Total Hip Replacement

Hello,

 I am Dr. Hitesh Kubadia, orthopaedic and the joint replacement surgeon in Mumbai and I am here to talk about a common surgery which is done in orthopaedics called the total hip replacement. There are lot of myths and there are lot of questions about this surgery. I thought I will answer a few of them. Like in the knee joint, when the non-surgical methods fail to give relief for knee pain and we think about knee replacement. Similarly, for a hip joint problems, when the non-surgical method like medications, physical therapy and drugs fail to give relief and a person finds it difficult to get on with his day to day activities and activities of daily living, that is when a surgical option can be thought about. First let's understand about the hip joint. Hip joint is a big, large ball and socket joint of the lower limb, which connects the pelvis to the lower limb. And being a large joint and it is a being a weight bearing joint, any problem with the joint can cause pain.

Common most common problem with the hips are seen are osteoarthritis, rheumatoid arthritis, avascular necrosis of the femur, fractures of the neck of femur these are all very common problems about the hip which can make a life very disabling for the patient. These are the few conditions where you know hip joint replacement may become very necessary for the patient to continue with his day to day activities. First let's understand what the hip joint is made up of. Hip joint has a socket which is the acetabulum part of the pelvis and a ball and a ball and a ball on the femoral side which articulates with the acetabulum and has a smooth glistening surface which is called the articular cartilage and which causes friction-less movements. Any problem with this cartilage or any avascular necrosis of the head of the femur causes this cartilage to denude and over a period of time causes a lot of wear and tear and this wear and tear causes a lot of friction friction full movements across the hip joint and causes pain.

This is simply nothing but osteoarthritis of the hip joint. All these common problems are normally first treated non-surgically with medications, with physical therapy, with physical aids like a cane or a walker. But when these modalities stop giving enough relief to the patient in their day to day activities like walking, get going up and down the stairs, getting in and out of the chair or getting in and out of the car even. So, these are very activities of daily living and when these start getting affected in day to day activities, then a surgical option should be thought about. Total hip replacement is one of the most consistent methods of giving you pain relief and has become the gold standard and and almost all these hip problems, it has become the most consistent way of giving patient pain relief and getting him back to routine activities and living. It has now become pretty safe also with the advent of modern-day anaesthesia, with modern day techniques of surgical approaches so it has become very very safe today. So, what is done in a total hip replacement? Total hip replacement is a surgery where the damaged part of the hip joint is replaced by a metallic prosthesis. Okay. So, it is formed of 2 as the hip is formed of 2 components: the socket and the ball. Similarly, the components of the prosthesis are also of 2 things.

One is the socket which has a metal shell and has a plastic or a ceramic liner to it and has a femoral stem which goes into the hollow part of the femur and gets fixed into it. And has a ball, which is either a metal or a ceramic head liner. So, these when they are attached to to each other, and this causes friction less movements. There are various types of prosthesis which are available today. They can be cemented, they can be uncemented. When this that is up to the surgeon's discretion what is best for the patient and looking at the X-rays, looking at the physical examination of the patient, we very often conclude what would be best for the patient. In today's niche, the trend is more towards cementless fixation having a scratch fit into the bone of the patient and they are they seem to be working longer than the cemented versions. And also, there are other things which come into consideration is the liners which we use.

You know nowadays there are enough reports across the world that the liners of ceramic with polyethylene or ceramic on with a with a ceramic liner, they seem to be having much less wear over a longer period of time and probably will last for a very very long time for the patient. There are enough reports which suggest they may even last beyond 20-25 years too. I hope this information was useful to you.