This post explains how to do a cemented Exeter Total Hip Replacement Arthroplasty in detail. Rather than re-write the Total Hip Replacement procedure, I have included a PDF version from the manufacturer – this can be read by clicking on the below link.
Exeter Total Hip Replacement
Exeter V40 Total Hip Replacement Arthroplasty procedure
What are the common precautions after Total Hip Replacements to prevent dislocations?
They are:
1. Not to bend the hip by more than 90degree. Hence no squatting, sitting in a low chair or couch.
2. Never cross your legs.
3. Never swivel on your new hip, take small steps to turn while lifting feet.
4. Never twist your upper body while your feet are fixed.
5. Avoid extreme positions of the hip while having sex.
6. Swimming is fine but breast-stroke must be avoided.
7. Avoid activities which have a higher risk of falling like skiing.
8. Avoid bending knees higher than the hips.
9. Avoid turning your hips inwards.
10.Avoid bending down to your hips.
Related Topics:-
* Precautions after a Total Hip Replacement
* Complications of Total Hip Replacement
* Complications of Dynamic Hip Screw – DHS
The surgical steps of Total Hip Replacement surgery consist of placing the patient on to the appropriate side on the operation table after appropriate anaesthetic.
The patient is suitably prepped and draped using appropriate aseptic precautions.
A 6 to 10 cm long incision is made on the side of the upper part of thigh.
This exposes the subcutaneous fat tissues.
Further dissection is carried out in between the various muscular layers.
This exposes the capsule of the hip joint.
A further incision is made to gain access to the neck of the femur bone.
Using a battery operated power saw the head is cut and removed.
The next step consists of reaming the shaft of the femur bone to an appropriate depth, allowing implantation of the prosthesis.
Then the acetabulum is reamed to a suitable depth.
The shaft part of the prosthesis is fixed using special biocompatible anti-biotic mixed cement as the anchoring substance.
Depending on the reason for doing the THR a suitable acetabular prostehsis is fixed using the same special cement.
Once the cement sets, the prosthesis is reduced back into the hip joint. In select cases the surgeon may decide not to use cement if he feels that the bone stock is strong enough.
The metallic head is attached to the neck of the prosthesis. The wound is closed in layers using stitches. A dressing is applied on top, which is removed in a few days time. Usually, the patient is allowed to start weight-bearing in the next few days as tolerated.
What are the types of Hip Replacements?
There are various types of prosthese:
1. Metal on Plastic: Here metallic head of the prosthesis articulates with plastic insert of the socket. Usually both the parts are fixed by using acrylic cement. Occasionally only the femoral component is fixed using cement and the acetabular component is made to fit in sungly. This is called a hybrid hip.
2. Resurfacing Hip: Here the ball part of the femoral bone is retained and shaved from the top. This is fitted with a metallic cap. This is used for younger patients and can be later on converted into a total hip replacement. This tends to have a lower dislocation rate and gives better function. It is not suitable for low bone density or osteoporosis.
3. Ceramic on ceramic: Not very popular – though usage is increasing every year. We think, in the next coming years, ceramic on ceramic THR will be a common procedure for the young patients.
Related Topics:-
* Precautions after a Total Hip Replacement
* Complications of Total Hip Replacement
* Complications of Dynamic Hip Screw – DHS
Dislocated Hip Replacement
Complications of Total Hip Replacement are as follows:
Please read Total Hip Replacement before reading the complications of THR
1. Blood clots in the leg’s or lungs (called as DVT or P.E). These happen due to prolonged immobilization, stress of surgery and dehydration. These conditions tend to produce reduced blood flow causing it to clot where it gets pooled within the vein.
2. Infection: Each time there is a cut made to the surface of the skin there is a chance of infection. The surgery is usually done in clean sterile environments, but infection can still happen. In case of infection treatment lies in intravenous antibiotics for a few days to a few weeks and in extreme cases by removal of the prosthesis (Girdle-stone Procedure).
3. Anesthetic problems. The stress of surgery can give patients problems like heart attacks, chest pains, irregular heartbeat, stroke or mini stroke.
4. Excessive blood loss: Some patients tend to lose more blood doing hip surgery than normally tolerated by the body. They may need blood transfusions to make up for the loss.
5. Dislocation of the prosthesis from the hip joint: Once the prosthesis has been implanted after surgery, any further fall onto the affected side can result in the prosthesis getting dislocated out of the hip joint. This dislocation might get reduced by simple traction under sedation in emergency departments or might need open surgery again.
6. Fracture of the femur can occur at any stage of the procedure.
7. Perforation of the pelvis or blood vessels in the pelvis may occur in case the screws fixing the acetabular components are too long.
8. Loosening of the implant and plastic wear and tear of the polyethylene component may happen leading to need for further revision surgery.
9. Localized bone resorption (osteolysis) may happen around the prosthesis site. This may make the implant loose leading to failure.
10. Nerve damage may happen temporarily or long term.
11. Limb length discrepancies: The leg may get shortened or longer occasionally. This might be corrected by a heel raise.
Related Topics:-
* Precautions after a Total Hip Replacement
* Complications of Total Hip Replacement
* Complications of Dynamic Hip Screw – DHS
Total Hip Replacement
What is a Total Hip Replacement (THR)?
The hip joint is a ball and socket joint between the socket in the pelvis called acetabulum and the head of the femur bone.
In this procedure both the parts of the hip joint namely the upper part of femur and the acetabulum (weight bearing socket in the pelvis) are replaced by prosthetic devices made of metal, plastic or other biocompatible materials.
The stem of the prosthesis is made of Vitallium, forged Titanium alloy and stainless steel along with a lot of other substances. The acetabular component can be made of metal and plastic.
THR procedure reduces pain and improves mobility. But they are not as strong or long lasting as a normal, healthy hip joint.
Types of Total Hip Replacement
Broadly there are 2 types of Total Hip Replacement:
1. Cemented Total Hip Replacement ( Bone Cement Used)
2. Un-Cemented Total Hip Replacement
Why do we need a Total Hip Replacement?
Some of the reasons are
1. Severe arthritis( rheumatoid arthritis or osteoarthritis) leading to constant pain present all the time not relieved by painkillers, affecting quality of life and reducing mobility. Arthritis means wearing away of cartilage at bony ends.
2. Displaced intra-capsular fracture of the neck of femur in a fit and active person usually above the age of 60 years.
3. Non-inflammatory degenerative joint disease like avascular necrosis
4. As a second procedure for treating complications of hip fracture which were initially treated by some other procedure like screw fixation.
5. To treat reactive arthritis in young people after traumatic injury to the hip.
What are the conditions in which THR should not be performed?
Conditions where THR should not be performed are:
1. Infection in the hip joint
2. Infection elsewhere in the body which can be carried through the blood stream to the hip joint at a later stage.
3. Patients who may not be complaint with post operative instructions due to mental diseases, severe dementia, frequent fallers as they are at a higher risk of complications and dislocations.
4. Severe osteoporosis and obesity may cause an increased risk of failure.
What are the factors affecting a successful outcome post THR?
Success post THR depends on:
1. Body weight of the patient: An overweight patient’s THR may not last as long due to increased wear and tear.
2. Patient’s activity levels and profession: Excessive physical activity can reduce the life of the prosthesis by increasing wear and tear.
3. Substance abuse, smoking or mental illness: They are associated with a higher complication rate.
4. Taking appropriate precautions life long to prevent dislocations.
5. Reasonable level of physical activity is desirable.
Now read about the Complications of Total Hip Replacement
Related Topics:-
* Precautions after a Total Hip Replacement
* Complications of Total Hip Replacement
* Complications of Dynamic Hip Screw – DHS