Total hip prosthesis is a surgery to replace the damaged joint with an artificial joint in patients whose hip joint is severely damaged. Hip prosthesis consists of main parts made of cobalt chrome or titanium and plastic, metal or ceramic spacers where they articulate.
Hip prosthesis can be attached to the bone in two ways. In older patients whose bone quality is not very good, the prosthesis is fixed to the bone with a filling material called bone cement. This type of prosthesis is called cemented hip prosthesis. In younger patients with good bone quality, prostheses covered with a porous material are placed very tightly into the bone, and then the body's bone moves into the pores on the prosthesis and provides fixation. This type of prosthesis is called cementless hip prosthesis.
WHO IS TOTAL HIP PROSTHESIS SUITABLE FOR?
Hip prosthesis is applied to people whose hip joint is severely damaged due to arthritis, hip dislocation, fracture or vascular disorder, if other treatment methods (medication, physical therapy, intra-articular injections, use of cane) fail to produce results.
Hip prosthesis is the best treatment option in cases of severe pain, movement limitation and shortness that prevent daily living activities. It is preferred that the patient is over 60 years of age, but it can also be applied to younger patients when necessary (e.g. rheumatoid arthritis).
WHAT ARE THE LATEST DEVELOPMENTS IN HIP PROSTHESIS?
Schematic view of the hip prosthesis
The prosthesis, which was first applied in 1960, has seen great developments in materials, technology and surgical techniques over the years. Today, metal-metal and metal-ceramic interfaces have been added to prostheses, which previously consisted only of metal and plastic interfaces. These new materials have superior wear properties and are expected to last longer than plastic interface prostheses. In this way, a field of application also emerges in younger patients.
While early hip prosthesis designs only allowed fixation with bone cement, today cementless hip prostheses have also been added. Thus, the prosthesis It is possible to attach directly to the bone without the need for a filling material.
Thanks to the design changes made in the size and geometric structure of the articulating parts of the hip prosthesis, the risk of dislocation of the prosthesis has been reduced. This has enabled the elimination of some restrictions imposed on old-designed hip prostheses during daily living activities.
In the past, interventions were made with much larger incisions and in a way that would damage large muscle groups, but today there are smaller incisions and It can be done by paying attention to the soft tissues around the hip. This made it easier to return to daily living activities after surgery.
Thanks to the improvements in post-operative pain control, hospital stay times have been shortened.
TOTAL WHAT SHOULD I EXPECT AFTER HIP PROSTHESIS?
After hip prosthesis surgery, hip pain disappears completely in the majority of patients, and there is a significant improvement in daily living activities such as walking, going up and down stairs. Leg shortness between 2-3 cm can be corrected.
It is not appropriate to do activities such as running, jumping and doing heavy work after the prosthesis. These will lead to premature wear of the prosthesis. It is not appropriate to sit on low chairs and cross your legs after the prosthesis, especially in the first 6 months. You should not sit at a table or sitting on a squat toilet all your life. Such excessive movements can cause hip joint dislocation and repeated surgeries. If you pray, you must do it while sitting on a chair.
You can drive 6-8 weeks after the surgery, but the driver's seat must be high and the hip joint must not be excessively bent. Your doctor will inform you about this. You should have a pillow between your legs while lying down for six weeks. Some of these restrictions may not apply to hip prostheses with new designs and large head structures.
6 weeks after the prosthesis surgery, you can do sports such as swimming, golf, walking and use an exercise bike. Sports such as tennis, football and basketball are not suitable.
TOTAL K DOES A LOWER LOWER PROSTHESITY HAVE A LIFETIME?
The parts that make up the total hip prosthesis wear out over time due to the friction that occurs during movement. The prosthesis is separated from the bone to which it is attached as a result of the body's response to metal and plastic pieces that are too small to be seen with the naked eye and appear due to wear. This leads to painful prosthesis loosening. The lifespan of hip prostheses made using appropriate surgical techniques and modern prosthesis designs has now been extended to 15-20 years. This period is expected to be longer in newly developed hip prostheses with ceramic and metal interfaces. Excessive weight and repetitive strenuous activities will increase wear and shorten the life of the prosthesis. In most patients, loosened prostheses can be removed with a second surgery and a hip prosthesis can be placed again, but the second surgery is more difficult, requires the use of larger prostheses, and the life of the second prosthesis is not as long as the first one.
HOW WILL MY SURGERY BE?
X-ray image of a patient who has undergone hip prosthesis
Total hip prosthesis can be performed with general or epidural anesthesia. The surgery takes around 2 hours. Pain pumps inserted through epidural or vascular access are used to prevent postoperative pain. Blood can be given intravenously to replace the blood you lost during and after the surgery. For the first few days, a V-shaped pillow can be placed between your legs. After waking up, breathing exercises are started. You will be able to stand up the day after surgery. You can walk short distances using a walker or crutches. Since it is not appropriate to sit in low places, you need to use toilet elevating devices in the hospital and at home. It may be necessary to avoid putting full weight on your operated leg for a certain period of time, in accordance with your doctor's recommendations. Hospital stay is between 3-7 days. After you are discharged, it is very important that you do the recommended exercises at home. To prevent blood clots from forming in your legs, you may need to use blood thinners for a while after leaving the hospital.
DO NOT DO AFTER SURGERY!
You may need to use blood thinners for at least 8 weeks. Do not cross your legs
Lean forward and eat while sitting Do not take anything from the toilet
Do not raise your knees above hip level
Do not sit on a squat toilet
Do not lean forward excessively when sitting or standing
WHAT COMPLICATIONS MAY OCCUR AFTER TOTAL HIP PROSTHESIS?
Serious complications after total hip prosthesis surgery occur at a very low rate. The most common problem is the formation of clots in your veins (deep vein thrombosis) due to slow blood flow in your leg. To prevent this, preventive treatment is applied with blood thinning medications after surgery. This treatment can be extended for up to 20 days if necessary. Starting to walk early after surgery and avoiding being sedentary will reduce this risk. The use of compression stockings may be beneficial.
After total hip prosthesis, infection, that is, inflammation of the prosthesis, is seen between 0.1% and 1.5%. Having an infection elsewhere in the body (e.g. in the urinary tract, teeth), having diabetes and other chronic diseases may increase this risk. It is necessary to treat any infections that may occur elsewhere in the body before surgery. Preventive antibiotic treatment is administered during surgery and the risk of infection is reduced by taking special precautions during surgery. If infection develops in the hip prosthesis, procedures such as repeated surgeries, removal of the prosthesis and reinsertion after a certain period of time may be required.
After total hip prosthesis, dislocation of the prosthesis is seen in 5-8%. It is very important to avoid certain movements after surgery, especially for the first 6 weeks. With the developments in surgical techniques and prosthesis design, dislocation rates have decreased compared to previous years.
During surgery, special precautions are taken to eliminate the height inequality between the legs. However, in some cases, leg lengthening may be necessary to restore soft tissue balance in the hip and prevent the risk of dislocation. Length differences up to 2 cm do not cause any problems as they will be balanced by the body. If necessary, the problem can be solved by placing height inside the shoe.
Apart from those listed above, wound healing problems, vascular or nerve injuries Complications such as fractures, dislocation of some parts of the prosthesis, fractures around the prosthesis, and fractures in the prosthesis itself may occur, but these are very rare.
WHAT SHOULD BE DONE TO PREVENT INFECTION AFTER TOTAL HIP PROSTHESIS?
Even if it is low, there is a risk that bacteria mixed with the blood will reach your hip prosthesis, settle there and cause an infection. If you are going to have a dental or urinary tract surgical procedure within the first two years after hip replacement surgery, you must use antibiotics beforehand. It is important to prevent infection with an appropriate antibiotic, especially one hour before procedures such as tooth extraction, stone cleaning and root canal treatment. It would be appropriate to consult your orthopedic doctor for the dosage and duration of the antibiotic.
You should also pay attention to foot care and inform your orthopedic doctor if signs of foot and nail infection occur.
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