Basic definitions

Anatomy of the hip joint

As a ball and socket joint, the natural hip joint is capable of a wide range of motion. The ball-like head (femoral head) of the thigh bone (femur) is placed in the bowl-like cavity (acetabulum) of the hip bone. The articular cartilage makes the inner surface of the bowl smooth and slippery and covers the ball-like head. The natural cartilage allows the ball-like head of the femur to move smoothly inside the socket so that the hip joint has a full range of motion without pain

Diseases of the hip joint
Arthritis

Arthritis or joint inflammation is a condition in which joint cartilage is damaged and destroyed, and the joint loses its soft and painless movement and its mobility is limited
Patients with hip arthritis have pain especially during activities such as walking, climbing stairs, getting up from a sitting position and standing for a long time. They may also have difficulty performing sports activities that involve rapid changes of direction, and movement in wider ranges than normal may cause pain
The most common type of hip joint inflammation is the destructive type or osteoarthritis, in which the cartilage of the hip joint is destroyed, or in some cases, the cartilage of the hip joint is broken and does not cover the hip joint. And the pain is in the patient
Another type of inflammation of the hip joint is called rheumatism, in this case, we see chronic inflammation of the hip joint, and in this type of disease, the body's immune system is disturbed, and as a result, it leads to swelling and pain in the hip joint. If left untreated, it may not only lead to a decrease in hip function and its disability, but in addition to hips and thighs, it may also damage knees, hands, and feet
Bone fracture

This fracture includes the fracture of the acetabulum or femur bone, which is usually more common in old age due to the decrease in bone density, or may occur as a result of an accident or accident
Avascular necrosis

In this type of disease, the blood supply to the head of the femur is cut off, causing the bone to die and the head of the femur to turn black, and the dead bone changes its shape after losing its hardness and strength under the pressure of the trunk
Femoral head necrosis in children is called Perth's disease
Congenital hip dislocation or DDH dysplasia

In this type of disease, the head of the femur bone is not placed in the right place due to the shallowness of the acetabular cavity, and it can even be placed in a false cavity that may slide in place and easily come out of place, which occurs from the time of birth. Gives

Choosing treatment and being a candidate for surgery

If, according to the doctor's diagnosis, taking into account all the consequences of the disease, you need surgery, hip arthroplasty or hip joint replacement should be performed
In some cases, there are other treatments that, if it cannot solve your problem, joint replacement is recommended as the final treatment, which includes the following
Adjusting and modifying daily activities is important in reducing the inflammatory symptoms of the hip joint. This means that it is better to reduce walking, especially if it is for exercise. Walking for long periods of time will definitely increase your pain. It is better to avoid climbing stairs. Also, it is better to avoid a series of sports activities such as running or sudden changes of direction that increase your pain. Although it is better to correct your movements, the important thing is to keep the joints mobile at the same time to maintain their range of motion and muscle strength. Your doctor may prescribe physical therapy for you. You can also use a stationary bike with a high saddle height and minimal resistance. Softening in water is also a good way to increase muscle strength and reduce weight pressure on painful joints. Some patients feel better by heating the involved joint, but the heat does not have much effect because it cannot penetrate the hip joint, which is located deep. Cooling using an ice pack can also be used, but most patients do not feel well with this method. The use of support equipment such as canes and crutches in the hand opposite the affected hip joint is useful for walking because it transfers weight from the affected joint to the healthy joint
Along with these methods, the use of oral drugs is also effective. These drugs usually start with drugs that do not require a doctor's prescription: such as combinations of aspirin, acetaminophen, and ibuprofen. If these drugs are not effective in reducing pain, your doctor may prescribe non-corticosteroid drugs for you. New medicinal supplements such as glucosamine and chondroitin sulfate may be effective in moderate to severe osteoarthritis. Another method of treatment is to inject coronet inside the affected hip joint, which reduces inflammation and finally reduces pain. This method may be repeated several times a year. The effect of this injection and how long its effect lasts cannot be predicted. Sometimes, for this injection, fluoroscopy or radiology method is used to guide the needle correctly before injecting the drug
Hip joint inflammation disease is usually progressive, which means it gets worse over time. The progress of the disease may not be seen in the radiological pictures, but it shows itself with increasing pain and decreasing tolerance. Sometimes the radiological picture shows progress in joint inflammation and bone destruction around the hip joint will indicate this progress. In some cases, this destruction may occur in a short time
The mentioned items may be allowed for people with hip arthritis

Let them continue their lives with these conditions. But if these other cases fail, the surgeon will suggest joint replacement

Hip replacement surgery and its purpose

Hip replacement surgery, which is also called total hip arthroplasty, includes removing the defective joint and replacing it with an artificial joint (prosthesis) with the aim of relieving pain, improving joint movements and function. The type of these prostheses is compatible with the human body and will not cause any reaction in the human body

Hip prosthesis includes the following parts

 
     This prosthesis is the main replacement of the femur bone, which is placed inside the femur bone after removing the head of the femur bone and creating a suitable channel in the body of the bone. The stoma may be non-cement, which can grow on its surface without the intervention of bone, or it may be cement, which is placed inside the bone and fixed by cement. Stems have different covers and sizes, which are chosen by the surgeon depending on the patient's needs
     femoral head
     After removing the femoral head, this prosthesis replaces the femoral head, which is placed on the neck of the stem and the other side is placed inside the liner and moves. The head can be made of metal or ceramic in different sizes
     Cup
     This prosthesis is placed inside the acetabular cavity after removing the bone, which has two types of cement and non-cement. The non-cement cup is usually made of metal, which has a kind of coating that allows the bone to grow on or inside it and leads to the strengthening of the cup in the acetabular cavity, and cement cups are generally made of hard plastic, which The bone cement medium is placed inside the acetabulum cavity and fixed. Sometimes screws are also used for non-cement cups
     Liner
     The liners are placed between the femoral head and the cup and are usually made of polyethylene and sometimes ceramic and metal, and they facilitate the movement of the head inside the cup

Necessary measures to prepare for surgery

Preparation for hip replacement surgery starts weeks before the exact date of surgery. The surgeon may discuss the following with you

     Dental examination: Dental surgeries such as tooth extraction and gum surgery should be done before joint replacement surgery to prevent infection
     Medication recommendations: The surgeon may advise you to stop taking some medications before the surgery, so before the surgery, it is necessary to inform the doctor or nurse of all the medications you are taking, whether chemical or herbal, and your food or drug sensitivities. Please inform. Some drugs that thin your blood will increase bleeding after surgery and interfere with your recovery, and the use of these types of drugs should be stopped before surgery, such as warfarin and...
     Stop smoking: smoking increases the risk of developing pulmonary problems after surgery and has a negative effect on wound healing.
     Weight loss: Patients who are overweight reduce the pressure on their new joint by losing weight
     Laboratory tests: Blood tests, urine tests, ECG and chest X-ray may be done before surgery to check the readiness of the operation
     Health and increase in body muscle strength: It is important to be in the best state of your general health in order to perform the surgery as well as possible, so be sure to consume healthy food and plenty of fluids a few days before the operation, and rest and exercise. Make sure you have enough. Considering that you will have to use a walker or cane for some time after the operation, so in the video below, some exercises that the surgeon may recommend to you to increase the strength of the joints are introduced.
     Remember to consult your doctor before starting any exercise program. Also, inform your doctor in case of pain and swelling after exercise
     Asking questions: Be sure of what is going to be done and it is important to ask the surgeon every little question you have in mind before surgery. It is also important to talk to your surgeon about the surgical procedures that can be used for you
     Insurance coverage: If you use insurance coverage, make sure it is valid

Hip replacement surgery technique

Anesthesia
Hip replacement surgery is performed under general anesthesia or spinal anesthesia (epidural or spinal). So that during the surgery, you will not feel any pain or discomfort, and depending on the patient's condition, the medical team will determine the type of anesthesia for the patient

The steps of hip surgery are as follows
In joint replacement surgery, damaged cartilages and bones are removed and artificial organs are removed
(prosthesis) is placed in it according to the following

     To start the operation, the surgeon makes a skin incision in the hip joint area to access the soft tissue and muscles around the hip joint
     After reaching the joint, a piece of bone is removed from the cavity and the neck of the femur is removed by making an incision
     By removing the head of the bone, the cavity of the hip joint is made available, and after measuring the cavity for the correct selection of the prosthesis, the inside of the cavity is prepared with a special device to match the shape of the outer part of the prosthesis. The cup prosthesis is carefully placed inside the prepared cavity
     This prosthesis is fixed in place with different methods depending on the preferred method of the surgeon based on the quality of your bone. this The procedure may include the use of orthopedic cement to hold the cup in place. Most prosthetic cups are designed to allow bone to grow into the metal surface of the prosthesis to hold the prosthesis in place. This type of fixation may require screws to hold the prosthetic cup in place prior to bone growth
      The inside of the femur is emptied with special devices so that the trial model of the prosthesis can be placed inside it. The ball head test sample is placed on the hip prosthesis and the plastic layer is placed inside the cup prosthesis
     Then, the hip joint is activated by placing a ball-like head inside the bowl, its movement is checked in different directions, and its stability is evaluated
     When the best combination of prostheses is obtained, the final prosthesis is placed inside the femur and fixed
     At the end, your surgeon carefully closes the layers of soft tissue and skin with stitches, and after the surgery, the patient is transferred to the recovery room