Total Hip Replacement

What is Total Hip Replacement?

Total hip replacement is a surgical procedure in which the damaged cartilage and bone are removed from the hip joint and replaced with artificial components. The main indication for total hip replacement is arthritis.

Arthritis is the inflammation of joints, which results in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability. 

Symptoms of Arthritis

The most common symptom of hip arthritis is joint pain and stiffness, resulting in a limited range of motion. Vigorous activity can increase pain and stiffness, which may cause limping while walking. 

Diagnosis of Arthritis

Diagnosis is made by evaluating your medical history, performing a physical examination and taking X-rays of the arthritic joint.

Total Hip Replacement Procedure

Mr Sakis Pollalis may recommend Hip Replacement Surgery if conservative treatment options such as anti-inflammatory medications, physical therapy, and intra-articular injections do not relieve your symptoms. 

• The surgery is performed under regional (spinal) or general anaesthesia using a RAPID RECOVERY PROTOCOLS. An incision is made over the hip to expose the hip joint and the femur is dislocated from the acetabulum.
• Mr Sakis Pollalis then cleans the surface of the socket and the damaged or arthritic bone removed using a reamer. The acetabular component is inserted into the socket either by a press fit or by using bone cement. Screws may be used occasionally for improved fixation. A liner made of plastic, ceramic or metal is placed inside the acetabular component. 
• The femur or thighbone is then prepared by removing the arthritic bone using special instruments to exactly fit the new metal femoral component. Your hip is tested using trial implants to check the stability, leg length, soft tissue tension, and range of movement. After that, the final femoral component is inserted to the femur either by a press fit or using bone cement.
• Next, the hip joint is tested again through its range of motion and the final femoral head component made of metal or ceramic is placed on the femoral stem. The muscles and tendons around the new joint are repaired. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed with absorbable sutures and a sterile dressing is placed over the incision. Drains are generally avoided to enable early mobilisation and discharge.

Postoperative Care following Total Hip Replacement

Rehabilitation begins immediately following the surgery. Initially, you will be taken to a recovery area where your pain levels will be monitored, and you will be encouraged to begin moving your knee. You will soon be moved to the ward where you will be assisted to get dressed and you will be offered a meal. You will be given pain medications to ease pain. Whilst in hospital you will have to wear stockings to prevent blood clots in your legs. Physical therapists will work with you to take your first steps using a walker or crutches. They will also provide you with a home exercise program to strengthen your thigh and calf muscles. You will have blood tests and an x-ray to check the positioning of the implants. Mr Sakis Pollalis will review you regularly whilst in hospital and after your discharge to make sure you are progressing well

After undergoing total hip replacement, you must take special care to avoid extreme positions of your new hip. This is to prevent the new joint from dislocating and ensure proper healing. Some of the common precautions to be taken include:

• Do not do resistive exercise on the bike, treadmill, or gym equipment for six weeks after surgery.
• Avoid the combined movement of bending your hip and turning your foot inwards.
• Avoid pillows behind your knees or recliners for six weeks after surgery as they encourage your hips to heal in a bent position.
• Sleeping on your back is the best position for your hips. It keeps them straight during the healing process. If you are going to sleep on your side, be sure to use a pillow between your knees to maintain your hip precautions.
• When choosing a chair, be sure that your hips are higher than your knees (so your hip is bending to fewer than 90 degrees) when you sit.
• Do not cross your unoperated leg under your operated leg — this breaks a hip precaution! A leg lifter strap may help you to get in an out of bed without crossing your legs.
• Use an elevated toilet seat.
• Avoid bending down to pick up things; instead, a grabber can be used to do so.
• Do not be afraid to walk. Walking is a great source of exercise. It strengthens your muscles, increases your flexibility, and improves your endurance.

Risks and Complications of Total Hip Replacement

As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement may include:

• Infection
• Blood clots in the leg or lung
• Hip pain, stiffness, or limited mobility
• Dislocation
• Leg length inequality
• Fracture of the femur or pelvis
• Nerve or Blood Vessel Injury
• Bleeding and Hematoma
• Prosthesis Failure or Loosening
• Requirement of additional surgery
• Cardiovascular risks, also leading to life-threatening complications
• Allergic reaction
• Anaesthetic risks

If you would like to have additional information on the treatment of hip arthritis or would like to learn more about total hip replacement, please contact Mr Sakis Pollalis, serving the communities of Buckinghamshire and Berkshire.