Total Hip Replacement Surgery in India | Best Orthopedic Surgery Hospital India

Total Hip Replacement 

Hip Joint replacement or Total Hip Replacement is surgery to replace all or part of the hip 

joint with an artificial device to restore joint movement (prosthesis). 

There are different types hip replacements. If a hemi-arthroplasty is performed, either 

the femoral head or the hip socket (acetabulum) will be replaced with a prosthetic device. In a total hip replacement, both the femoral head and the hip socket is replaced by the 

prosthetic device. 

WHAT IS ARTHRITIS AND WHY DO JOINTS WEAR OUT?

The normal joint in our body is made up of two bones which are lined by surface 

cartilage. The joint is surrounded by a capsule which has a thin lining of synovial cells which produce a thin layer of lubrication film. The lubrication film (synovial fluid) together with the surface cartilage (articular cartilage) acts as a shock absorber and allows the joint to move smoothly and lasts for many, many years. 

If the surface cartilage is badly damaged or if the joint surfaces are not aligned properly 

(example, in a shallow hip) then the cartilage will wear out much more quickly than the 

normal wear and tear and as a result the bone under the cartilage layer is exposed. The 

exposed bone starts to rub against each other and the process of osteoarthritis (wear 

and tear) is established. 

Osteoarthritis is therefore the result of mechanical wear and tear on a joint. The main 

feature is a loss of surface cartilage with bone rubbing on bone. This process produces 

pain. The body tries to relieve this pain by increasing the amount of fluid in the joint. 

This is why joints are sometimes swollen. The formation of bone spurs and cysts around 

the joint is another hallmark of osteoarthritis. 

In an arthritic hip

• The cartilage lining is thinner than normal or completely absent. The degree of 
  cartilage damage and inflammation varies with the type and stage of arthritis.
• The capsule of the arthritic hip is swollen
• The joint space is narrowed and irregular in outline; this can be seen in an X-ray image.
• Bone spurs or excessive bone can also build up around the edges of the joint.

The combinations of these factors make the arthritic hip stiff and limit activities due to pain or fatigue.

Diagnosis

• The diagnosis of osteoarthritis is made on history, physical examination & X-rays
• There is no blood test to diagnose Osteoarthritis (wear & tear arthritis)

Surgical procedure 

You are admitted to the hospital and after appropriate pre-operative tests and admission 

procedures you will be taken to the operating theatre. The anaesthetist will discuss with you the type of anaesthetic. Anaesthesia may be either general or regional. With a general anaesthetic you are asleep and with a regional (spinal or epidural) your legs and hips are numb allowing you to have the operation without pain. Usually the anaesthetist will either sedate you or give you a full anaesthetic if you have a spinal/epidural procedure. 

Most approaches to the hip are done with the patients lying on their side. When you are 

asleep you are positioned in a special brace that stabilises your pelvis and keeps you on 

your side. An incision is made along the side of your hip joint and the muscles carefully split and divided to expose the hip joint. 

The worn out joint is exposed and the femoral head is resected. This allows visualisation 

of the acetabulum (socket). The socket is then cleared of debris and a reamer is inserted to appropriately fashion the socket to accept the artificial acetabular component. 

After reaming is complete, the artificial socket is inserted. There are two types of sockets, 

(a) a cemented socket or (b) an uncemented socket. A cemented socket is cemented into 

the bone and an uncemented socket allows bone to grow into it. Your surgeon will advise 

you which is the most appropriate socket for your bone quality. 

An uncemented socket has the ability to accept a socket lining which is either polyethylene (special plastic), ceramic or metal. The liner is inserted into the socket. Ceramic and metal articulating joint surfaces have lower wear rates than plastic sockets and therefore tend to be used in younger patients. The newer plastics last a lot longer than the older ones and are appropriately used in older patients. 

After preparation of the socket, the femoral bone is prepared with various instruments to 

accept either a cemented or an uncemented femoral component. Once the canal is prepared the femoral stem is inserted with or without cement. A trial femoral head is placed on the stem and the hip is reduced. During the trial reduction the hip is tensioned appropriately and put through a range of motion. At the same time leg lengths and stability are examined. 

Advantages of Total Hip Replacement Surgery

Hip replacement improves quality of life. Age is no barrier to hip replacement benefits. Hip replacement is cost effective. High rate of patient satisfaction associated with hip replacement The artificial hip often improves the movements in a hip joint that has become increasingly stiff from the effects of long term arthritis and this permits the patient to resume at first gentle activity and then their favourite leisure hobbies Improves mobility Independence of arthritis sufferers