Total Hip Replacement
Why undergo a total hip replacement?
Total hip replacement (THR) is used to replace the joint between the femur and the pelvis when it is damaged by osteoarthritis, that is, when there is damage to the cartilage.
Osteoarthritis is most often idiopathic, meaning it is due to wear and tear, but it can also be secondary :
- In the case of a fracture, we then speak of post-traumatic osteoarthritis,
- arthritis linked to an inflammatory disease or infection
- osteonecrosis of the femoral head
- hip dysplasia
- femoroacetabular impingement
In the images below, on the left, a normal hip with normal cartilage thickness, and on the right, a hip with supero-lateral coxarthrosis with bone-on-bone contact.
What is a total hip replacement?
A total hip replacement (THR) consists of:
- a hollow cup that is implanted in the acetabulum and articulates with the ball of the prosthesis; it can be impacted or cemented, with single or dual mobility
- a stem that is implanted in the femur; it can be made of steel or other materials (chromium/cobalt alloy or titanium). It can be coated with hydroxyapatite to adhere to the bone or cemented into the bone
- a ball that will articulate with the acetabular cup; it can be made of ceramic or a chromium/cobalt alloy
Lifespan is over 25 years in 90% of cases, but the most recent prostheses will likely have a longer lifespan.
How does the procedure proceed?
After a blood test, cardiological examination and an anesthesia consultation, the procedure most often takes place under general anesthesia and lasts about an hour.
A minimally invasive anterior approach is most often used, as it allows the prosthesis to be placed without cutting any muscle. Recovery is therefore faster and the risk of dislocation (loosening) of the prosthesis is reduced.
In certain specific cases, the surgeon will prefer to use a posterior approach or even a trochanterotomy for the most complex cases.
An infiltration of local anesthetics in the soft tissue around the joint, allows for a significant reduction in post-operative pain and limits the need for pain medication.
After the procedure?
After the procedure, patients can walk the same day with their full body weight; a pair of crutches is used for safety at first.
The length of hospital stay varies from 1 to 3 nights, but the procedure can sometimes even be done on an outpatient basis.
After the procedure, it is necessary to have the scar cared for for about two weeks and to take an anticoagulant treatment in tablet form to prevent phlebitis for 5 weeks.
Rehabilitation is prescribed at the beginning, but the most important thing is to walk as much as possible.
Resuming driving and sports activities is possible after a month and a half.