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Total hip joint replacement 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 stiffness. Pain is usually in the groin, sometimes in the buttock and may extend to the thigh and sometimes the back. Hip pain continues while resting, either day or night and limits everyday activities such as walking or stair climbing. And stiffness in a hip joint limits the ability to move, bend or lift the leg sideways.

For information concerning a revision of your hip prosthesis click here.

Treatment

The prosthetic implant consists of an acetabular cup, the femoral component and the articular interface.

The procedure of a hip prosthesis surgery is as follows:

• The operation is performed under general anesthesia (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 doctor's assistant and/or 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.
• 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 physical therapist.
• 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 replacement: 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)

How long takes a hip replacement procedure?
The average duration of a hip replacement session is between 50 and 75 minutes.

How long should I use the injections to prevent thrombosis?
6 weeks after surgery

How long do I need walking with crutches?
At least 6 weeks after surgery

When can I ride a bicycle?
First exercise on a stationary bicycle so you have sufficient control over your leg. After 6 to 12 weeks start with bicycling. Use a ladies' bike because of the low step.

How long will a hip replacement last?
Research shows that 95% stays longer than 15 years. Each individual has potential differences, especially in relative young patients and heavy use can shorten the lifecycle.

How old do I have a knee or hip replacement to get?
For young people with arthritis (usually under age 40-50) it is desirable to avoid a joint replacement if possible, since patients in that age group are very likely to outlive the joint replacement. In those individuals, who represent a very unusual circumstance, there are other surgical options available. For people in "middle age" or older, a knee replacement is usually the best choice to relieve the pain of knee arthritis, and restore a reasonable level of function.

How often should I do my exercises after surgery for a hip replacement?
You exercise three times a day for 10 minutes. There is no maximum.

How can I care for the wound?
You must taking care that the wound area stays clean and dry. The skin around the wound may take a red and / or irritated look but that decreases after the sutures and/or staples have been removed.

When can I get a shower?
You can take a shower when the wound is completely dry, usually after 5 days. The use of soap around the wound is not recommended.

When can I return on my side?
The first 6 weeks after surgery you should sleep on your back with a pillow between the knees. After 6 weeks you may lie on your operated side, also using a pillow between the knees.

When can I drive a car?
Depending on the progress of your recovery, 6 to 12 weeks after surgery.  Discuss this with your surgeon and read the policy conditions of your insurance. It is not advisable to participate in traffic if you sue painkillers and /or crutches.

How long will my hip sore?
You will notice that the pain gradually decreases during a period of 3 to 4 months after surgery.

My leg is swollen after surgery of the hip prosthesis, how long will this continue?
Swelling of the leg is common after surgery but you will notice that this will decrease in the first week after surgery. Good practice is important to reduce swelling; reduce swelling if you arranged your leg at high positions.

Will I ‘beep’ at an airport, with hip prosthesis, as I go through the gate?
Not common but especially in thin patients or multiple implants it can happen.

It seems that my operated leg is longer, can this be true?
Yes this is true occasionally. It may be the result of altered muscle use or may be due to a real extension. This assessment will be done by checking with your orthopedic surgeon.

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