Introduction

'THE SAMUI CLINIC' AND  'BANDON INTERNATIONAL HOSPITAL'  HAVE LINKED TO PROVIDE THIS AFFORDABLE 'HIP REPLACEMENT SURGERY' WHICH IS CARRIED OUT BY OUR  HIGHLY QUALIFIED AND SKILLED ORTHOPEADIC SURGEONS.

'WHY WAIT ANY LONGER?"  WHEN YOU CAN NOW HAVE THE SURGERY THEN REHABILITATE ON A TROPICAL PARADISE ISLAND WITH ALL MODERN FACILITIES FOR A JUST A FRACTION OF THE COST.

          Your ability to lead a full and active life can be severely afffected by a painful hip. During and over the  last twenty five years, major advancements in hip replacement have improved the outcome of the surgery greatly. Hip replacement surgery is becoming more and more common as the population of the world begins to age.

Anatomy

There are many conditions that can result in degeneration of the hip joint. Osteoarthritis is perhaps the most common cause that patients need to undergo hip replacement surgery. This condition is commonly referred to as "wear and tear arthritis". Osteoarthritis can occur with no previous history of injury to the hip joint - the hip simply "wears out". There may be a genetic tendency in some people that increases their chances of developing osteoarthritis.

Avascular necrosis is another curious cause of degeneration of the hip joint. In this condition, the femoral head (the ball portion) looses a portion of its blood supply and actually dies. This leads to collapse of the femoral head and degeneration of the joint. Avascular necrosis (AVN) has been linked to alcoholism, fractures and dislocations of the hip, and long term cortisone treatment for other diseases.

Abnormalities of hip joint function resulting from fractures of the hip and some types of hip conditions that appear in childhood can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear - just like the out of balance tire that wears out too soon on your car.

Symptoms

The symptoms of a degenerative hip joint usually begin as pain while bearing weight on the affected hip. You may limp, which is the body's way of reducing the forces that the hip has to deal with. The degeneration will lead to a reduction in the range of motion of the affected hip. Bony spurs will usually develop which can limit how far the hip can move. Finally, as the condition becomes worse, the pain may be present all the time and may even keep you awake at night.

Diagnosis

The diagnosis of a degenerative hip starts with a complete history and physical examination by your doctor. Xrays will be required to determine the extent of the degenerative process and suggest a cause for the degeneration. Other tests may be required if there is reason to believe that other conditions are contributing to the degenerative process. MRI Scanning may be necessary to determine whether avascular necrosis is causing your hip condition. Blood tests may be required to rule out systemic arthritis or infection in the hip.

Normal Hip Xrays

Degenerative Hip Xrays

Treatment Options

Medical Treatment

Not all hip conditions require a hip replacement as the initial treatment. Your doctor may suggest several alternative treatments to put off the decision for replacing the hip as long as possible. Using a cane may help alleviate some of your pain and allow you to walk more comfortably. Anti-inflammatory medications may reduce the inflammation from the arthritis and reduce your pain.

Surgery

Most degenerative problems will finally require replacement of the painful hip with an artificial hip replacement. The decision to proceed with surgery should be made jointly by you and your doctor only after you feel that you understand as much about the procedure as possible.

Once the decision to proceed with surgery is made, there are several things that may need to be done. Your orthopedic surgeon may suggest a complete physical examination by your medical or family doctor. This is to ensure that you are in the best possible condition to undergo the operation. You may also need to spend time with the Physical Therapist who will be managing your rehabilitation after the surgery. The therapist will be able to begin the teaching process before the surgery to ensure that you are ready for the rehabilitation afterwards.

Finally, you may be asked to donate some of your own blood before the operation. This blood can be donated 3-5 weeks before the operation and your body will make new blood cells to replace the loss. At the time of the operation, you will receive your own blood back from the blood bank in case you need to have a blood transfusion.

The Artificial Hip

There are two major types of artificial hip replacements:

Cemented Prosthesis

Uncemented Prosthesis

Both are still widely used. The choice is usually made by the surgeon based on your age, your lifestyle, and the surgeons experience.

Each prosthesis is made up of two parts:

The acetabular component (socket portion) replaces the acetabulum.

The femoral component (stem portion) replaces the femoral head.

The femoral component is made of metal(some actually have a ceramic ball attached to the metal stem). The is made of a metal shell with a plastic inner socket liner that acts like a bearing. The plastic used is very tough and very slick - (so slick and tough that you can ice skate on a sheet of the plastic with out much damage to the material).

A cemented prosthesis is held in place by a type of epoxy cement that attaches the metal to the bone. An uncemented prosthesis has a fine mesh of holes on the surface that allows bone to grow into the mesh and attach the prosthesis to the bone.

The Operation

You can download a surgical animation showing the steps involved in replacing a diseased hip with an uncemented artificial hip. The steps involved in replacing the hip begin with making an incision on the side of the thigh to allow access to the hip joint. There are several different approaches used to make the incision, usually based on the surgeon's training and preferences.

Removing the Femoral Head

Once the hip joint is entered, the femoral head is actually dislocated from the acetabulum and the femoral head is removed by cutting through the femoral neck with a power saw.

Reaming the Acetabulum

Attention is then turned towards the socket, where using a power drill and a special reamer, the cartilage is removed from the acetabulum and the bone is formed in a hemisperical shape to exactly fit the metal shell of the acetabular component.

Inserting the Acetabular Component

Once the right size and shape is determined for the acetabulum, the acetabular component is inserted into place. In the uncemented variety of artificial hip replacement, the metal shell is simply held in place by the tightness of the fit or by using screws to hold the metal shell in place. In the cemented variety, a special epoxy type cement is used to anchor the acetabular component to the bone.

Preparing the Femoral Canal

To begin replacing the femur, special rasps are used to shape the hollow femur to the exact shape of the metal stem of the femoral component.

Inserting the Femoral Stem

Once the size and shape are satisfactory, the stem is inserted into the femoral canal. Again, in the uncemented variety of femoral component the stem is held in place by the tightness of the fit into the bone (similar to the friction that holds a nail driven into a hole drilled into wooden board - with a slightly smaller diameter than the nail). In the cemented variety, the femoral canal is rasped to a size slightly larger than the femoral stem, and the epoxy type cement is used to bond the metal stem to the bone.

Attaching the Femoral Head

The metal ball that makes up the femoral head is attached.

The Completed Hip Replacement

And, voila!, you have a new bearing surface for the diseased hip. Here is an Xray with an artificial hip in place.

Rehabilitation

Prior to your scheduled hip surgery, you may have the opportunity to visit your physical therapist for a preoperative assessment. One purpose of this visit is to get a baseline of information that includes the location and severity of your pain, your functional abilities, and your strength and available motion of each hip. A second purpose of the preoperative visit is to prepare you for your upcoming surgery. Your therapist will go over some very important hip precautions for you to follow after your surgery. If the surgical site is from the back of the hip (posterior) the following precautions will be issued:

Avoid crossing your legs (either in bed or seated)

Avoid bending your hip greater than 90 degrees (as when seated upright or bending forward to tie your shoe)

Avoid turning your foot inward

Do keep a wedge or pillow between your knees while in bed to avoid crossing the legs

Do lean back slightly when sitting to keep the hip bending greater than 90 degrees

 

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The preoperative visit is also a time for you to begin practicing some of the exercises you’ll use just after surgery. You’ll also be trained in the use of either a walker or crutches. Whether the surgeon used a cemented or non-cemented artificial joint will determine how much weight you’ll be able to apply through your foot while walking.

Finally, an assessment will be made of any needs you’ll have at home once you’re released from the hospital.

Your therapist will be scheduled to see you on the first day after your surgery to begin your rehabilitation program.

Complications

As with all major surgical procedures, complications can occur. Some of the most common complications following hip replacement are:

Thrombophlebitis

Infection

Dislocation

Loosening

This is not intended to be a complete list of the possible complications, but are the most common.

Thrombophlebitis

Thrombophlebitis, sometimes called Deep Venous Thrombosis(DVT), can occur after any operation, but is more likely to occur following surgery on the hip, pelvis, or knee. DVT occurs when the blood in the large veins of the leg forms blood clots within the veins. This may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung, where they get lodged in the capillaries of the lung and cut off the blood supply to a portion of the lung. This is called a pulmonary embolism. (Pulmonary = lung, embolism = fragment of something traveling through the vascular system). Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible!

Some of the commonly used preventative measures include:

Pressure stockings to keep the blood in the legs moving

Medications that thin the blood and prevent blood clots from forming.

Infection

Infection can be a very serious complication following an artificial joint. The chance of getting an infection following total hip replacement is probably somewhere around 1%. Some infections may show up very early - before you leave the hospital. Others may not become apparent for months, or even years, after the operation. Infection can spread into the artifical joint from other infected areas. Your surgeon may want to make sure that you take antibiotics when you have dental work, or surgical procedures on your bladder and colon to reduce the risk of spreading germs to the joint.

Dislocation

Just like your real hip, and artificial hip can dislocate (where the ball comes out of the socket). There is a greater risk just after surgery, before the tissues have healed around the new joint, but there is always a risk. The therapist will instruct you very carefully how to avoid activities and positions which may have a tendency to cause a hip dislocation. A hip that dislocates more than once may have to be revised (which means another operation) to make it more stable.

Loosening

The major reason that artificial joints eventually fail continues to be a process of loosening where the metal or cement meets the bone. There have been great advances in extending how long an artificial joint will last, but most will eventually loosen and require a revision. Hopefully, you can expect 12-15 years of service from an artificial hip, but in some cases the hip will loosen earlier than that. A loose hip is a problem because it causes pain. Once the pain becomes unbearable, another operation will probably be required to revise the hip.

 

 

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