Hip Replacement

The hip joint is one of the largest weight bearing joints in the human body. It plays a vital role in mobility and stability. A variety of causes may lead to destruction of this joint such as Osteoarthritis (most common). When this happens, replacement of the damaged portion is essential for alleviating pain and improving the quality of life.

Causes

Multiple factors may lead to hip joint damage, the common causes are listed below-

• Osteoarthritis: It is caused due to the degradation of cartilage lining which allows smooth motion between the bones within the hip joint. As a result, the bones begin to rub against each other resulting in wear and tear, causing severe pain with movements of the joint.
• Hip Fracture: Fracture by itself or due to complications such as avascular necrosis or non union (the bone does not unite even after sufficient time as required for healing has passed) damages the joint requiring replacement surgery.
• Rheumatoid arthritis: Misdirected action of immune system on the joint lining causes rheumatoid arthritis. It can lead to hip damage.
• Hip dysplasia: It is the abnormal growth of hip bones. Hip replacement will be necessary to correct hip dysplasia. Mostly, younger individuals are affected with these kinds of disorders.
• Avascular Necrosis : It is the deformity in the joint caused by reduced blood supply of the head of femur bone leading to its collapse. It is common in smokers, deep sea divers and with prolonged steroid use. Young individuals are commonly affected.

Symptoms & Indications

• Continuous pain affecting day-to-day activities.
• Difficulty in walking
• Shortening of the leg
• Inability to squat
• Reduced hip movements

Advantages :

• Significant pain relief
• Improved ambulatory status
• Increased hip movements
• Correction of shortening
• An active lifestyle not limited by pain

Limitations

• Patients cannot squat/ sit crosslegged on the floor or use Indian commodes
• Patient cannot be involved in high energy activities and contact sports
• Implants get worn out over a period of time requiring revision surgery

Types of joint replacement

• Partial hip replacement (Resurfacing) : As the name indicates, only a part of the hip which is worn out is replaced. Hip joint is made of 2 bones – the cup of the pelvic bone and the head of thigh bone (femur). When only the head is involved, then this surgery is the ideal choice
• Total hip replacement: Total joint arthroplasty is indicated when both the cup and the ball (femur head) get worn out. This is the most commonly done surgery and has good results in terms of pain and activity level. Hip replacement may be cemented (where the artificial prosthesis are fixed to the bone with bone cement) or uncemented.
• Patient selection: Patients with the above mentioned indications are ideal candidates for joint replacement. Age is not a major criterion for joint replacement but symptoms are. Patients with associated co-morbidities like diabetes, hypertension, heart conditions, lung and urinary tract infections, dental caries etc. need a complete pre operative evaluation before deciding on surgery.