Total Hip Replacement

Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief.
The normal hip joint is a ball and socket joint. The socket is a "cup-shaped" component of the pelvis called the acetabulum. The ball is the head of the thighbone. Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal or ceramic ball and stem inserted into the femur bone and an artificial plastic or ceramic cup socket. The metallic artificial ball and stem are referred to as the "femoral prosthesis" and the plastic cup socket is the "acetabular prosthesis." Upon inserting the prosthesis into the central core of the femur, it is fixed with bony cement called methylmethacrylate. Alternatively, a "cementless" prosthesis is used that has microscopic pores which allow bony in growth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is considered especially for younger patients. Total hip replacement is also referred to as total hip arthroplasty.
Major causes of Hip Pain

• Osteoarthritis – occurs when inflammation and injury to a joint cause a breaking down of cartilage tissue. In turn, that breakdown causes pain, swelling, and deformity. Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. It is primarily made up of water and proteins. The primary function of cartilage is to reduce friction in the joints and serve as a "shock absorber." Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people get older.
• Rheumatoid arthritis – This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis." Doctors believe that the major cause RA may be genetics, environmental factors and hormones.
• Post-traumatic arthritis – Post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, a vehicle accident, a fall, a military injury, or any other source of physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
• Avascular necrosis – An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis. The lack of blood may cause the surface of the bone to collapse resulting in arthritis.
• Childhood hip disease – Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

WHEN YOUR SURGEON WILL RECOMMEND TOTAL HIP REPLACEMENT SURGERY:

• The progressively intense chronic pain
•  Impairment of daily function including walking, climbing stairs, and even arising from a sitting position.
• When pain impedes normal function despite use of anti-inflammatory and pain medications.

    ADVANTAGES OF TOTAL HIP REPLACEMENT SURGERY

• Allows for normal activities and motion.
• Lasts the expected 15-20 years or more.
• With minimum precautions can lead to normal daily life.
• Has a good track record of use in joint replacement recipients (this should be 5-10 years minimum).

TYPES OF SURGERIES AVAILABLE IN INDIA
Total Hip Replacement: with Acrylic Cement Fixation
A cemented prosthesis is designed to have a layer of bone cement, typically an acrylic polymer called polymethylmethacrylate (PMMA), in between the patient’s natural bone and the prosthetic joint component. Bone cement allows a surgeon to affix prosthetic joint components to a bone that is slightly porous from osteoporosis. A small amount of antibiotic material can be added to the bone cement, helping to decrease the risk of post-surgical infection.
Total Hip Replacement: without Cement Fixation.
Also called as press-fit prosthesis it is a surgical procedure in which bone is attached to a metal implant if the surface of the metal has certain “topography”. This process is called porous ingrowth or osseointegration. The bone must be prepared precisely for these devices because close apposition to bone is necessary for bone to grow up to the smooth surface (osteointegration) or into the pores of the porous surfaces. Surface coatings, such as hydroxyapatite, are also being utilized in an effort to hasten and/or enhance bone fixation.
Metal-on-metal hip resurfacing
Resurfacing the original socket and the ball of the thigh bone is a different form of hip replacement. Instead of removing the head of the thigh bone and replacing it with an artificial ball, a hollow metal cap is fitted over the head of the thigh bone. The socket part of the joint is also resurfaced with a metal component. People who have this type of operation have a lower risk of dislocation and may be able to return to a higher level of physical activity compared with those having a conventional hip replacement.

Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief.
The normal hip joint is a ball and socket joint. The socket is a "cup-shaped" component of the pelvis called the acetabulum. The ball is the head of the thighbone. Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal or ceramic ball and stem inserted into the femur bone and an artificial plastic or ceramic cup socket. The metallic artificial ball and stem are referred to as the "femoral prosthesis" and the plastic cup socket is the "acetabular prosthesis." Upon inserting the prosthesis into the central core of the femur, it is fixed with bony cement called methylmethacrylate. Alternatively, a "cementless" prosthesis is used that has microscopic pores which allow bony in growth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is considered especially for younger patients. Total hip replacement is also referred to as total hip arthroplasty.
Major causes of Hip Pain

• Osteoarthritis – occurs when inflammation and injury to a joint cause a breaking down of cartilage tissue. In turn, that breakdown causes pain, swelling, and deformity. Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. It is primarily made up of water and proteins. The primary function of cartilage is to reduce friction in the joints and serve as a "shock absorber." Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people get older.
• Rheumatoid arthritis – This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis." Doctors believe that the major cause RA may be genetics, environmental factors and hormones.
• Post-traumatic arthritis – Post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, a vehicle accident, a fall, a military injury, or any other source of physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
• Avascular necrosis – An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis. The lack of blood may cause the surface of the bone to collapse resulting in arthritis.
• Childhood hip disease – Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

WHEN YOUR SURGEON WILL RECOMMEND TOTAL HIP REPLACEMENT SURGERY:

• The progressively intense chronic pain
•  Impairment of daily function including walking, climbing stairs, and even arising from a sitting position.
• When pain impedes normal function despite use of anti-inflammatory and pain medications.

    ADVANTAGES OF TOTAL HIP REPLACEMENT SURGERY

• Allows for normal activities and motion.
• Lasts the expected 15-20 years or more.
• With minimum precautions can lead to normal daily life.
• Has a good track record of use in joint replacement recipients (this should be 5-10 years minimum).

TYPES OF SURGERIES AVAILABLE IN INDIA
Total Hip Replacement: with Acrylic Cement Fixation
A cemented prosthesis is designed to have a layer of bone cement, typically an acrylic polymer called polymethylmethacrylate (PMMA), in between the patient’s natural bone and the prosthetic joint component. Bone cement allows a surgeon to affix prosthetic joint components to a bone that is slightly porous from osteoporosis. A small amount of antibiotic material can be added to the bone cement, helping to decrease the risk of post-surgical infection.
Total Hip Replacement: without Cement Fixation.
Also called as press-fit prosthesis it is a surgical procedure in which bone is attached to a metal implant if the surface of the metal has certain “topography”. This process is called porous ingrowth or osseointegration. The bone must be prepared precisely for these devices because close apposition to bone is necessary for bone to grow up to the smooth surface (osteointegration) or into the pores of the porous surfaces. Surface coatings, such as hydroxyapatite, are also being utilized in an effort to hasten and/or enhance bone fixation.
Metal-on-metal hip resurfacing
Resurfacing the original socket and the ball of the thigh bone is a different form of hip replacement. Instead of removing the head of the thigh bone and replacing it with an artificial ball, a hollow metal cap is fitted over the head of the thigh bone. The socket part of the joint is also resurfaced with a metal component. People who have this type of operation have a lower risk of dislocation and may be able to return to a higher level of physical activity compared with those having a conventional hip replacement.