Total Hip Replacement

What is Total Hip Replacement?

Total hip replacement is a surgical procedure that involves replacing a damaged hip joint with an artificial joint in patients with advanced degeneration of the hip joint. The hip prosthesis can be attached to the bone in two ways. In older patients with poor bone quality, the prosthesis is fixed to the bone using a filler material called bone cement. These types of prostheses are called cemented hip prostheses. In younger patients with good bone quality, prostheses with a porous coating are tightly inserted into the bone, and the body’s bone growth into the pores of the prosthesis ensures fixation. These types of prostheses are called uncemented hip prostheses.

Who is a Candidate for Total Hip Replacement?

Total hip replacement is performed in individuals with advanced damage to the hip joint due to conditions such as arthritis, hip dislocation, hip fracture, or vascular disorders when other treatment methods (medication, physical therapy, intra-articular injections, walking aids) fail to provide relief. Hip replacement is the best treatment option for severe pain, limited mobility, and disability that interfere with daily activities.

What Can I Expect After Total Hip Replacement?

After hip replacement surgery, most patients experience complete relief from hip pain and significant improvement in daily activities such as walking and climbing stairs. Leg length discrepancies of 2-3 cm can be corrected.

Engaging in activities such as running, jumping, and heavy lifting is not recommended after the prosthesis surgery as they can cause early wear of the prosthesis. Especially in the first 6 months after the procedure, it is not advisable to sit on low chairs or cross your legs. Throughout your lifetime, it is important to avoid sitting on the floor and using squat toilets. These excessive movements can lead to hip dislocation and subsequent revision surgeries. If you practice religious activities such as prayer, you should perform them while sitting on a chair.

Six weeks after the prosthesis surgery, you can engage in activities like swimming, golf, walking, and use an exercise bike. However, sports such as tennis, soccer, and basketball are not suitable.

Does Total Hip Replacement Have a Lifespan?

The components that make up the total hip prosthesis wear out over time due to friction during movement. The prosthesis may become loose from the bone due to the body’s response to the small metal and plastic particles that result from wear, causing painful prosthesis loosening. With appropriate surgical techniques and modern prosthesis designs, the lifespan of hip prostheses has now extended up to 20 years. The use of newly developed ceramic and metal-on-metal hip prostheses is expected to further extend this duration. Excessive weight and repetitive strenuous activities can increase wear and shorten the lifespan of the prosthesis. If the prosthesis becomes loose, it can be removed and replaced with another hip prosthesis in most patients, but the second surgery is more challenging, requires the use of larger prostheses, and the lifespan of the second prosthesis is not as long as the first one.

What complications can occur after total hip replacement?

Serious complications following total hip replacement surgery are very rare. The most common issue is the formation of blood clots in the deep veins of the legs (deep vein thrombosis) due to slowed blood flow in the legs. To prevent this, preventive treatment with blood-thinning medications is administered after surgery. This treatment may be extended for up to 30 days if necessary. Starting walking early after the surgery and avoiding immobilization can reduce this risk. Wearing compression stockings can be beneficial.

After total hip replacement, infection (inflammation of the prosthesis) occurs in about 0.1% to 1.5% of cases. Infection in another part of the body (e.g., urinary tract, teeth), the presence of diabetes and other chronic diseases can increase this risk. Treatment of possible infections in other parts of the body before surgery is necessary. Protective antibiotic treatment is administered during surgery, and special precautions are taken to reduce the risk of infection. If an infection develops in the hip prosthesis, repeated surgeries may be necessary, such as removing the prosthesis and re-implanting it after a certain period.

Dislocation of the prosthesis occurs in about 5-8% of cases after total hip replacement. Avoiding specific movements, especially during the first 6 weeks after surgery, is crucial. With advances in surgical techniques and prosthesis design, the dislocation rates have decreased compared to previous years.

Special measures are taken during hip surgery to correct leg length discrepancies. However, in some cases, lengthening of the leg may be necessary to achieve soft tissue balance in the hip and prevent dislocation. Length differences up to 2 cm can be compensated for by the body without causing problems. If needed, the issue can be addressed by using inserts to adjust the height inside the shoes.

In addition, complications such as wound healing problems, vascular or nerve injuries, displacement of certain prosthesis components, periprosthetic fractures, and fractures within the prosthesis itself can occur, but these are extremely rare.

How to Prevent Infection after Total Hip Replacement?

Although the risk is low, there is a possibility of bacteria entering your hip prosthesis through the bloodstream and causing an infection. If you are going to undergo any surgical procedures related to the teeth or urinary tract within the first two years after hip prosthesis surgery, it is essential to use antibiotics beforehand. In particular, taking appropriate antibiotics for infection prevention one hour before procedures such as tooth extraction, tartar cleaning, and root canal treatment is important. It is advisable to consult your orthopedic doctor for the dosage and duration of the antibiotic. Additionally, you should pay attention to foot care and inform your orthopedic doctor if there are any signs of foot or nail infection.

How Will Hip Prosthesis Surgery Be Performed?

Total hip replacement surgery can be performed under general or epidural (spinal anesthesia). The surgery takes about 2 hours. Suitable antibiotics are used for prophylaxis at the beginning of the surgery. Epidural or intravenous pain pumps are used to prevent pain after the surgery. Blood transfusion through the veins may be required to compensate for the blood loss during and after the surgery. A V-shaped pillow may be placed between your legs for the first few days. Breathing exercises are initiated after waking up from anesthesia. You will be assisted to stand up on the day after the surgery. You can walk short distances using a walker or crutches. Due to the unsuitability of sitting on low surfaces, you will need to use toilet seat elevators in the hospital and at home. It may be necessary to avoid fully bearing weight on the operated leg for a certain period as advised by your doctor. The length of hospital stay is between 3 to 7 days. After discharge, it is crucial to perform the recommended exercises at home. The use of blood-thinning medications may be necessary for a period to prevent blood clots in the legs.

What Precautions Should Be Taken After Hip Prosthesis Surgery?

• Avoid crossing your legs for at least 8 weeks.
• Do not bend forward to pick up something from the floor while sitting.
• Do not lift your knees above hip level.
• Avoid using squat toilets.
• Do not lean forward excessively when sitting or standing up.