Hip arthroplasty is an orthopedic surgery used to replace the hip joint with a metal, polyethylene or ceramic prosthesis.
This surgery is more common and older, from the age of 68, and can be performed in two ways: partial or total. In addition, it can be made with different materials such as metal, polyethylene and ceramics, and all these choices must be made by the orthopedic doctor who will perform the surgery.
When to put a hip prosthesis
Hip arthroplasty is usually used in the elderly with joint wear due to arthrosis, rheumatoid arthritis or ankylosing spondylitis, however, it can also be used in young patients if a femoral neck fracture occurs, for example. Basically there is indication for surgery in case of joint wear, chronic pain or inability to walk, climb and descend stairs, or getting in the car, for example.
How is the surgery done
Hip arthroplasty is performed under anesthesia in the operating room, which may be a regional block or general anesthesia. The surgeon makes a cut on the front of the thigh, the back or the side of the thigh, depending on your choice, and removes the arthrosis-worn parts and places the prosthesis.
The duration of surgery is approximately 2.5 hours, but may be longer depending on the patient’s condition. The length of hospital stay can vary from 3-5 days and physical therapy should be started early postoperatively.
The surgeon usually prescribes analgesics and anti-inflammatories such as Paracetamol or Ibuprofen after surgery and while the patient is in pain, requiring physical therapy for 6 months to 1 year.
Care after hip replacement
The hip arthroplasty recovery lasts about 6 months and during this period the patient should take some precautions, such as:
- Lie on your back with your legs open. It may be helpful to place a pillow between your legs;
- Do not cross the legs to avoid dislocating the prosthesis;
- Avoid turning the operated leg in or out on itself;
- Do not sit in very low places: Always place seats to elevate the toilet and chairs;
- Avoid lying on your operated leg, especially in the first month after surgery;
- When climbing steps, you must first place the unoperated leg and then the operated one. To go down, first goes the operated leg and then the unoperated leg;
- Practice light activities, such as walking in the first weeks, but activities such as dancing, only after 2 months of recovery and under the guidance of the doctor or physiotherapist.
After the first review appointment, the patient should return to the doctor every 2 years for an x-ray to assess the positioning and wear of the prosthesis.
Physical therapy after hip prosthesis
Physical therapy for hip arthroplasty should begin on the first day after surgery and is important for relieving pain, reducing swelling, improving hip movement and strengthening muscles.
Normally, the physical therapy program should be guided by a physical therapist and includes guidelines for walking, sitting, lifting, how to use the walker, and exercises to learn how to walk with the prosthesis, to strengthen muscles and to develop balance.
After discharge from the hospital, the patient should maintain physical therapy for at least 6 months after hip arthroplasty. Also indicated are electrical devices for muscle activation, and balance exercises that can be performed underwater in the pool. The physical therapy treatment varies according to the type of prosthesis and the surgical approach, so it should be the physiotherapist to indicate the best treatment for each case.
Complications of arthroplasty are rare, especially when the patient follows proper guidelines and care after surgery. However, some complications may be:
- Deep vein thrombosis;
- Pulmonary embolism;
- Dislocation of the prosthesis;
- Bone fracture.
Generally, the patient should go to a review appointment 7-10 days after surgery to remove the stitches and to detect some complications, such as prosthesis detachment or infection. When complications are suspected, consult the orthopedic surgeon or go to the emergency room to begin appropriate treatment.
Most common questions about the hip prosthesis
Does the hip prosthesis get out of place?
Yes. It is possible for the prosthesis to move if the patient feels too low, crosses their legs, or turns their legs in or out before releasing the doctor or physiotherapist to perform these activities.
How long does the hip prosthesis last?
Usually, the hip prosthesis lasts for 20-25 years, requiring replacement after this period.
When to drive again?
Usually the doctor releases driving after 6-8 weeks of surgery.
When to have sex?
There is a minimum waiting period of 4 weeks, but some patients feel more confident about returning after 3-6 months.