I’m not a fan of this topic but I’ll
go for it anyway: hip replacement surgery. I am unashamed to admit
I’m squeamish and can’t stand things like needles or blood. In fact
I’m pretty sure the sight of these things makes my blood pressure
drop. If you’d like to watch an actual hip replacement you can look
it up on youtube but I am choosing not to watch the video in fear I
might experience my lunch again. So, if you want all the gory
details, have at it. Me, I’m sticking to the books.
First of all, the hip is the joint
between the femur and the pelvis. We need it to support our weight
when we walk, stand and do yoga postures (among other things).
Without a hip, you’d have a hard time maintaining any balance.
The hip is a ball-and-socket joint.
The socket is the acetabulum (part of the pelvis) and the ball is the
femoral head (the upper part of the thigh). The two are held together
by ligaments and there is layer of cartilage between the bones that
acts as a cushion. When the cartilage is worn down, the two bones rub
against each other which causes pain and stiffness. The most common
cause of the loss of cartilage is arthritis (an inflammation of the
joint).
Hip replacement surgery is usually a
last resort since there are some alternatives that pose less of a risk to the patient.
These alternatives include: anti-inflammatory drugs, cortisone
injections, physical therapy, losing weight if applicable and using a
cane. A less invasive surgery is hip resurfacing. Only a small amount
of the bone must be removed and a metal cap is placed on the ball and
a metal piece is used for the socket. Hip fusion surgery isn’t used
as much any more but is still an option. The bones are held together
with a metal plate and some screws. While effective, it eliminates
the ability to move the joint so the patient will be plagued by a
limp for the rest of their life. Another option, Resection
Arthroplasty, removes the bone around the hip joint and let’s scar
tissue take it’s place.
If a person is at high risk of
developing arthritis due to being born with a misalignment of the hip
bone preventative measures may be taken. For example, a hip osteology
can be performed to realign the bones in hopes of avoiding foreseen
problems.
Alright, enough about that. On to the
surgery! The first step is selecting the proper prosthetic hip. So,
before surgery X-Rays of the patient are taken to aid in the
determination. Once this is done, the patient sets up the surgery
date. On the day of the surgery, an anaesthesiologist will use general anaesthesia for the procedure. While the patient is unconscious, a surgeon and
his/her team goes to work. He/she will remove the damaged cartilage
and bone. This typical means removing the femoral head (the ball) and
using a ramer to sand down the damaged area of the socket. Then the
acetabular component is inserted (looks a lot like a cup) into the
socket area. Over time, the bone actually will grow into the surface
of the new socket. Next, a femoral stem which is basically a pole, is inserted
into the hollow center of the femur bone. Depending on the type of
surgery, the stem may be held in with cement. If cement is not used
the stem must be an exact fit for the bone so that new bone will grow
around it and it won’t move. Cement allows some space in between the bone and stem
since it will harden to hold the stem in place. The ball is then
attached to the tip of the stem and the then it is attached to the
socket. This is called reducing the hip.
The surgeon will ensure that the
implant is stable, otherwise there can be problems with dislocation
and other serious complications. Finally, he will sew up the patient and send him/her off to recovery! After a few days in the hospital the patient is sent home with a prescription for physical therapy and the appropriate medications which varies depending
on the patient.
So, there you have it. How hip
replacement surgery is performed. Hopefully this isn’t something
you’ll ever have to experience but if you do, this quick overview may be helpful. Now I’m going to go and try and erase all the
images I had to look at to get this information from my mind…