Introduction
Hip subluxation occurs due to the partial dislocation of the hip joint which leads to pain and spasm thus making it difficult to put weight on pressure on the affected side. The person also finds it difficult to stand up or walk properly in this condition due to extreme pain. Therefore, Hip subluxation and dislocation need surgical treatment for which various procedures and options are available. Extreme cases require hip replacement surgery. The subluxation can be treated with non-surgical methods. Severe cases may require surgical interventions depending on the patient’s need.
What Are the Non-surgical Modalities of Treatment?
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Using pain medication to subside the pain.
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Using skeletal muscle relaxants.
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Physical therapy.
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Implementing lifestyle changes to prevent excessive or repetitive strain on the hip joint.
Hip replacement surgery is necessary when these techniques mentioned above fail to address the underlying problems.
What Are the Types and Approaches for Hip Surgery?
A hip replacement surgery may be partial or total, depending upon the extent of the damage. The surgical approach can be of three types :
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From the front (anterior approach).
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From the back (posterior approach).
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From the side (lateral approach).
Can Hip Surgery Be Minimally-Invasive?
Hip surgery can be of the following two types :
1. Minimally Invasive Surgery
Minimally-invasive hip surgery aims to impact minimally on the adjacent healthy tissue such as bone, muscle, nerves, and blood vessels.
The advantages are as follows :
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Lower risk of muscle damage.
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Less pain.
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Quicker and easier recovery.
2. Traditional Surgery
Traditional hip replacement surgeries include a single, large incision that helps the surgeon access the hip. This is usually through the side (lateral approach) or the back (posterior approach). Recovery may take time. One may be at risk for a dislocation until all of the new hip's supportive structures are healed.
Which Is a Better Approach for Hip Surgery?
The surgical approach depends on various factors, including access to the hip, the type of implant, and its attachment. The age, activity level, shape, and health of the hip bones are also considered. The likelihood of revision surgery also determines the decision because of the surgical approaches and implant types used. This can make revision surgery easier or more challenging. As part of the evaluation for surgery, the specialist will determine the type and approach of the surgery and the implant to be used.
What Are the Constituents of a Hip Prosthesis?
The hip replacement implant, also called a hip prosthesis, has two parts:
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First, a ceramic ball is attached to a metal stem inserted into the thigh bone (femur) for stability.
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A titanium cup with an inner plastic layer is attached to the socket part of the hip joint (acetabulum) to allow smooth rotation of the prosthetic joint.
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Previously, the ball was made of metal, but the current standard is ceramic.
What Are the Types of Socket Implant Attachment?
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An uncemented prosthesis attaches to a porous surface, which allows the bone to grow over time and hold it in place.
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A cemented prosthesis attaches with bone cement.
Both uncemented and cemented approaches work well to secure the implant. With the evolution of hip replacement techniques over the years, the cement used has improved, as have methods to encourage natural bone regrowth. Therefore, for some hip replacements, the surgeon will combine methods. For example, cement on the femoral stem and an uncemented attachment on the socket piece that fits into the hip bone may be warranted.
Can Both Hips Be Replaced in a Single Surgery?
Both hips can be replaced during a single surgery, known as a bilateral hip replacement. However, suppose there are issues with both hips. In that case, the doctor might recommend a double hip replacement if the patient is in good health and can tolerate a more extended surgery and recovery.
What Happens During a Hip Replacement Surgery?
Although hip replacements are performed in a hospital or surgery center, they are often considered outpatient procedures, even though a stay for a night or two for observation or to resolve complications may be recommended.
A typical total hip replacement surgery without any complications has the following steps:
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First, an intravenous line and a urinary catheter may be inserted.
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Anesthesia, either general (whole-body) or below-the-waist (epidural), depends on the recommendation of the anesthesiologist and orthopedic surgeon.
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The surgeon will place the patient in an appropriate position to access the hip joint and make an incision. The incision's location depends on the surgeon's approach (front, back, or side).
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The head of the femur bone is removed, and the stem of the ball prosthesis with or without cement is inserted. This is followed by attaching a ceramic replacement head to the top of the implant.
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This is followed by the removal of the damaged cartilage from the acetabulum and attaching the new cup.
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The surgeon will then bend and move the leg to ensure proper functionality.
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Layers of tissue are closed with absorbable sutures. Finally, the outermost layer of skin is sealed with surgical glue.
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No suture removal procedure is needed after surgery.
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The patient is taken to a recovery room for a couple of hours and transferred to a hospital. The surgeon will inform the patient when it is safe to go home, which could be the same day, depending on the conditions.
How Long Does Hip Replacement Surgery Take?
Typically, hip replacement surgery lasts about two hours. While a bilateral or complete hip replacement takes longer, a partial replacement takes less time. The time of surgery might be extended due to complications. One may need imaging, or an X-ray, immediately after the procedure and during recovery.
What After a Hip Replacement?
Hip replacement recovery starts right away. The patient is encouraged to move around as soon as possible after surgery. In the absence of any other health conditions, patients are discharged as quickly as they demonstrate walking, climbing stairs, and embarking on or disembarking a vehicle. Inpatient rehabilitation may be advised to prepare for independent living at home. Whether discharged to go home or to a rehabilitation unit after surgery, physical therapy for several weeks will be prescribed until muscle strength and a good range of motion are regained. After the assessment, the surgeon, physical therapist, or occupational therapist may conclude when the patient is ready to walk with or without assistance and pain management. The provider will discuss rehabilitation needs, what to expect in the days and weeks ahead, and how to make the most of the recovery phase. Patient motivation and cooperation in completing the physical therapy are critical for an effective recovery process and overall success of the surgery.
What to Do During the Postoperative Recovery Phase?
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Keep the surgical area clean and dry, following specific bathing instructions.
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Take all medications as directed.
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Keep all the follow-up appointments.
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Attend physical therapy and complete home exercises.
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Resume a regular diet unless otherwise instructed.
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Elevation of the leg is recommended, and ice can be used to control swelling.
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Refrain from driving until otherwise instructed.
Some fluid might drain from the incision, which is expected during the first few days after surgery. Let the surgeon's office know if there is increased redness, swelling, draining from the incision, high fever, chills, or severe pain. Also, contact the office if the pain does not subside.
What Are the Risks Following Hip Replacement Surgery?
In most patients, hip replacement is uneventful. However, as with any surgical procedure, there are some risks during and after a hip replacement:
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Bleeding.
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Infection.
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Blood clots in the legs or lungs.
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Leg length discrepancy.
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Injury to nearby nerves.
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Continued pain or stiffness.
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Dislocation.
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Loosening or wearing out of the prosthesis.
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Unrelieved joint pain (this may be temporary).
In sporadic cases of bone surgery, mainly when using cement, an embolism can occur if bone marrow fat enters the bloodstream, which may raise the risk of a heart attack or stroke. In addition, there may be other risks depending on comorbid medical conditions.
After the surgery, consult emergency services if the following occurs;
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Redness, swelling, bleeding, or other drainages from the incision site even after a few days post-surgery.
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Increased pain at or around the area of surgery.
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Pain in the lower limbs unrelated to the incision.
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Increased swelling of the lower leg.
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Chest pain.
Is Revision Hip Replacement Surgery Necessary?
The hip implant may wear out or loosen over time. It might also become damaged due to an injury or dislocation. Revision surgery may be needed to replace the damaged parts of the prosthesis, with most implants lasting about 20 years. To extend an implant's life, regular low-impact exercise, avoiding high-impact exercise (such as jogging), and taking precautions to prevent falls may be done.
A rare risk of hip replacement is an infection if bacteria circulating in the bloodstream get caught in the prosthetic pieces. An infection may require revision surgery to remove the infected tissues and a course of antibiotics to kill the bacteria. A new prosthesis can be placed when the infection is gone. In the case of a partial hip replacement (only the ball part of the joint), a revision surgery to replace the socket may be needed.
Conclusion
Hip subluxation and dislocation have many treatment options available. Hip replacement surgery is necessary when non-surgical techniques fail to address the underlying problems. The hip replacement surgery usually lasts for one to two hours approximately. While a bilateral or complete hip replacement takes a bit longer, and a partial replacement takes less time compared to the other two.
