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Hip prosthesis surgery

Hip prosthesis surgery
  • Definition

    Total Hip Arthroplasty, or prosthetic hip replacement, is a surgical operation intended to replace a damaged or diseased hip joint with a prosthesis or implant that will perform a function similar to that of the original joint.

    The hip joint is described as a "ball and cup" type joint, with a very wide range of motion, associated with great stability. The surface of these bones is covered by cartilage (hyaline or articular cartilage) that, while healthy, allows movement with minimal friction. When articular cartilage wears out, its cushioning capacity is lost. Gradually it erodes, leaving the underlying bone exposed, causing friction and joint deformity, which limit mobility and cause pain. There are patients who limp and have the feeling that "the leg has become shorter."

    Total hip arthroplasty replaces the damaged joint with an artificial ball and cup. These components can be fixed to the bone either by means of a bone "cement" (polymethylmethacrylate), or they have porous surfaces on which new bone develops that definitively fixes the components. Depending on the type of initial fixation, the load on the operated leg may be earlier or should be limited for a time.

    The intervention seeks to relieve pain, decrease stiffness and, in most cases, restore the leg to its length, thus helping to improve mobility and function.
  • Indications

    There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from total hip replacement surgery often have:

    • Severe pain or stiffness of the hip with limited daily activities, including walking, climbing stairs, sitting, and getting up from a chair.
    • Moderate or severe hip pain while resting, both day and night.
    • Sensation of chronic inflammation and swelling of the inguinal and gluteal area that does not improve with rest or with medications.
    • They do not experience substantial improvement with other treatments such as anti-inflammatory drugs, cortisone injections, hyaluronic acid, and physical therapy.
    Candidates for surgery

    There are no absolute weight or age restrictions for total hip replacement. Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are between 50 and 80 years old, but orthopedic surgeons evaluate the patients individually. Total hip replacements have been performed successfully at all ages, from the young adolescent with juvenile arthritis to the elderly patient with degenerative osteoarthritis but in good physical condition.
  • Risks

    The complication rate after total hip replacement is low. Serious complications, such as infection of the hip joint, occur in less than 2% of patients. Major medical complications, such as heart attack or embolism, occur even less frequently. Certain chronic diseases can increase the potential for complications. Although rare, when these complications do occur they can prolong or limit full recovery. Discuss your concerns frankly with your orthopedic surgeon before surgery.
  • Prospects (prognosis)

    Basic precautions after hip arthroplasty

    Movements that should be avoided for 6-10 weeks after the operation. These precautions apply in any situation, including when you are sitting, and while getting up and out of bed or sitting and getting up from chairs.

    • Don't cross your legs.
    • Don't flex excessively the operated hip (> 90º).
    • Don't rotate the operated leg in or out.
    • Don't lie on your side without a pillow between the legs.
    Getting on and off the bed on the opposite side to the operated.

    1. Sit up in bed, bring your legs up to the edge (if necessary, place your healthy foot underneath the operated one and help yourself with it) and lift them out of bed, spinning your buttocks and body while doing so. Keep the knee of your operated leg without flexing with the help of the foot on the healthy side.

    2. Then sit on the edge of the bed by first placing the foot of your non-operated leg on the floor.

    3. Place your hands on the bed on both sides, keeping the operated leg half stretched, and stand up with the help of another person or your crutches or walker, while supporting the operated foot completely flat on the floor. As a rule, we recommend that patients "feel" the same load on the foot as they do when sitting with the soles of the feet on the floor.

    4. Once standing, take your time to make sure you don't get dizzy, and collect the sensations from your foot, knee, and hip. You will see that there is no pain, although it is normal that you have discomfort and insecurity. Avoid abrupt gestures.

    To return to bed, perform the reverse procedure. Remember to avoid abrupt gestures or drop into bed.


    1. Firstly the crutches or the walker are moved forward.

    2. Then the operated leg, so that the foot reaches just behind the line of the crutches.

    3. And finally, the non-operated leg is brought forward.

    You can turn to either side but you must not rotate with the foot fixed. To do this, take short steps and turn slowly.

    It is important that you take several short walks throughout the day, avoiding fatigue or overloading the operated leg, as this could cause inflammation and pain in the following days.


    1. To climb stairs, you must first place the non-operated leg on the next step, and then climb the operated leg, along with the crutches.

    2. To go downstairs, you must place the walker or crutches first, then the operated leg, and finally the non-operated leg. This seems complicated at first, but with patience and practice, you will quickly gain confidence.

    Get in and out of the car (to the passenger seat)

    The passenger seat should be pulled back as far as possible. The back of the seat should be slightly reclined.

    1. Make sure you are level with the car (watch out for curbs on the sidewalks), and stand with your back to the seat, with the door fully open.

    2. Get in the car on your side, with the back of your legs pressed against it.

    3. Lean on the back of the seat with your right hand and the base of the seat with your left hand. Do not hold on to the door: it could close or move, causing damage.

    4. As you sit down, allow the operated leg to stretch out in front of you. It will be easier if you lean back a little.

    5. Using the non-operated leg and hands, bring your body back to the driver's seat, keeping the operated leg stretched out in front of you.

    6. Leaning back and turning on your buttocks, slide your legs into the car. Be careful and don't rush. There are many patients who need help the first few times, to insert the operated leg into the car without making sudden gestures or suffering pain.

    7. Get into a comfortable position.

    To get out of the car, perform the reverse procedure.

    Typically, you will be allowed to drive 8 to 12 weeks after the operation, when you are walking properly and you do not need the 2 crutches to move.

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