Hip replacement

Overview of Treatment

Total hip arthroplasty is a common orthopedic procedure used to replace damaged hip joint structures. When the hip joint experiences severe pain and mobility impairment due to degeneration, trauma, or disease, physicians recommend this surgery to restore joint function. The procedure mainly involves replacing the femoral head and acetabulum with artificial components made of metal, ceramic, or high-molecular materials, helping patients regain walking ability and daily activities.

The surgical process typically involves making an incision, removing diseased tissue, installing the artificial joint, and suturing, performed under general or spinal anesthesia. Postoperative physical therapy is essential, with a recovery period of approximately 6 to 12 months. The ultimate goal is to relieve pain and improve quality of life.

Types and Mechanisms of Treatment

Total hip replacement is divided into "total hip arthroplasty" and "partial hip replacement." Total hip replacement involves replacing both the acetabulum and femoral head and is suitable for severe arthritis cases; partial hip replacement only replaces the femoral head and is often used for fractures or localized damage. The artificial joint consists of three parts: the acetabular cup, femoral stem, and artificial femoral head, using biocompatible materials to reduce rejection reactions.

Post-replacement, the artificial joint utilizes friction surfaces between metal and high-molecular polyethylene to mimic natural joint movement. Ceramic-on-ceramic materials have excellent wear resistance and are common in younger patients; metal-on-polyethylene is widely used due to lower cost. Bone cement or biological fixation techniques between the artificial joint and bone can enhance long-term stability.

Indications

Main indications include:

• Severe degenerative arthritis causing walking difficulty
• Hip fracture with non-union
• Joint destruction due to rheumatoid arthritis
• Congenital hip dysplasia

When non-surgical treatments (such as painkillers and physical therapy) are ineffective, physicians evaluate the necessity of surgery.

Special cases include infectious arthritis requiring infection control or patients with significant trauma sequelae, which are also considered for surgery. Physicians assess the risks and benefits based on age, bone density, and overall health status.

Usage and Dosage

This treatment involves a surgical procedure with no concept of "dosage." The operation lasts approximately 1.5 to 3 hours and is performed in an operating room. Surgeons select the appropriate joint size based on the patient's physique and ensure accurate placement using X-ray or navigation systems.

Early postoperative rehabilitation is crucial, including early mobilization during hospitalization and physical therapy plans after discharge. Nurses will guide home care, including wound care and avoiding specific movements.

Benefits and Advantages

Main therapeutic effects include:

• Long-term pain relief
• Restoration of normal gait and range of motion
• Improvement of limping or postural compensation caused by joint issues

85-95% of patients experience significant quality of life improvements within 5 years post-surgery.

Compared to conservative treatments, total hip replacement addresses structural damage, with modern biomaterials durability extended to 15-20 years. Minimally invasive techniques reduce tissue damage and shorten recovery time.

Risks and Side Effects

Potential risks include:

• Infection (incidence approximately 1-2%)
• Artificial joint loosening (more common after 10 years)
• Thrombosis (requiring anticoagulant therapy postoperatively)

Serious complications such as neurovascular injury are rare (<1%) but can lead to permanent nerve damage.

Short-term side effects often include wound swelling and temporary pain, which resolve within about 2 weeks in approximately 90% of patients. Long-term risks require regular monitoring of prosthesis wear, especially in younger, active patients.

Precautions and Contraindications

Contraindications include:

• Uncontrolled systemic infection
• Severe coagulation disorders
• Cardiopulmonary conditions unable to tolerate anesthesia

Patients should undergo comprehensive preoperative assessment of cardiopulmonary function and bone density.

Postoperative restrictions include avoiding "crossing legs," excessive bending, and similar movements for at least 6 weeks. Diabetic patients need to control blood glucose levels more strictly, and osteoporotic patients should receive bone-strengthening treatments to promote integration. High-impact activities are prohibited within 3 months after surgery.

Interactions with Other Treatments

Surgical treatment should be combined with medication therapy:

• Anticoagulants should be timed appropriately to prevent intraoperative bleeding
• Painkillers should be tapered under medical supervision
• Patients with osteoporosis may require long-term use of osteoporosis medications

Interaction with physical therapy is crucial postoperatively; early rehabilitation can reduce joint stiffness. However, activities that exert excessive pressure on the hip, such as deep squats or high-intensity training, should be avoided.

Effectiveness and Evidence

Clinical studies show that one year after surgery, patients' pain scores decrease by an average of 80%, and walking distance increases by an average of 300%. The American Academy of Orthopaedic Surgeons reports that the 10-year survival rate of modern prostheses exceeds 90%.

Applications of 3D printing and computer navigation systems have improved surgical accuracy by 20% and reduced the risk of joint malalignment. Long-term follow-up data confirm that patient satisfaction rates can reach up to 95% when appropriately selected.

Alternatives

Non-surgical treatments include:

• Non-steroidal anti-inflammatory drugs
• Intra-articular corticosteroid injections
• Assistive devices such as braces for walking

Invasive alternatives like hip arthroscopy are suitable for mild cartilage damage. However, for severe osteoarthritis or joint destruction, surgery remains the primary option. Biological agents can delay the need for surgery in rheumatoid arthritis patients but cannot repair structural damage.

 

Frequently Asked Questions

What preparations are necessary before undergoing total hip replacement surgery?

Preoperative assessment includes evaluating overall health, cardiopulmonary function, blood tests, and imaging. Physicians may require better control of chronic diseases such as diabetes or hypertension and recommend smoking cessation to reduce infection risk. Physical therapists will guide basic rehabilitation exercises to help patients adapt more quickly after surgery.

What precautions should patients take during daily activities after surgery?

In the early postoperative period, avoid bending over more than 90 degrees, crossing legs, or squatting to prevent dislocation. Use assistive devices like long-handled spoons and brushes for daily activities, and keep the operated limb abducted for at least 6 weeks. Gradually resume activity levels after discharge, avoiding lifting heavy objects or prolonged standing.

What non-pharmacological methods are available for pain management after surgery?

In addition to pain medications, ice packs can reduce swelling and pain (not exceeding 20 minutes per session). Heat therapy during physical therapy can relieve muscle soreness, and aquatic therapy or joint mobilization can promote circulation and reduce stiffness. Deep breathing exercises can help distract from pain, and using walking aids as prescribed can reduce joint load.

What factors influence the lifespan of a hip prosthesis?

The average lifespan of a prosthesis is 15-20 years, influenced by material (ceramic vs. metal), patient weight, and activity level. Excessive participation in high-impact activities like running may accelerate wear. Proper weight management and regular rehabilitation can extend the prosthesis lifespan. Regular follow-up allows early detection of abnormal wear signs.

When can patients resume driving or returning to work after surgery?

Unilateral surgery patients typically can resume short-distance driving after 4-6 weeks, depending on rehabilitation progress. If the work involves mainly sitting and no heavy lifting, returning to work in about 6-8 weeks is feasible; physically demanding jobs may require over 3 months. Physicians will provide personalized advice based on joint stability and muscle strength recovery.