3. INTRODUCTION
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Hip replacement
Also known for “Arthroplasty”
Arthroplasty is a reconstructive surgery to restore the joint motion and function and to relieve pain.
It generally involves the replacement of bony joint structure by a prosthesis.
It is the most common orthopaedic surgery.
Hip replacement surgery can be performed :-
Total replacement :- It consist of replacing both the acetabulum and the femoral head.
Half (hemi) replacement :- It consist of replacing of only femoral head in general.
Excision arthroplasty: In this type, one or both of the articular ends are excised so that a
gap is created between them. fibrous tissue that fills this gap its flexible, provides movement
at the joint.
5. ANATOMY
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The hip is one of the body's largest joints. It is a ball-and-socket
joint. The socket is formed by the acetabulum, which is part of
the pelvis bone. The ball is the femoral head, which is the upper
end of the femur (thighbone).
The bone surfaces of the ball and socket are covered with
articular cartilage, a smooth tissue that cushions the ends of the
bones and enables them to move easily.
A thin tissue called the synovial membrane surrounds the hip
joint. In a healthy hip, this membrane makes a small amount of
fluid that lubricates the cartilage and eliminates almost all friction
during hip movement.
Bands of tissue called ligaments (the hip capsule) connect the
ball to the socket and provide stability to the joint.
6. ANATOMY
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All of the nerves that travel down the thigh pass by the hip. The main nerves are the
femoral nerve in front and the sciatic nerve in back of the hip. A smaller nerve, called
the obturator nerve, also goes to the hip.
These nerves carry the signals from the brain to the muscles that move the hip. The
nerves also carry signals back to the brain about sensations such as touch, pain, and
temperature.
Traveling along with the nerves are the large vessels that supply the lower limb with
blood. The large femoral artery begins deep within the pelvis. It passes by the front of
the hip area and goes down toward the inner edge of the knee.
7. ANATOMY
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The femoral artery has a deep branch, called the profunda femoris (profunda means
deep). The profunda femoris sends two vessels that go through the hip joint capsule.
These vessels are the main blood supply for the femoral head. As mentioned earlier, the
ligamentum teres contains a small blood vessel that gives a very small supply of blood
to the top of the femoral head. Other small vessels form within the pelvis and supply the
hip.
8. INDICATIONS
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For patients with continuous pain and irreversibly damaged joints :-
Severe osteoarthritis.
Rheumatoid arthritis.
Selected fracture (femoral neck fracture).
Failure of Previous Reconstructive surgery
( osteotomy, femoral neck fracture complication ).
Congenital hip diseases.
Pathologic fractures from metastatic cancer.
Joint instability.
9. IMPLANTS
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The prosthetic implant used in hip replacement consist of different
part.
The acetabular cup.
The femoral component.
The articular interface.
Options exist for different patients and indications.
10. TYPE OF IMPLANT
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1. Ceramic
2. Metal-on-metal
3. Cemented, cementless or hybrid fixation of prosthesis.
11. TTPE OF FIXATION
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Cemented fixation :- cement stem
use acrylic bone cement to form a
mantle between the stem and the
bone.
Uncemented fixation :-
uncemented stem use friction, shape
and surface coating to stimulate
bone to remodel and bond to the
implant.
12. DESCRIPTION
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In a total hip replacement (Arthroplasty), the damaged bone and cartilage is removed
and replaced with prosthetic components.
The damaged femoral head is removed and replaced with a metal stem that is
placed into the hollow center of the femur. The femoral stem may be either
cemented or "press fit" into the bone.
A metal or ceramic ball is placed on the upper part of the stem. This ball replaces
the damaged femoral head that was removed.
The damaged cartilage surface of the socket (acetabulum) is removed and replaced
with a metal socket. Screws or cement are sometimes used to hold the socket in
place.
13. DESCRIPTION
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A plastic, ceramic, or metal spacer is inserted between the new ball and the socket
to allow for a smooth gliding surface
14. STEPS OF OPERATION
Removing the Femoral Head.
Reaming the Acetabulum.
Inserting the Acetabular Component.
Preparing the Femoral Canal.
Inserting Femoral Stem.
Attaching the Femoral Head.
The Completed Hip Replacement.
15. HEMIARTHROPLASTY
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A hemiarthroplasty is a surgical procedure
that involves replacing half of the hip joint.
Hemi means “half” and arthroplasty refers
to “joint replacement . A hemiarthroplasty
is generally used to treat a fractured hip. It
may also be used to treat a hip damaged by
arthritis.
A hemiarthroplastyTrusted Source procedure
results in less surgical time and less blood
loss than a THR. There may be less of a
chance of hip dislocation following a
hemiarthroplasty compared to a THR, too.
16. COMPLICATION RISKS
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Like any major surgery involving general anesthesia, hip replacement surgery carries
a low risk of blood clots, stroke, heart attack, arrhythmia, and pneumonia.
Bleeding
Blood vessel injury
Dislocation
Fractures
Infection
Leg-length inequality
Loosening of implant
Nerve injury
Pain
Stiffness
17. REFERENCE
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Louis Solomon, David Warwick, Selvadural Nayagam, “Apley’s system of
orthopaedics and fractures”, 9th edition.
Wiesel Dilahay Connel, “Essentials of orthopaedic surgery”,1st edition.
Samuel L Turek, “Orthopaedic – principles & their applications”, 4th edition,
volume-2.
William and Wilkins, “Lippincott Manual of nursing practices”, 9th edition.
Brunner & Suddarth’s, “Textbook of Medical-Surgical Nursing”, 12th edition,
volume-2.
https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/
https://www.hss.edu/condition-list_hip-replacement.asp
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hip-
replacement-surgery
https://www.drugwatch.com/hip-replacement/
