Hip
Total Hip Replacement
Hip Fracture Surgery
What is Total Hip Replacement?Total hip replacement is a surgical procedure in which the damaged cartilage and bone are removed from the hip joint and replaced with artificial components. The main indication for total hip replacement is arthritis.
Arthritis is the inflammation of joints, which results in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability.
Symptoms of ArthritisTotal Hip ReplacementThe most common symptom of hip arthritis is joint pain and stiffness, resulting in a limited range of motion. Vigorous activity can increase pain and stiffness, which may cause limping while walking.
Diagnosis of ArthritisDiagnosis is made by evaluating your medical history, performing a physical examination and taking X-rays of the arthritic joint.
Total Hip Replacement ProcedureSurgery may be recommended if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve your symptoms.
The surgery is performed under general anesthesia. During the procedure, a surgical cut is made over the hip to expose the hip joint and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone removed using a reamer. The acetabular component is inserted into the socket using screws, or occasionally, bone cement. A liner made of plastic, ceramic or metal is placed inside the acetabular component.
The femur or thighbone is then prepared by removing the arthritic bone using special instruments to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place using special cement. The muscles and tendons around the new joint are repaired and the incision is closed.
Postoperative Care following Total Hip ReplacementAfter undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and ensure proper healing. Some of the common precautions to be taken include:
Avoid the combined movement of bending your hip and turning your foot inwardsKeep a pillow between your legs while sleeping for 6 weeksNever cross your legs and bend your hips past a right angle (90)Avoid sitting on a low chairAvoid bending down to pick up things; instead, a grabber can be used to do soUse an elevated toilet seatRisks and Complications of Total Hip ReplacementAs with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement may include:
InfectionDislocationFracture of the femur or pelvisInjury to nerves or blood vesselsFormation of blood clots in the leg veinsLeg length inequalityWearing out of the hip prosthesisFailure to relieve painScar formationPressure sores
Arthritis is the inflammation of joints, which results in pain, swelling, stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability.
Symptoms of ArthritisTotal Hip ReplacementThe most common symptom of hip arthritis is joint pain and stiffness, resulting in a limited range of motion. Vigorous activity can increase pain and stiffness, which may cause limping while walking.
Diagnosis of ArthritisDiagnosis is made by evaluating your medical history, performing a physical examination and taking X-rays of the arthritic joint.
Total Hip Replacement ProcedureSurgery may be recommended if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve your symptoms.
The surgery is performed under general anesthesia. During the procedure, a surgical cut is made over the hip to expose the hip joint and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone removed using a reamer. The acetabular component is inserted into the socket using screws, or occasionally, bone cement. A liner made of plastic, ceramic or metal is placed inside the acetabular component.
The femur or thighbone is then prepared by removing the arthritic bone using special instruments to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place using special cement. The muscles and tendons around the new joint are repaired and the incision is closed.
Postoperative Care following Total Hip ReplacementAfter undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and ensure proper healing. Some of the common precautions to be taken include:
Avoid the combined movement of bending your hip and turning your foot inwardsKeep a pillow between your legs while sleeping for 6 weeksNever cross your legs and bend your hips past a right angle (90)Avoid sitting on a low chairAvoid bending down to pick up things; instead, a grabber can be used to do soUse an elevated toilet seatRisks and Complications of Total Hip ReplacementAs with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement may include:
InfectionDislocationFracture of the femur or pelvisInjury to nerves or blood vesselsFormation of blood clots in the leg veinsLeg length inequalityWearing out of the hip prosthesisFailure to relieve painScar formationPressure sores
What is Hip Fracture Surgery?Hip Fracture SurgerySurgical correction of a hip fracture is known as hip fracture surgery.
Hip fractures involve a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
AnatomyThe hip joint is a “ball and socket” joint. The “ball” is the head of the femur or thigh bone, and the “socket” is the cup-shaped acetabulum. The hip joint enables the upper leg to bend and rotate at the pelvis. The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint.
Causes of Hip FracturesHip fractures are most frequently caused after minor trauma in elderly patients with weak bones, and by a high-energy trauma or serious injuries in younger people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of hip fractures.
Signs and Symptoms of Hip FracturesSigns and symptoms of hip fractures include:
Pain in the groin or outer upper thighSwelling and tendernessDiscomfort while rotating the hipShortening of the injured legOutward or inward turning of the foot and knee of the injured legDiagnosis of Hip FracturesYour doctor is able to diagnose a hip fracture based on your symptoms, abnormal posture of your leg and hip, and a thorough physical examination. Your doctor may also order imaging tests, such as X-rays, MRI scan, or bone scan to confirm and view the hip fracture.
Preoperative AssessmentA preoperative assessment will be made before surgery to check your overall health to make sure you are ready for the surgery. You will be asked about any medications that you are taking and the need to stop if necessary. You will have an anesthetic assessment to decide on what type of anesthesia will be used during surgery. You will be given antibiotics to reduce the risk of wound infection post surgery. An anticoagulant such as heparin may be given since the surgery carries the risk of a blood clot. Blood tests, urine samples, chest X-rays, electrocardiograms will be checked to look for any irregularities.
Surgical Treatment of Hip FracturesSurgery is employed when a conservative approach such as medications, injections, and physiotherapy fail to provide satisfactory results.
Hip fracture surgery is performed under anesthesia either arthroscopically or through open surgery. Your surgeon will decide which approach is the best for your condition.
In general, an incision is made at the top of your thigh to expose the bones of the hip joint. The fractured or damaged joint is replaced with a prosthesis. The leg is moved to check for a satisfactory range of motion once the prosthesis is placed. The surgical incision is then closed with sutures and dressings to complete the operation.
Different surgical procedures are used for the treatment of hip fractures, and the type of surgery normally depends upon the severity and location of the fracture.
Total Hip Replacement: This is an operation to replace both the natural socket in the hip and femoral head with prostheses. The upper femur and the socket in your pelvic bone are replaced with a prosthetic implant.Partial Hip Replacement: This is an operation to replace the damaged femoral head with a prosthesis. The traumatically fractured or damaged ball-like head of the thigh bone (the femoral head) is replaced with a prosthetic implant.Internal Fixation: This is an operation to hold the bone in place while it heals with screws, pins, rods, or plates. Your fracture will be corrected by placing a sliding hip screw into the head of the thighbone (femur), secured to the top of the thigh bone to hold the fracture together.Postoperative Care InstructionsInstructions for postoperative care include:
Use of assistive devices such as splints and crutches for walkingKeep your leg elevated to decrease swellingRest the hip as much as possibleMedications to control pain and swellingLimited weight-bearing activitiesFollow a balanced, varied dietPhysiotherapy to improve flexibility, range of motion, and strengthen musclesAdhere to follow-up appointmentsWhat are the Risks Associated with Hip Fracture Surgery?As with any surgery, some of the potential risks associated with hip fracture surgery include:
Improper or non-union of boneInfection and wound complicationsDamage to nerves and blood vesselsLeg-length discrepancyFractureBleedingDeep vein thrombosis (blood clot)Bedsores due to lack of movement post surgeryMuscle atrophyDeterioration of mental health in old patientsAvascular necrosisWhat are the Benefits of Hip Fracture Surgery?Some of the benefits associated with successful hip surgery include:
Reduced painDecreased stiffnessImproved mobility, strength, and coordinationAbility to maintain an active lifestyle
Hip fractures involve a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
AnatomyThe hip joint is a “ball and socket” joint. The “ball” is the head of the femur or thigh bone, and the “socket” is the cup-shaped acetabulum. The hip joint enables the upper leg to bend and rotate at the pelvis. The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint.
Causes of Hip FracturesHip fractures are most frequently caused after minor trauma in elderly patients with weak bones, and by a high-energy trauma or serious injuries in younger people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of hip fractures.
Signs and Symptoms of Hip FracturesSigns and symptoms of hip fractures include:
Pain in the groin or outer upper thighSwelling and tendernessDiscomfort while rotating the hipShortening of the injured legOutward or inward turning of the foot and knee of the injured legDiagnosis of Hip FracturesYour doctor is able to diagnose a hip fracture based on your symptoms, abnormal posture of your leg and hip, and a thorough physical examination. Your doctor may also order imaging tests, such as X-rays, MRI scan, or bone scan to confirm and view the hip fracture.
Preoperative AssessmentA preoperative assessment will be made before surgery to check your overall health to make sure you are ready for the surgery. You will be asked about any medications that you are taking and the need to stop if necessary. You will have an anesthetic assessment to decide on what type of anesthesia will be used during surgery. You will be given antibiotics to reduce the risk of wound infection post surgery. An anticoagulant such as heparin may be given since the surgery carries the risk of a blood clot. Blood tests, urine samples, chest X-rays, electrocardiograms will be checked to look for any irregularities.
Surgical Treatment of Hip FracturesSurgery is employed when a conservative approach such as medications, injections, and physiotherapy fail to provide satisfactory results.
Hip fracture surgery is performed under anesthesia either arthroscopically or through open surgery. Your surgeon will decide which approach is the best for your condition.
In general, an incision is made at the top of your thigh to expose the bones of the hip joint. The fractured or damaged joint is replaced with a prosthesis. The leg is moved to check for a satisfactory range of motion once the prosthesis is placed. The surgical incision is then closed with sutures and dressings to complete the operation.
Different surgical procedures are used for the treatment of hip fractures, and the type of surgery normally depends upon the severity and location of the fracture.
Total Hip Replacement: This is an operation to replace both the natural socket in the hip and femoral head with prostheses. The upper femur and the socket in your pelvic bone are replaced with a prosthetic implant.Partial Hip Replacement: This is an operation to replace the damaged femoral head with a prosthesis. The traumatically fractured or damaged ball-like head of the thigh bone (the femoral head) is replaced with a prosthetic implant.Internal Fixation: This is an operation to hold the bone in place while it heals with screws, pins, rods, or plates. Your fracture will be corrected by placing a sliding hip screw into the head of the thighbone (femur), secured to the top of the thigh bone to hold the fracture together.Postoperative Care InstructionsInstructions for postoperative care include:
Use of assistive devices such as splints and crutches for walkingKeep your leg elevated to decrease swellingRest the hip as much as possibleMedications to control pain and swellingLimited weight-bearing activitiesFollow a balanced, varied dietPhysiotherapy to improve flexibility, range of motion, and strengthen musclesAdhere to follow-up appointmentsWhat are the Risks Associated with Hip Fracture Surgery?As with any surgery, some of the potential risks associated with hip fracture surgery include:
Improper or non-union of boneInfection and wound complicationsDamage to nerves and blood vesselsLeg-length discrepancyFractureBleedingDeep vein thrombosis (blood clot)Bedsores due to lack of movement post surgeryMuscle atrophyDeterioration of mental health in old patientsAvascular necrosisWhat are the Benefits of Hip Fracture Surgery?Some of the benefits associated with successful hip surgery include:
Reduced painDecreased stiffnessImproved mobility, strength, and coordinationAbility to maintain an active lifestyle
Trochanteric Bursitis
Revision Hip Replacement
TRONCHANTERIC BURSITISBursas are small sacs of fluid that cushion and lubricate the areas between tendons and bones. Bursitis is inflammation of these sacs.
The trochanteric bursa is located around the gluteal muscles that attach to the greater trochanter at the upper end of the thigh. Trochanteric bursitis is more common in middle-aged or elderly women but can occur in anyone.
Trochanteric bursitis can be caused by an acute injury but more often than not has no obvious cause. It is however more common with repetitive activities such as jogging or bicycling.
SymptomsSymptoms of trochanteric bursitis may include:
Hip pain, and sometimes buttock pain that spreads down the outside of the thigh to the knee area. Pain may be worse during activities such as walking, running, or sitting cross-legged. The pain may be aggravated by lying on that side and may wake you up.There may be tenderness when you press on the affected area.Limping.Mild swelling.TreatmentTreatment for bursitis includes:
Rest.Ice packs to the affected area.Simple analgesics or anti-inflammatory medication.Weight loss.Physiotherapy is an important part of treatment involving stretching exercises as well as strengthening exercises for muscles around the hip.Avoiding prolonged standing or other activities that causes pain.Using a cane, to reduce pressure on the hip.If the above treatment does not relieve the pain, medical treatment such as local anaesthetic or steroid injections into the bursa may help.
Occasionally several injections are required. Surgery is a last resort but may occasionally be recommended.
Injection TechniqueTroch BursitisPositioning of injection for Trochanteric Bursitis
The choice of steroid varies. Celestone is one of the more common steroids used. Mix 2 ampoules of Celestone with local anaesthetic (lignocaine) in a 10ml syringe. Mix and inject using an aseptic technique using a blue or green (21,23G) needle. Spread the injection in an area approx 3 to 5 cm without withdrawing the needle totally from the skin, ie.withdraw sligtly and move the needle around 2 or 3 times.
To view an operative video of a Trochanteric Injection, click here.
How Long Does it Last?The effects usually take 24-48 hours to work. For the first day or two there can actually be a slight increase in pain as the corticosteroid starts to work. The effects can last anywhere from a week to 6 months but it is only temporary. The injection can be repeated if required (up to three a year).
Where is it Done?Corticosteroids can be injected into the trochanteric bursa in the office under aseptic conditions.
ContraindicationsSuspected infection.Immunosuppression.Allergy to local anaesthetic or steroids.Side EffectsAll side effects are rare.Risk of infection is very low (1 in 5000).Skin discoloration.Fat Necrosis.Flare up of symptoms for a day or two.Rise in sugar levels in diabetics- need to monitor levels carefully for two days.
The trochanteric bursa is located around the gluteal muscles that attach to the greater trochanter at the upper end of the thigh. Trochanteric bursitis is more common in middle-aged or elderly women but can occur in anyone.
Trochanteric bursitis can be caused by an acute injury but more often than not has no obvious cause. It is however more common with repetitive activities such as jogging or bicycling.
SymptomsSymptoms of trochanteric bursitis may include:
Hip pain, and sometimes buttock pain that spreads down the outside of the thigh to the knee area. Pain may be worse during activities such as walking, running, or sitting cross-legged. The pain may be aggravated by lying on that side and may wake you up.There may be tenderness when you press on the affected area.Limping.Mild swelling.TreatmentTreatment for bursitis includes:
Rest.Ice packs to the affected area.Simple analgesics or anti-inflammatory medication.Weight loss.Physiotherapy is an important part of treatment involving stretching exercises as well as strengthening exercises for muscles around the hip.Avoiding prolonged standing or other activities that causes pain.Using a cane, to reduce pressure on the hip.If the above treatment does not relieve the pain, medical treatment such as local anaesthetic or steroid injections into the bursa may help.
Occasionally several injections are required. Surgery is a last resort but may occasionally be recommended.
Injection TechniqueTroch BursitisPositioning of injection for Trochanteric Bursitis
The choice of steroid varies. Celestone is one of the more common steroids used. Mix 2 ampoules of Celestone with local anaesthetic (lignocaine) in a 10ml syringe. Mix and inject using an aseptic technique using a blue or green (21,23G) needle. Spread the injection in an area approx 3 to 5 cm without withdrawing the needle totally from the skin, ie.withdraw sligtly and move the needle around 2 or 3 times.
To view an operative video of a Trochanteric Injection, click here.
How Long Does it Last?The effects usually take 24-48 hours to work. For the first day or two there can actually be a slight increase in pain as the corticosteroid starts to work. The effects can last anywhere from a week to 6 months but it is only temporary. The injection can be repeated if required (up to three a year).
Where is it Done?Corticosteroids can be injected into the trochanteric bursa in the office under aseptic conditions.
ContraindicationsSuspected infection.Immunosuppression.Allergy to local anaesthetic or steroids.Side EffectsAll side effects are rare.Risk of infection is very low (1 in 5000).Skin discoloration.Fat Necrosis.Flare up of symptoms for a day or two.Rise in sugar levels in diabetics- need to monitor levels carefully for two days.
IntroductionThis means that part or all of your previous hip replacement needs to be redone. This operation varies from very minor adjustments to massive operations replacing significant amounts of bone and hence is difficult to describe in full.
A Hip Replacement consists of a femoral component with a ball placed onto it, an acetabular component attached to the pelvis, and an insert in between.
Why does a Hip need to be Revised?Pain is the primary reason for revision. Usually the cause is clear but not always. Those hips without an obvious cause for pain in general do not do as well after surgery.Plastic (polyethylene) wear. This is one of the less complicated revisions where only the plastic insert is changed.Dislocation (instability) which means the hip is popping out of joint.Loosening of either the femoral or acetabular component. This usually presents as pain but may be asymptomatic. It is for this reason that you must have your joint followed up for life. There there can be changes on x-ray that indicate that the hip should be revised despite having no symptoms.Infection – usually presents as pain but may present as an acute fever or a general feeling of being unwell.Osteolysis (bone loss). This can occur due to particles being released into the hip joint which result in bone being destroyed.Pain from hardware e.g., cables or wires causing irritation.InvestigationsX-rays are essential and should be of good quality.A CT scan may be ordered to look closer at the anatomy.Routine blood tests – especially to rule out infection.Bone scans can help to determine if a component is loose.Aspiration of the joint is occassionally done to diagnose or rule out infection.SurgeryIt will be explained to you prior to surgery what is likely to be done but in revision surgery the unexpected can happen and good planning can prevent most potential problems.
The surgery is often, but not always, more extensive than your previous surgery and the complications similar but more frequent than the first operation. (see complications section in Total Hip Replacement).
The surgery varies from a simple liner exchange to changing one or all of the components. Extra bone (cadaver bone) may need to be used to make up for any bone loss.
Post-OperativeAgain this is similar but often a bit slower than the first hip replacement. The amount of weight you can put on it and the recovery period really does depends on what was done and is hard to generalise.
A Hip Replacement consists of a femoral component with a ball placed onto it, an acetabular component attached to the pelvis, and an insert in between.
Why does a Hip need to be Revised?Pain is the primary reason for revision. Usually the cause is clear but not always. Those hips without an obvious cause for pain in general do not do as well after surgery.Plastic (polyethylene) wear. This is one of the less complicated revisions where only the plastic insert is changed.Dislocation (instability) which means the hip is popping out of joint.Loosening of either the femoral or acetabular component. This usually presents as pain but may be asymptomatic. It is for this reason that you must have your joint followed up for life. There there can be changes on x-ray that indicate that the hip should be revised despite having no symptoms.Infection – usually presents as pain but may present as an acute fever or a general feeling of being unwell.Osteolysis (bone loss). This can occur due to particles being released into the hip joint which result in bone being destroyed.Pain from hardware e.g., cables or wires causing irritation.InvestigationsX-rays are essential and should be of good quality.A CT scan may be ordered to look closer at the anatomy.Routine blood tests – especially to rule out infection.Bone scans can help to determine if a component is loose.Aspiration of the joint is occassionally done to diagnose or rule out infection.SurgeryIt will be explained to you prior to surgery what is likely to be done but in revision surgery the unexpected can happen and good planning can prevent most potential problems.
The surgery is often, but not always, more extensive than your previous surgery and the complications similar but more frequent than the first operation. (see complications section in Total Hip Replacement).
The surgery varies from a simple liner exchange to changing one or all of the components. Extra bone (cadaver bone) may need to be used to make up for any bone loss.
Post-OperativeAgain this is similar but often a bit slower than the first hip replacement. The amount of weight you can put on it and the recovery period really does depends on what was done and is hard to generalise.