Many patients are worried about their upcoming surgery to replace the hip joint with an artificial one (endoprosthesis). Many of these concerns, however, can be overcome with the necessary information on how occurs such a surgery and how you can prepare - mentally and physically - to get through it.
Preoperative planning and preparation for surgery
What we should know before undergoing an hip replacement surgery?
Endoprothesis and artificial hip implants requires a lot of effort to preoperative preparation and planning of the sole procedure. Your physician should explain the procedure in detail and make the necessary examinations and tests to check undisputed that such an operation would benefit the patient. It is important to pay attention to all the risks and benefits.
In short, preoperative preparation goes through the following steps:
• Examination of the general condition of the patient
• Full range of tests - complete blood count, chemistry, ECG, X-ray of the heart and lung and other
• Compliance requirements for subjecting the operation - in certain cases, surgery is not recommended, or may require a different type of preparation - such is the case in the presence of various indicators, and diseases such as heart failure, arterial hypertension, diabetes mellitus and others.
• Evaluation and supervision of current medications administered by the patient – one must cease taking anti-inflammatory, non-steroidal anti-inflammatory drugs and some other painkillers at least a week before the intervention, in order to reduce the risk of bleeding during surgery.
• Providing of blood transfusion: hip replacement surgery is major surgery associated with significant blood loss, which usually require blood transfusion.
Hip replacement surgery: how it’s done?
The operation is performed under general or local (regional) anesthesia. The patient is completely unconscious. Breathing is maintained artificially. Local anesthesia - spinal, epidural or combined – is preferred. Anesthesia is administered by special needle in the spinal cord and provides a total insensitivity and immobility of the patient from the waist down. The patient is fully conscious, but can be sedated - voluntarily or on medical advice.
There are several different options for performing this surgery. In the most general case the surgeon reaches the natural hip in depth, then the femoral head is sprained manually. Using a special tool the femoral neck is cut and the head is removed from the femur, thus the bone canal of the thigh is revealed. The joint capsule and the joint of the pelvis (acetabulum) is partially removed with a special tool. Precise test measurements of the length of the components and their correct orientation are made. Then the prosthesis is positioned and assembled inside.
Posterior approach
The posterior (Moore or Southern) approach accesses the joint and capsule through the back, taking piriformis muscle and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip abductors and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.
Lateral approach
The lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors (gluteus medius and gluteus minimus) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley),[citation needed] or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using sutures. Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.
Antero-lateral approach
The anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.
Anterior approach
The anterior approach uses an interval between the sartorius muscle and tensor fasciae latae. This approach was commonly used for pelvic fracture repair surgery before it was adapted for performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are lower because supporting muscle tissue, including the iliotibial tract, receives very little damage during the surgery. There is a 10% rate of numbness in the thigh following this approach, due to injury to the lateral femoral cutaneous nerve. The anterior approach results in a quicker and less painful recovery. Immediately following surgery patients are instructed to go about their normal hip function, including weight bearing activity and bending their hip freely.
Recovery after surgery
Full recovery after hip endoprosthesis occurs between 2 and 4 months after surgery.
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