Physiotherapy Center: Don't Ignore Your Back Pain

About To Have Hip Replacement Surgery?

The hip functions as a “ball-and-socket” joint. The top of the thigh (femur) bone (ball) fits into a part of the pelvis called the acetabulum (socket), allowing the joint to move smoothly in multiple directions. Total hip replacement is a surgical procedure that replaces the hip joint with artificial parts. Adults of any age can be considered for a hip replacement, although most are carried out on people between the ages of 60 and 80. A modern artificial hip joint is designed to last for at least 20 years. Most people experience a significant reduction in pain and improvement in their range of movement. Hip replacement surgery is usually necessary when the hip joint is worn or damaged to the extent that your mobility is reduced, and you experience pain even while resting. The most common reason for hip replacement surgery is osteoarthritis. Other conditions that can cause hip joint damage include: Rheumatoid arthritis, Hip fracture, Septic arthritis, Ankylosing spondylitis, Dysplasia, Avascular necrosis etc. Total hip arthroplasty is an orthopedic procedure that involves the surgical excision of the head and proximal neck of the femur and removal of the acetabular cartilage. A canal is created in the proximal medullary region of the femur, and a metal femoral prosthesis, composed of a stem and small-diameter head, is inserted into the femoral medullary canal. An acetabular component composed of a high-molecular- weight polyethylene articulating surface is inserted proximally into the enlarged acetabular space. To yield successful results, these total hip arthroplasty components must be fixed firmly to the bone, either with polymethylmethacrylate cement or, in more recent uncemented designs, by bony ingrowth into a porous coating on the implant, resulting in “biologic” fixation. Traditional hip replacement surgery involves making an incision on the side of the hip (lateral approach) or the back of the hip (posterior approach). Both techniques involve detachment of muscles and tendons from the hip to replace the joint. Detachment of these muscles may result in increased pain after surgery, and often prolongs the time to fully recover by months or even years. Failure of these muscles to heal after surgery may increase the risk of hip dislocation (the ball and socket separating), which is the leading cause of hip replacement failure. Hip precautions after surgery (no bending greater than 90 degrees, no crossing legs, no excessive rotation) are generally required for this reason. Minimally invasive techniques have reduced the incidence of complications and increased the speed of recovery enabling patient to be put on accelerated rehabilitation programs. Mini lateral approach with

Dr. Alwin Almeida with hip replacement surgery patient Mrs. Carole Sinclair from Jamaica.

the Gibson’s modification or the more recent Direct Anterior approach are examples of such techniques and are routinely used at Health City, Cayman Islands. Directanteriorhip replacement isaminimally invasivesurgical technique. This approach involves a 3 to 4-inch incision on the front of the hip that allows the joint to be replaced by moving muscles aside along their natural tissue planes, without detaching any tendons. This approach often results in quicker recovery, less pain, and more normal function after hip replacement. Because the tendons aren’t detached from the hip during direct anterior hip replacement, hip precautions are typically not necessary. This allows patients to return to normal daily activities shortly after surgery with a reduced risk of dislocation.

Contributed by: - Dr. Alwin S. A. Almeida, MBBS, MS (Ortho) Senior Consultant, Orthopedic Surgeon, and Head of Department of Orthopedics

For more information please contact us at: Health City Cayman Islands 1283, Seaview road, P.O. Box No. 10590 Grand Cayman KY1-1005, Cayman Islands T: +1(345) 640-4040 C: +1(345) 525-2052

25 Eclipse Drive, P. O. Box 10742 George Town, Grand Cayman, KY1-1007

Phone : (345) 943-8700 Fax : (345) 943-8701

www.thephysiotherapycenter.com

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