What is hip replacement?
Hip joint is a ball and socket joint. Hip replacement surgery requires change of either the ball (hemi-replacement) or both the ball and the socket lining (Total Hip Replacement). In a total hip replacement surgery, the painful parts of the damaged hip are replaced with artificial hip parts called prosthesis, a device that substitutes or supplements a joint. The prosthesis consists of metal, plastic or ceramic components: a socket, ball, and stem. The outer shell of the socket is usually made of metal and the inner shell consists of plastic, or the entire socket may be plastic. When the metal ball is joined with the socket, the new hip can allow for smooth, nearly frictionless movement.
Some of these surgeries may be done without changing the entire ball but by resurfacing the damaged cartilage with a metal liner just like retreading an old worn out tyre.

Do I need Hip replacement ?
Patients with damaged lining cartilage require hip replacement. The pain and handicap should be severe enough to warrant surgery. This may be in arthritic conditions of the hip like rheumatoid arthritis, arthritis following injury to the hip joint etc. AVN (avascular necrosis) of the femoral head (the ball) is another condition which may require joint replacement surgery, particularly in advanced state. Patients with fracture neck of femur particularly the elderly patients require hip replacement as it has more predictable outcome.

What is the benefit of hip replacement operation?
Hip replacement gives you pain-free stable hip joint that permits functional movement. It may fully or partly restore limb length. The patient can expect to walk comfortably on a flat surface besides stair-climbing and walking on the slopes. The patient can use regular chair and sofa to sit on Floor level activities are usually not permitted.

How long can I postpone hip replacement?
Your orthopedic surgeon will decide if you are a candidate for the surgery, based on history, examination and X-rays. He/ she will ask you to decide if your discomfort, stiffness and disability justify undergoing surgery. There usually is no harm in waiting if conservative, non-operative methods are controlling your discomfort. Do not postpone hip replacement if it is affecting the walk- mechanics and if the pain is not tolerable. A young patient may defer it as long as possible for he/ she should expect revision surgery after 15-20 years following first revision.

Am I too old for this surgery?
Age is not an issue if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your physician or specialist for his/her opinion about your general health and readiness for surgery.

How do I prepare for hip replacement surgery?
If you and your surgeon decide that total hip replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by a physician. This will help to ensure that other health problems you may have, such as diabetes or high blood pressure, will be identified and treated before surgery.
You doctor may suggest that you lose weight and initiate an exercise program. If you smoke, be sure to speak with your doctor about it, as smoking can dangerously increase surgical risks and slow down the healing process. If you are on a blood thinner you need to stop it one week prior to surgery after consulting your physician. You should also finish any dental work that may be underway to prevent germs in your mouth from entering the bloodstream and infecting the joint. It is likely that you will need blood during hip surgery, and your surgeon may place an order with the blood bank in case a transfusion is needed. If you prefer, or if your surgeon feels it is needed, you may want to donate your own blood ahead of time to reduce the risk of your body reacting to the blood transfusion.

Is the operation painful?
The surgery may be done under General anaesthesia or epidural/ spinal anaesthesia both ways it is a pain-free procedure. Post-operatively pain relief may be achieved using epidural analgesia (like painless labour) or intravenous analgesics, which give adequate pain relief.

What should I expect during hospitalization? How long does the surgery take? What is the recovery time?
You are admitted one or two days prior to surgery for pre –operative investigations and pre-anaesthesia check-up. On the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia.

The surgery usually takes about 1 hour, although this is dependent upon the severity of the arthritis in your hip. The procedure is performed through an incision over the side of the hip. The ball-end of the thighbone (femur) is cut and replaced with the new metal ball and stem component to fix it. It may be stabilized with or without cement. The damaged surface of the socket is smoothed in preparation for the insertion of the new socket. The ball and socket are then joined. When the surgeon is satisfied with the fit and function, the incision will be cleaned , closed and covered with dressings. A small drainage tubes coming out of the hip is left to drain fluid from the wound. In the post- operative room, a urinary catheter may be inserted and left in place for one or two days. Compression stockings and pneumatic sleeves are put on both legs.
You are sent to the recovery room/ HDU and as the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. You will also be given pain medication and will find a foam wedge or pillows placed between your legs to help hold your joint in place. Next day you will be taken back to your hospital room where physiotherapy and walking is initiated

What are the chances of recovery?
The chances of recovery are over 98%. However there should be participation on the part of the patient to ensure that.

How long will it take to recover?
Total recovery takes about 10-12 weeks, however patient with cemented prosthesis walks earlier as immediate weight bearing is permitted. Patients with cementless hips walk independently after 6-12 weeks. In both the cases a walker is required initially followed by a cane.

How long will my new hip last and can a second replacement be done?
All implants have a limited life expectancy depending on an individual’s age, weight, activity level and medical condition(s). A total joint implant’s longevity varies in every patient. It is important to remember an implant is a medical device subject to wear, which may lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your implant will last for a specific length of time however the expected life span is 15 years on an average. A revision hip surgery is then performed.