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Total Hip Replacement

Total Hip Replacement

How a Normal Hip Works

The hip is one of your body's largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. The bone surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.

A thin, smooth tissue called synovial membrane covers all remaining surfaces of the hip joint. This membrane makes a small amount of fluid that lubricates and minimizes friction in your hip joint.

    

 

If the hip joint is damaged extensively by arthritis or trauma, or by other reasons ascertained by your doctor, a hip replacement surgery may be needed to restore its function.

 

Different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component and the socket component.

 

Special surgical cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint. Non-cemented prostheses are also used most often in younger, more active patients with stronger bones.    

          

 

Possible Complications After Operation

1. Deep Vein Thrombosis (DVT)

DVT is the formation of blood clots in veins of leg or pelvis. It is the most common complication after hip replacement surgery. It can occur in the first few weeks after surgery. Signs and symptoms include:

  • Pain in your calf and leg unrelated to your incision
  • Tenderness or redness of your calf
  • Swelling of your thigh, calf, ankle or foot
  • Shortness of breath
  • Chest pain, particularly with breathing

 

2. Hip Replacement Infection

The infection rate of hip replacement is low (less than 2 percent). Warning signs are:

  • Persistent fever (higher than 100 degrees Fahrenheit orally)
  • Shaking chills
  • Increased redness, tenderness or swelling of the wound
  • Presence of wound discharge
  • Increased hip pain with both activity and rest

 

3. Dislocation of prosthesis

To ensure proper recovery and prevent dislocation of the prosthesis, you must take the following precautions during the first 3 months after operation.

  • Do not cross your legs.
  • Do not bend your operated hip more than a right angle (90 degrees).
  • Do not turn your operated leg excessively inward or outward.
  • Place an “abduction pillow” between your legs when you sleep. This prevents your legs from crossing over.

 

Living With Your New Hip

Important tips:

  • Use pain or discomfort as your guide in moving your operated hip. Avoid positions that cause excessive pain or discomfort.
  • Lie down and elevate your legs if they swell after walking.
  • Use firm chairs with armrests. Avoid sofas and recliners.
  • DO NOT force your operated hip to move by any mean. When you exercise, let your leg move by itself.

Call your doctor right away if any of the following things happen:

  • Presence of redness, swelling, or discharge around your incision.
  • An unexplained fever (temperature over 100 degrees Fahrenheit or 38 degrees Centigrade) or chills that last more than a day.
  • Severe hip pain that is not relieved by analgesics.
  • Unusual shortening or rotation of your leg.
  • Sudden swelling in your thigh or calf.

 

Correct Hip Positioning

  • Keep your operated leg facing forward in sitting, walking, or lying down.
  • Keep your knee lower than your operated hip.
  • Use a toilet with a raised seat, even in the community.
  • Use special equipment (reacher, dressing stick) to put on your underwear and pants. DO NOT lean forward.
  • Use "sock aid" to put on your socks. Seek for assistance if you find it too difficult.
  • Wear slip-in shoes with rubber bottoms if possible. They can be put on more easily.
  • Getting into bed with non-operated side first
  • Getting out of bed with operated side first.
  • Lying on the bed: sleep on either side ONLY if you have an abduction pillow between your legs.
  • Use an abduction pillow while sleeping for at least three months after your surgery.

 

Postoperative Early Exercises – Bed Exercises

* Make sure you have your abduction pillow between your legs during the following exercises *


Postoperative Intermediate Exercises –Standing Exercises

After surgery, you may feel dizzy during the first few times of standing. As you regain strength, you will be able to stand independently. While doing these standing exercises, make sure you are holding onto a firm surface such as a bar attached to your bed or a wall.

 

Repeat the following exercises 10 times per session. Do it for 3 or 4 sessions a day

 

Advanced Exercises and Activities

A full recovery will take many months. More advanced exercises and activities will help your hip muscles recover better. Your physiotherapist will prescribe exercise according to your rehabilitation progress. Common exercises include:

  • TheraBand Exercise – To improve muscle power.
  • Cycling - To help you regain muscle strength and hip mobility.
  • Walking - Take a cane with you until you have regained your balance. Increase intensity gradually as your strength and endurance improve.

 

(All information provided is for reference only. Please contact your physiotherapist or physician should you have any enquiry.)

 

The above information was produced by Physiotherapy Department, Canossa Hospital (Caritas).

Please call 28255392 for physiotherapy appointment

 

References:

  1. American Academy of Orthopaedic Surgeons (AAOS)
  2. Hong Kong Orthopaedic Association