Total hip replacement, both primary and revision, is carried out to correct bone irregularities of the acetabulum and/or the femoral head of the hip, using prostheses to replace the damaged surfaces of the joint.
The most common condition to require total hip replacement is acute osteoarthritis, which represents 70% of all cases.
Since it was first introduced in 1969 and following repeated testing and experimentation with different materials and prostheses, which led to significant innovation, it has become a very successful technique by now.
The indication for total hip replacement is intense pain and reduced day-to-day activities.
Total hip replacement is justified if the pain persists despite any conservative measures, such as oral administration of non-steroidal anti-inflammatory drugs, weight loss, reduced activity or use of walking aids.
What conditions are dealt with by total hip replacement?
There are also other conditions that can be dealt with by the use of this type of operation. All of them, however, tend to cause secondary osteoarthritis.
These include developmental dysplasia of the hip (DDH), Paget’s disease, trauma and femoral head osteonecrosis.
Patients suffering from rheumatoid arthritis or other collagen-related conditions, such as systemic lupus erythematosus (SLE) and ankylosing spondylitis, can also benefit from such an operation.
Patients undergoing total knee replacement would rather be above 60 years of age, as physical requirements tend to be reduced over time and the longevity of the operation is almost the same as their life expectancy.
However, there are a good deal of younger people who may need this operation in order to continue working, doing sport and leading an active life.
Moreover, the development of new materials has now extended the life cycle of prostheses.
What does orthopedic hip surgery include?
It is an orthopedic operation that consists in removing the damaged femoral head, placing a metal stem (pin) into the hollow center of the femur, on top of which a metal or ceramic ball is affixed to replace the damaged femoral head.
The damaged cartilage surface of the socket (acetabulum) is also removed and replaced with a metal socket.
A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
It has been demonstrated that the operation fully relieves or eliminates pain and improves the functionality of the joint significantly in more than 90% of carefully chosen patients.
Just like any other surgical procedure, total hip replacement poses certain risks, which are rare though.
Dislocation of the hip is a postoperative issue if the artificial hip is smaller than the initial one. Thrombosis or infection may also occur.
In some cases the prosthesis may loosen or there may be mechanical failure or acute or chronic infection, which will require revision surgery.
During the revision, the initial prosthesis is removed and replaced by a new one.
This operation is more difficult in terms of technique due to the risk of fracture.
However, the advanced methods and materials used in the initial replacement surgery have reduced the need for revision.
Patients must have realistic expectations with respect to the level of activity which they will be able to carry out safely with the prosthesis, given that it may loosen due to long-term activity.
What minimally invasive method is used for total hip replacement?
In recent years, various Minimally Invasive Surgery (MIS) methods have been developed for total hip replacement.
These include the anterior, lateral and posterior approach to the hip.
However, the most revolutionary method in minimally invasive surgery is A.M.I.S. (Anterior Minimally Invasive Surgery), developed by MEDACTA.
This is so because the hip is only approached from the front side, with a short 5-8 cm long incision, without detaching or cutting any muscles!
The surgeon works his/her way through the muscles and nerves, without cutting them.
This helps minimize the risk of damage to periarticular structures, including tendons, vessels and nerves.
How is total hip replacement carried out using the A.M.I.S. – MEDACTA method?
Although the A.M.I.S. – MEDACTA method is difficult to implement, its results are very well established.
It was launched in France and developed by an international team of specialized surgeons who standardized it.
Thanks to the development of appropriate tools, it is now capable of meeting both physician and patient expectations for safe and quick results.
Due to the approach/technique used by the surgeon, the A.M.I.S. – MEDACTA method offers patients multiple advantages.
Immediate advantages include:
- Less intraoperative blood loss
- Minimal postoperative pain
- Immediate postoperative muscle tone preservation
- Shorter stays in hospital
- Faster recovery
- Faster return to daily activities
- Reduced risk of dislocation
Mid- and long-term advantages include:
- Prevention of trochanteric pain and limping
- Reduced risk of muscle degeneration
- Easier revision, if necessary
Moreover, it is a surgical method that ensures joint stability.
When practiced by experienced surgeons:
- It minimizes the need for extra tools due to the reduced risk of soft tissue damage
- It prevents the excessive use of retractors, thus causing no soft tissue damage.
- It facilitates femoral head osteotomy, thus ensuring the anatomical and ideal length of the leg.
The financial benefit is also very important, as it costs less than open surgery.
It has been established that total costs are reduced significantly thanks to faster recovery, fewer complications (and therefore shorter stays in hospital), no need for extra medication and other treatment, and faster return to work.
What do patients have to be careful about after the operation?
Patients who have undergone total hip replacement using the A.M.I.S. – MEDACTA method are able to walk without any restriction as soon as they feel ready to do so, even before they are dismissed from hospital.
Both before and after the operation, patients must see to it that they avoid any infections, to prevent the artificial hip from being infected.
Testing is needed for dental problems (gum disease, periodontitis, dental caries), infections of the lower urinary tract (often caused by incontinence) and skin infections, including nail infections, as they can compromise the prosthesis and shorten its life cycle.
Even in the event of suspected infection in a remote part of the body, patients should notify their physician immediately.
Regular osteoporosis testing is also needed, as the prosthesis may loosen and a fracture may occur in the periprosthetic area.