Whats new and “Hip“ about it - HIP HIP HURRAY

Master Kunal Shah (name changed) was involved in an accident when he was in 16 years old. He had immediate surgery to fix the ball of his hip which had fractured but was told that there was a high chance that the hip would fail because the blood supply of the ball was affected by the trauma.

Sure enough one and a half years later the ball collapsed (a condition called avascular necrosis) and he had unbearable pain rendering incapability of sitting for his class 12 exams. He was then told that he had no choice but to undergo a hip replacement. He underwent the surgery the following month and is now 8 years post surgery and he is doing well. He works, even plays an occasional game of football and for all practical purposes leads a normal life. People who see him walk cannot tell he has an artificial joint.

Hip replacement is a surgery in which the damaged hip joint (usually from arthritis) is changed to an artificial one.

The hip joint has 2 basic components. It is a ball and socket joint. The ball is the head of the femur (thigh bone) and the socket or cup is called the acetabulum. When damaged they lose their smooth surface and become rough. In the surgery, the socket is replaced by an artificial cup and the head of the femur with a stem with a ball on top.

What are the indications for a hip replacement?

The commonest reason for hip replacement is arthritis. In the hip, the causes of arthritis are avascular necrosis (blood supply of the hip ball gets affected causing damage), osteoarthritis (age-related, not as common as in the knee), rheumatoid arthritis and other rheumatoid-like inflammatory arthritis.

Another subgroup of patients is those in which the hip ball has been damaged post-fall (fracture neck femurs in the elderly) or if there has been a fracture that has been previously fixed and has failed due to some reason.

Avascular necrosis as mentioned earlier is an important subgroup. In this, the blood supply to the head of the femur (hip bone) gets reduced causing the head to die and then collapse and cause secondary arthritis and pain.

Usual causes are trauma, steroids, alcohol, and tobacco to some extent. In the early stages stopping the use of alcohol and steroids helps along with certain medicines to strengthen the bone.

When do I need surgery for the hip?

In fracture cases, your doctor will be able to guide you if your fracture can be fixed (plate and screws or nail) or needs to be replaced.

In arthritis, the symptoms are the pain, decreased movements (difficulty tying shoes or sitting crossed legged even on the bed), limp when walking and sometimes even night pain.

You will need surgery when your pain affects your quality of life and restricts your mobility.

Is there an age that it can be done in?

  • Depending on your degree of arthritis and the cause you may need surgery even really early.
  • Avascular necrosis and rheumatoid patients can be in their early twenties when they need surgery.
  • Age is not a criterion for hip replacement surgery.

Does doing surgery at an early age mean that I will need more surgeries as I get older?

The artificial hip is not like the artificial knee. The life of an artificial hip is more than that of the knee. Today we have better materials like delta ceramic and better plastics with reduced wear and hence ensure a longer life of the implant.

In a younger patient, we generally prefer ceramic as a bearing option.

Why were some hip joints recalled in the past? 

There was a phase from 2005 to 2009 when metal on metal hips was used. The principle was that they were hard surfaces and there would be no or very little wear and tear and hence would last longer. Unfortunately, many people developed loosening and allergic reactions and needed to be revised. However, there are a lot of people who have these hips and are doing well. These hips are no longer available and have been withdrawn from the market.

This does not mean that all hips will fail.

What are the types of hip replacement?

There are essentially two major types. Cemented and uncemented (cementless). Cemented hip replacements are usually done in elderly, osteoporotic patients and the parts are cemented to the bone. In uncemented hip replacements, the components are fitted into the native bone and the bone grows into the implants. These are usually preferred in younger patients with stronger bones.

How soon can I walk after surgery and how long will it take me to resume work?

You can usually start walking putting all your weight on the joint the day after the surgery. Initially, you will need a walker and then a stick before you walk normally. This period is variable and depends on the age and physical condition of the patient before the surgery. 

Hip replacement surgery is a very rewarding surgery to the patient with satisfaction rates that are much higher than for knee replacement.

What are the precautions after surgery?

What can I do and what can I not do? A hip replacement lets you have stable painless and mobile joint. You will be able to lead a normal life like walk and climb stairs and even go to the gym.

Certain floor activities like Indian toilet and vajrasan are best avoided.

What are the complications with this surgery?

As with any surgery, this surgery also has certain complications associated with it. Dislocation (the ball comes out of the socket) is the biggest and earliest possible complication. To prevent this you will be told to avoid certain movements for 3 months post surgery.  

What are the latest developments in the field of hip replacement?

The latest developments have been in the kind of implants that are available. These ensure a more natural feel to the hip. A better range of motion is achieved and the life of these joints is also longer.

Newer and better surgical expertise ensure that the patients return to normal function soon.