Hip replacement at Nordorthopaedics clinic

 

hip replacement Lithuania in private clinic
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About hip replacement
Anatomy of hip joint
Indications
Types of procedure
Types of implants
Technique
Recovery
Compilcations
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Hip replacement price

3.810 € / 3.300 £ / 4.500 $ (hip replacement surgery & rehabilitation)

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from 1.650 € / from 1.500 £ / from 1.980 $ (hip implants )

Interview with a surgeon

Defining hip replacement

The hip replacement, also known as the hip arthroplasty, is a surgical procedure when the damaged hip joint is replaced by the artificial one. Today it is one of the most common orthopaedic operations.

Anatomy of the hip joint

The hip joint is a connection between the pelvis and the femur (the thighbone). It is a ball-and-socket type joint where ‘the ball‘ is the head of the femur (also known as the femoral head) and ‘the socket‘ is the acetabulum (a cup-shaped cavity on the hipbone). The main function of the hip joint is to provide the stability when the person is standing and walking.

Indications

The most common indications for the hip replacement are sever pain and disfunction of the hip. These symptoms are persistent and limiting everyday activities. Before going through the hip replacement surgery, the doctor prescribes painkillers and physiotherapy. If conservative treatment is ineffective the only method is the hip replacement. Pain and disfunction of the hip joint are commonly caused by diseases which can affect people of all age groups.
What damages hip joint?

The most common disorder leading to the hip replacement is osteoarthritis. It is the main disorder causing the degeneration of the hip joint. According to the evidence based data, 80 to 90 percent of people older than 65 years have symptoms of primary osteorthritis. Women are more prone to have osteoarthritis then men.

Other disorders which damage hip joint are: rheumatoid arthritis (a chronical systemic inflammatory disease), osteonecrosis also known as avascular necrosis (a bone infarction caused by failure of the blood supply), bone tumors, Paget‘s disease associated arthritis, ankylosing spondylitis also known as Bekhterev‘s disease (a disorder of the spine involving hips), juvenile rheumatoid arthritis, protrusio acetabuli (a deformity of the acetabulum).

About 13 percent of all hip replacements are carried out in patients with hip traumas including hip fractures and traumatic arthritis.

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Types of the procedure

There are two main types of the hip replacement: total and hemi hip arthroplasty. During the total hip replacement surgery both parts of the joint – the acetabulum (‘the socket‘) and the femoral head (‘the ball‘) - are replaced while in the hemiarthroplasty only the head of the femur is operated.

Additionally, the total hip replacement can be classified into the classical total hip replacement and the articular surface replacement (ASR). In the classical method the neck and the head of the femur are replaced while in the ASR only the femoral head is operated.

Types of implants

The implant of the femoral head is called a femoral stem and the implant of the acetabulum is called the acetabular component or acetabular cup. Depending on the material used in the manufacturing of the implants, they can be:

  • polyethylene-on-metal, where the acetabular component is made of polyethilene and the femoral stem is made of metal;
  • metal-on-metal, where both components are metallic;
  • ceramic-on-ceramic, where both components are ceramic.

Depending on the fixation type, the implants are classified into the cemented and uncemented. The first type is commonly used for older patients because they are not considered to require revision surgery.

The most modern selection of the hip joint implants is called the Charnley‘s design. It consists of stainless steel femoral stem, polyethylene acetabular component and acrylic bone cement.

Technique

At first, the surgeon makes a 20 to 30 cm length incision over the hip and thigh. Secondly, the damaged tissues (cartilage and bone) of the hip joint are removed. The head of the femur is cut off using a small saw and then removed. Some surgeons use a hammer and a chisel instead of the saw.

If the total hip arthroplasty is being performed, the preparation of the acetabulum is also necessary. It is abraded with a special device called reamer in order to create a healthy and smooth surface. Once this is done, the surfaces of the bones are appropriate to accept the implants.

The thighbone is a hollow bone so there is no need to make an extra tunnel in order to attach the femoral stem. The implant is inserted directly into the natural canal of the thighbone. In the total hip replacement the acetabular component is implanted before the femoral stem. It can be threaded or cemented or just wedged into the prepared cavity.

Finally, the margins of the incision are closed with clips or stitches and the wound is covered with a sterile plaster.
The operation is performed under the general or regional (epidural or spinal) anaesthesia.

Recovery

The period of hospitalization after the hip replacement is usually 3 to 5 days. Some patients are encouraged to start walking on the day of the operation. However, if the patient is not physically strong and generally well, very early movements are not recommended. On the first 2 days at the hospital walkers or crutches are prescribed. The patient should use them while walking in order to decrease the load on the operated joint.

Moreover, a special pillow between thighs can be used in order to avoid the dislocation of the new joint while sleeping.
If the patient suffers from pain, ibuprofen or paracetamol can be prescribed.

Additionally, in order to prevent deep vein thrombosis, the anticlotting therapy is prescribed on the day of the operation.
The essential part of the recovery after the hip replacement is physiotherapy. A physiotherapist draws up the individual plan of exercises for each patient. Additionally, the patient should avoid some movements like crossing legs and twisting hips for about 6 weeks after the operation.

Usually a full recovery period lasts for about 3 to 6 months.

Complications

Complications which may occur during the operation or immediately after it are deep vein thrombosis, thromboembolism, infection, nerves (the sciatic or the femoral) palsy, fracture of the thighbone.

Other complications might occur later after the operation. For instance, the dislocation of the new hip joint. This means that the femoral head slips out the acetabulum. It is the most common complication of the hip arthroplasty. The other complication is the loosening of the new joint. It causes pain and requires extra surgery. Finally, really rare but possible complications are the breakage of the implants and the change in the leg length.

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