Total hip replacement
What is it?
When is this procedure indicated?
This surgery is indicated in cases of primary coxarthrosis, secondary coxarthrosis (advanced stages of congenital hip dysplasia, post-traumatic arthritis, outcomes of septic arthritis, advanced stages of femoro-acetabular conflict, outcomes of femoral head epiphysiolysis, immune-mediated arthritis...), and osteonecrosis of the femoral head.
How is it performed?
Hip replacement surgery is usually performed under epidural anesthesia (in which only the lower body is insensitive to pain) + sedation. The procedure can be divided into:
Step 1
Surgical access:
- minimally invasive posterolateral approach: involves access through the gluteus maximus muscle and disconnection of the tendons of the short extra-rotator muscles of the hip;
- minimally invasive anterior approach: involves access through an intermuscular weep passing through the sartorius muscle and the tensor fascia lata muscle.
Step 2
Removal of damaged osteo-cartilaginous surfaces.
Step 3
Implantation of the prosthetic trial components.
Step 4
Verification of restoration of pre-pathological anatomical joint characteristics and stability testing.
Step 5
Implantation of definitive prosthetic components.
Step 6
Postoperative radiological control.
Recovery
The patient can ambulate, with the help of Canadian sticks and physiotherapy staff, as early as the first 6h after surgery.
Physiokinesiotherapy begins the day after surgery, and includes: training for prevention of prosthetic implant dislocation, progressive and complete active and passive joint recovery, global lower extremity strengthening exercises and exercises for selective strengthening of the m. medius gluteus and quadriceps bilaterally, gait training, stair ascent/descent training, joint stretching.
Full recovery, and resumption of normal activities, occurs after about 1-2 months. Among normal activities, practice of some sports may take place, mainly those in which sudden movements and bumps are not expected. Therefore, soccer, skiing, horseback riding, rugby, etc. are strongly discouraged.
Short-term complications
Total hip replacement surgery, although for all intents and purposes a major surgery, is considered safe. However, some complications are possible, albeit in rare cases (less than 1% in our case series). These risks are usually increased if the patient has prior illnesses that complicate the overall clinical picture.
There are general medical complications due to the anesthesia procedure (cardiovascular and cerebrovascular events, pneumonia) and general complications of surgery (hemorrhage, nerve injury, peri-articular soft tissue injury, early infection (increased risk related to implantation), and lower extremity venous thrombosis (increased risk)).
Specific complications of prosthetic replacement surgery, on the other hand, are: intraoperative periprosthetic fractures, recurrent dislocation, lower extremity heterometry.
Long-term complications
After the recovery period, the patient is usually able to return to a completely normal life. In some cases, however, it is good to know that there may be long-term consequences that may lead to revision surgery.
Implanted components are bound to wear out: under optimal conditions they have a life span of about 25 years, but there are several factors that can lead to premature wear (overuse, overweight).
The implant may not osseointegrate optimally and mobilize from the site of surgical placement.
The prosthesis is a foreign body implanted in the human body and can promote the development of bacterial colonies on its surface: infections can start from anywhere and reach through the blood to the prosthetic component.
As much as prosthetic replacement surgery can very accurately restore pre-arthritic anatomical relationships, some patients may complain of persistent hip stiffness and pain unresponsive to conservative treatment.
In all these cases, partial or total revision surgery of the implanted prosthesis may be necessary.
Where do we treat it?
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