Hip joint implant

Complaints

Total hip Joint replacement surgery is one of the most common treatments for certain types of osteoarthritis in the hip in the Netherlands. Joint Replacement surgery replaces the deteriorated joint and cartilage with artificial joints. The symptoms usually develop gradually but may also have a sudden and rapid course, for example caused by hip fractures or injuries. Osteoarthritis deteriorates the joints surrounding cartilage causing symptoms as pain, immobility and disturbed night rest.

The hip implant selection depends on several aspects such as durability, convenience and safety, and the possibility of any revisions afterwards. The type of material used for its construction is very important. We have a vast array of hip implants to choose the optimal prosthesis for you according to your daily activity level, your age and medical history. The hip implants we use are made of ceramics, a material which is more durable than metal. We can have different sizes of cups which the stability of the hip prosthesis influences. We can cement the implants but also have ingrowths types.

A hip resurfacing and a hemi (half) knee implant can be used for young, active patients.

Your orthopedic surgeon will choose the implant that suits you best.

Treatment

The procedure of a hip prosthesis surgery is as follows:

The operation is performed under general anesthesia or spinal anesthesia and lasts 50 to 75 minutes
Once the arthritic ball is removed, the worn out socket can be addressed.
Once the damaged bone has been removed, the artificial socket or acetabular cup can be inserted and with the bone prepared to accept the stem of the femoral component the femoral stem is inserted.
With the socket, stem, and ball inserted, the hip joint performance is examined and finally placed in position.
The wound is applied with a drain for excess of blood and/or fluid disposal, local anesthesia and closed with staples or dissolvable stitches.
The wound is wrapped with a bandage and inspected 2 days after surgery.

We use the latest techniques to minimize tissue damage so that recovery is progressing at a fast pace after surgery.

Hip Approach
In the Netherlands approximately 23,000 times a year a hip joint is placed. Besides the choice for the type of hip prosthesis, the surgical approach is important. There are different approaches and access takes advantage of the muscular planes, shape of the hip and fat surrounding the hip joint.

Orthopedium prefers the anterior or invasive posterior hip approach. Both approaches ensure excellent access to the acetabulum and femur and less muscle groups are affected, preservation of stabilizing muscle groups, shorter recovery times and fewer post-operative precautions.

A lateral approach can be considered in revision surgery or because of the specific anatomical structure of the patient. Dislocation of the hip is very rare (1-2%). Elderly patients retain their independence and usually go straight home from the hospital.

Preperation

How to prepare for your hip operation

You visit the anesthesiologist to determine whether the operation is possible. Besides they will explain the various forms of anesthesia and pain management, both during and after surgery. More information about anesthesia, click here.
Finally the day of surgery of is scheduled. The total hospital stay is planned for three days. You arrive on the day of surgery at the clinic. The days after surgery are used to recover and to receive instructions and exercise from the physiotherapist.
You should borrow crutches as you will need them to walk following your surgery. For more information click www.thuiszorgwinkel.nl.
Usually it takes the two weeks to walk with a crutch at home. If you have lack of help at home please discuss this with the transfer nurse of the Vlietland hospital or home care setting of your home.

To undergo a hip replacement is not a daily matter. A hip replacement is major surgery with an extended recovery period. It is important to consider all consequences. The better your physical condition before your treatment, the better your recovery after surgery.

Day of surgery

At your arrival please wear comfortable clothing and shoes. Bring your personal items such as medicines, clean clothes, toilet articles and your crutches with you. Leave valuables at home as much as possible.

Day of surgery

You appear sober at the hospital
After your medical preparation prior to surgery you will positioned and treated in the operating suite
After surgery you will be moved to the recovery room to recover from your anesthesia
Back on the ward the nurse checks you out. During the immediate recovery period you are given intravenous fluids and pain medication.

The day after your surgery, the physiotherapist will show you how to exercise and walking with crutches

Recovery

The recovery period after a hip replacement comprises three to six months. The days after surgery you are still hospitalized.

You get pain medication and you start physical therapy immediately with instructions for home practice. After two days, the wound dressing will be removed and the wound assessed.
After a few days the pain is usually bearable and pain medication will be reduced. Additionally, blood thinners will be prescribed to prevent thrombosis and pulmonary embolism.
Two weeks after surgery you use two crutches and while progressing in recovering occur you use one crutch, used on the unoperated side.
The stitches will be removed about 14 days after surgery
After surgery it takes at least 6 weeks before you may bend your hip joint more than 90 degrees, avoid any twist at the hip. Do not cross the operated lower extremity across the midline of the body (not crossing the leg over the other leg) because of the risk of dislocating of the replaced joint.
During the recovery process, you will return to a more active and normal lifestyle within a few months.
It is important to realize that you do not drive a car by yourself or ride a bike.

Complications

Although surgery is not without risks, complications may be related to anesthesia or infections. Consult your surgeon with the following complications:

Subsequent bleeding into the hip
The wounds remains sensitive long after hip replacement
There may be thrombosis or pulmonary embolism occurs.
Instability of the hip
The joint ‘clicks’ during movements
Dislocation of the replaced joint
The wound remains vulnerable sometimes long after the hip replacement.
There is a difference in leg length occurred or not corrected after getting a new hip
There is a pelvic instability created or after getting a hip replacement.
Infection of the hip prosthesis
Damage caused by the operation of structures around the hip, such as nerves or blood vessels

Sometimes the result of the hip prosthesis is not what you had hoped. There can be a painful sensation in the hip remain despite the hip prosthesis.

Note: In patients with a hip prosthesis infection elsewhere in the body pose a risk to the prosthesis. If you have an active infection in your body, please consult your specialist.

Expectations

You have high expectations of a total hip implant: a painless hip, which moves better than before the operation and no leg length difference. It is not guaranteed but usually the situation is much better after a hip replacement than before the operation. Nevertheless, you should realize that an operation is a risk of complications and needs an extensive recovery process. Your decision to choose for a total hip prosthesis must be well thought! However, most patients are extremely satisfied with their new hip.

Frequent asked questions (FAQ)

There are many different implants, which is most suitable for me?
The hip implant selection depends on several aspects such as durability, convenience and safety, and the possibility of any revisions afterwards. We have a vast array of hip implants to choose the optimal prosthesis for you according to your daily activity level, your age and medical history.

I have a nickel allergy: is there nickel in the hip implant?
No, the cementless hip prosthesis is made of titanium. The head and part of the bowl are usually ceramic or plastic.

I get a new hip with a metal ball and socket instead of a metal ball and plastic socket. This would be less wear. Are there any drawbacks?
Metal to metal shows less wear and prevents debris as seen using plastic sockets. Because we use large ball heads the hip is more stable. But still it is not really clear what the consequence of the higher metal concentration in the blood by the development of metal debris. Be carefully with pregnancy: consult your surgeon.

Prepare yourself by reading all the information given. For any questions please telephone or email contact with Orthopedium.