anaesthesia and time taken to wear off the effects of anaesthesia can take upto another hour before you are brought out of the operation theatre. Complex cases, complicated cases and revision surgery can take anywhere between two to three hours to complete.

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Who should be operating on me?

Studies world over have proved that only the surgeon trained in these kind of surgeries should be doing hip replacement surgeries. It is not how many he does but how well he does it is important. Result of these operations by an occasional surgeon or by a trainee are not equivalent to those being done by experts. Make sure your joint is not being offered to you because it is a "Joint Factory". Discuss the alternatives, pros and cons with your treating surgeon in detail and then make a decision.

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How much would I be able to walk with the new hip?

The artificial hip is designed to provide you with painless mobility for a long time. You should be able to walk unlimited distance eventually. There is no restriction imposed as to the distance you can walk, though you should be using your hip sensibly to enjoy a pain free life and not for competitive sports. A conservative approach in using your hips goes a long way in making it last longer.

 
 
 
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Dr. Harsh Shah - Joint Replacement Specialist
Appointments No. : 0960 181 8844
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