Total hip arthroplasty

Total hip arthroplasty involves the removal of the femoral head and the outer surface of the femoral condyle, replacing them with artificial prostheses usually made of metal, plastic or ceramic. The procedure can be performed either by open surgery or by a minimally invasive technique.Total hip replacement is performed in cases of arthritis or cases of fractures. The purpose of the operation is to replace the head of the femoral bone with a spherical implant fixed to a stylet and to place a cup in the position of the pelvic bone. The materials from which these implants are made vary, as do the ways in which they are fixed.

It has been proven to be a very safe surgical procedure, with extremely high success rates. The rare chance of failure is due to factors that are not always controllable, such as, for example, a local infection, normal wear and tear and a post-operative fracture. Then the need arises for the patient to undergo a revision, i.e. a second hip operation. Revision carries more risks and its success in some cases is not completely guaranteed as there are additional factors involved. Thus, the longevity of the initial total hip replacement is key to avoiding this second operation.

The main symptom is pain. The pain is usually focused in the groin area, in your side and sometimes it can be reflected in the knee. The joint becomes stiff, making your movements difficult. The discomfort can worsen to the point that it prevents you from walking. As arthritis progresses, the muscles that move your joint weaken because they don't work properly. You don't walk normally, which often causes problems with your knee, spine, other hip, etc.

Correct positioning of the prosthesis is vital because any deviation from the ideal position has a negative impact on the loading of the hip and ultimately on the survival of the implant. The aim of the surgery is to accurately reproduce the biomechanical environment of the joint as it existed when the patient had no problems. This process is called "hip soft tissue balancing". In this procedure, selecting the appropriate prosthesis for each patient is a complex process for the surgeon and requires a great deal of experience of the subject.

The doctor, to determine the severity of your condition, relies on indications such as:

the frequency of taking medication to relieve the pain,

lameness when walking, its worsening, or the need to walk

with the use of a walking stick,

the distance you can walk without pain, possible difficulty in walking, possible difficulty in walking, or

to put on your shoes,

the difficulties you experience in your daily and social life, etc.
X-ray is the technique that uses rays (X-rays) to see the bones inside the body. But it does not allow us to see the cartilage. The significant reduction in the "space" between the head of the femur and the cavity of the pelvis in which it is feminized (cotyledon) shows that the thickness of the cartilage between the bones is decreasing. X-rays show gradual deformations of the bone and the appearance of small protrusions (osteophytes). Sometimes, more specialised techniques are needed, such as CT scans and especially MRI scans, which allow us to better assess the condition of the cartilage and muscles.

Usually, the surgeon makes an incision in the lateral surface of the hip. The size of the incision varies depending on the technique, about 10 to 20 cm. The joint is deep and the surgeon needs to have a perfect visual contact to intervene. After the incision in the skin, the surgeon removes and/or dislocates the muscles and tendons. He then opens the sac (pouch) that surrounds the joint. This procedure is done with great precision and minimises the risk of damage to nerves, blood vessels or muscles. Total joint replacement surgery can be performed under either general anaesthesia or regional (dorsal or epidural) anaesthesia.

Total hip replacement surgery consists of two stages

The approach is a very important part of the surgery because on the one hand it influences the selection and placement of materials and on the other hand it has a direct impact on the postoperative recovery. There are three approaches for the hip, the anterior approach, the lateral approach, the posterior approach.

All of these can be performed either by conventional methods or by minimally invasive methods (e.g. Direct Superior Plus, AMIS).
The experienced surgeon should be familiar with all accesses in order to choose the most appropriate one for the patient depending on the condition, body type, bone quality and the materials used (not all accesses are compatible with all materials). The implantation of the prosthesis, i.e. the way in which the artificial joint is placed and stabilised.

Total hip arthroplasty is usually a very successful procedure that can relieve patients from pain and significantly improve their quality of life. However, it is important to discuss the details, benefits and risks of the procedure with your doctor to make the best choice for your health. All patients are mobilized with full weight-bearing of the operated limb (at pain thresholds) from the same day of surgery with the help of a physiotherapist and without any restrictions. For the first two weeks they use 2 crutches, and for the next two they use one crutch each. Most patients are discharged from the hospital in 1-2 days. For 28-32 days they receive anticoagulation.

The first post-operative visit takes place 4-6 weeks after surgery. The majority of patients can drive a car four weeks after surgery, and mild exercise can begin after the first three months. Although 90% of recovery is achieved in the first trimester, 100% of recovery is achieved in the first year. The patient should be followed up at regular intervals. At first every year and then every three years.