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Total Hip Replacement B/L: Symptoms, Classification, Diagnosis & Recovery

Total hip replacement surgery also called total hip arthroplasty, is a surgical procedure conducted to replace the damaged or diseased hip joint with an artificial joint or prosthesis. The hip prosthesis contains the following three components:

  • A stem, which fits into the thigh bone
  • A ball that fits into the stem
  • A cup which is inserted into the socket of the hip joint

The two types of prostheses used in total hip replacement surgery include a.) cemented and b.) uncemented prostheses. A combination of both is sometimes used during the surgery, depending on the recommendation made by the patient.

Hip joint surgery is conducted in patients when other non-surgical and surgical alternatives fail to work and relieve the patient of terrible hip pain. A successful hip joint surgery ensures increased mobility, improved function of the hip joint, and pain-free movement.

Two types of total hip replacement surgery differ based on whether a single or both hip joints are replaced. Total hip replacement bilateral refers to the replacement of joints on both sides of the hips. This procedure is conducted when both sides are affected.

The following are the conditions that require hip replacement surgery:

  • Osteoarthritis: Commonly called wear-and-tear arthritis, it gradually damages the slick cartilage that covers the ends of bones and helps joints move smoothly.
  • Rheumatoid arthritis: It is triggered by an overactive immune system, including inflammation that can erode cartilage and, at times the underlying bone, resulting in damaged and deformed joints.
  • Osteonecrosis: This condition occurs by the insufficient blood supply to the ball portion of the hip joint, and might result from dislocation or fracture that leads to deformities.

Before undergoing total hip replacement (THR) surgery, individuals typically undergo diagnostic tests and evaluations to ensure that the procedure is necessary and that the patient is a suitable candidate. The specific tests may vary among healthcare providers, but common diagnostic assessments before total hip replacement include:

  1. Medical History and Physical Examination: A detailed medical history is obtained to understand the patient's overall health, previous surgeries, and any existing medical conditions. A physical examination helps evaluate the condition of the hip joint, assess mobility, and identify any potential issues.
  2. X-rays: X-rays provide detailed images of the hip joint, allowing orthopedic surgeons to assess the extent of joint damage, the alignment of the bones, and the presence of conditions such as osteoarthritis or avascular necrosis.
  3. Blood Tests: Routine blood tests may be conducted to assess the patient's overall health, including blood count, kidney function, liver function, and indicators of inflammation.
  4. MRI (Magnetic Resonance Imaging): In some cases, an MRI may be ordered to obtain more detailed images of the soft tissues around the hip joint, such as muscles, ligaments, and tendons. This can help identify any additional issues that may impact the surgical plan.
  5. CT (Computed Tomography) Scan: CT scans provide detailed cross-sectional images of the hip joint and surrounding structures, helping in surgical planning and evaluation of bone quality.
  6. Joint Aspiration (Arthrocentesis): Fluid may be withdrawn from the hip joint using a needle to analyze for signs of infection or inflammation.
  7. Bone Scan: A bone scan may be performed to assess the overall bone health and identify areas of increased activity or abnormalities.

The surgeon may decide to operate both sides of the hips in a single surgery or they may schedule two different surgeries with a gap in between them. The surgical approach that the hip replacement surgeon chooses before the procedure depends on the patient's condition and the surgical team's experience. Two approaches can be used to conduct the procedure – minimally invasive and open surgery.

Minimally Invasive Hip Replacement Surgery

Minimally invasive hip replacement is a relatively new procedure that allows for minimal healing and recovery time and small incisions. Open surgery, on the other hand, involves the creation of a single large incision that increases recovery and healing time. Each of these approaches has its pros and cons.

Before the surgery, the hip replacement surgeon will give you general anesthesia or a sedative. You would receive an intravenous line in the arm or hand. The surgical area is cleaned with an antiseptic solution and an incision is made in the hip area.

The surgeon then removes the damaged part of the hip joint and replaces the joint with an artificial joint or prosthesis.  The incision is closed with stitches or surgical staples and a drain is placed to remove fluid. The incision site is secured with a sterile bandage dressing.

Hip Implants: Cost, Quality, and Effectiveness

During the procedure, the surgeon removes a part of the thigh bone including the head of the bone, and replaces it with the prosthesis. The surface of the acetabulum is first roughened so that the new socket implant can attach to it well. Usually, a majority of artificial joint components are fixed using acrylic cement. However, cementless fixation has gained a huge popularity in the last few years.

The hip replacement implants may have plastic, metallic, or ceramic components. Metal-on-plastic implants are the most commonly used for hip replacement. Ceramic-on-plastic and ceramic-on-ceramic are used in younger and more active patients. Metal-on-metal is rarely used in younger patients.

  • Post-surgery, the patient will be moved to a recovery area for a few hours while the anesthesia wears off. Medical staff will monitor blood pressure, pulse, alertness, pain or comfort level, and need for medications.
  • Patients will be asked to breathe deeply, cough, or blow into a device to help keep fluid out of their lungs. How long you stay after surgery depends on your individual needs. Many people can go home that same day, recovery time varies from one patient to the other. The success of this surgery hugely depends on your ability to follow the instructions given by the surgeon's home care during the first few weeks after the procedure.
  • At the time of discharge, you will still have sutures and stitched under the skin. The doctor will remove stitches approximately two weeks after the surgery. You can bandage the wound to avoid irritation from clothing or support stockings.
  • During the first few weeks of surgery, make sure to perform the exercises advised by the doctor. You may experience a little discomfort during activity and at night for several weeks. The patient will be able to return to conduct light activities within three to six weeks after the surgery. Pain after hip replacement surgery goes away gradually. Patients may be given medications to manage pain after the surgery for a few days until it goes away completely.

Patient from Mauritius underwent Hip Replacement
Aakash Bissesur


Patient from Mauritius underwent Hip Replacement Read Full Story

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Frequently Asked Questions

Q. What is the ideal bilateral hip replacement recovery time?

A. Usually, patients are discharged within five to seven days after the surgery. However, complete recovery takes three to six months, depending on the type of surgery performed and the overall health of the patient.

Q. When should I have a hip replacement?

A. Only an experienced surgeon can figure out whether you should undergo hip replacement or not. The decision is based on your medical history, physical examination, and X-ray results.

Q. What is the bilateral hip replacement surgery time?

A. The surgery may last for two to two and a half hours, depending on the approach used to replace the diseased hip joint.

Q. When would I be able to resume work?

A. Generally, you should take a one-month rest from work after the surgery to recover peacefully at home. You may need more rest time in case of a strenuous job.

Q. When will I be able to get out of bed?

A. You will be able to get out of bed the next morning after the surgery. You can sit in a chair and walk with the help of a walker.