About hip pain
What is hip joint?

Hip is a ball- and- socket joint where thigh bone (femur) meets hip bone (pelvis). A healthy hip has layers of smooth cartilage that covers the ball-

shaped end of the femur and socket part of the pelvis. Cartilage acts as a cushion and allows the ball of the femur to glide easily on the socket of the pelvis. Muscles around the joint support your weight and help move the joint smoothly so that you can walk without pain.

What is a degenerated hip Joint ?

When smooth cartilage layer around the ball of the femur and the pelvic socket wears down, the condition is called degeneration. It can happen because of arthritis, injury or as a side effect from medicines, such as steroids. When the joint wears down, smooth surfaces become rough. Instead of gliding smoothly with leg movement, the ball grinds in the socket causing pain and stiffness.

 

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How is hip pain treated?

In early stage of hip arthritis, pain can be controlled with weight reduction, physiotherapy and mild medication.

During the last stage of arthritis, when degeneration or arthritis worsens, there’s a severe decrease in the joint leading to and significant increase in amount of pain while walking, getting up from chair, and sometimes even while resting. In such a scenario, surgery may be required to replace the hip.

What is total hip replacement?

Total hip replacement is an operation that replaces the worn out or damaged hip joint. It involves replacement of both the joint socket and the head of thigh bone with a hip prosthesis, which is made of metal, plastic, ceramic or a combination of these materials.

Perquisites before surgery?
  • I, with you help, will make sure that you don’t have any source of infection in the body, such as skin boils, dental, urine and chest infection.
  • Please inform me if you are taking blood-thinning medicines. These medicines may have to be stopped a few days before surgery.
  • If you have any other medical issues such as diabetes, hypertension, asthma, hypothyroidism, etc., ensure that appropriate measures are taken to control the same before surgery.
What is the Surgery process?
  • You will be admitted one day prior to surgery
  • Relevant investigations will be done
  • You should mention if there are other medical issues such as diabetics, hypertension & asthma etc., so that a physician can be consulted
  • You will be seen by a member of the anaesthesia team
  • You can discuss choice of anaesthesia with anaesthetist (epidural or general)
  • Hip replacement is usually done under epidural anaesthesia (injection on the back to make the legs numb). This avoids certain problems associated with general anaesthesia
  • You shouldn’t eat or drink anything after midnight. Eight hours of fasting is necessary before surgery
  • Shower should be taken in the morning and legs cleaned with soap and water. Legs are not shaved in the room. If required, it is done in the operation theatre
  • Couple of tablets may be given in the morning if required. They’re to be taken with a small sip of water
  • You will be shifted to preoperative area about an hour before being taken to the operation theatre
  • After the operation you will be kept in recovery ward for 4-6 hours and then sent back to the room or ICU as necessary
  • Following surgery, a bulky dressing is made around the hip, with a small tube (drain) to collect any blood oozing out of the operated area
  • The drain will be removed 24-48 hours after surgery
What is the recovery process ?
Deep Breathing exercises

These exercise help to keep the chest as clear as possible. Three or four deep breaths are to be taken (not more as it may make the patient feel light headed). It is recommended to breathe in deeply, and after the last breath, try to puff the air out

Circulation exercise

You should start moving foot and ankle up and down as many times as possible after you regain power in the legs following recovery from anaesthesia. This should be carried out throughout the hospital stay. It helps pump the blood up and prevent complications like thrombosis (blood clot in the veins)

Lower limb exercises to improve circulation and muscle strength
  • With legs straight, ankles are pulled forward and then the back of the knees are pressed into the bed. Knees are held tight for five seconds and then released gently. To be repeated 10 times every hour
  • The bottom muscles are clenched together, held for five seconds then released gently. To be repeated 10 times every hour
  • The physiotherapist would advise on gentle knee bending exercise of the operated leg and how much should the knee be bent
Walking
  • You will be made to stand with the help of a walking frame 24-48 hours after surgery and will be encouraged to start walking. This can help in preventing complications like thrombosis
Pain Relief
  • We use special technique of injecting local anaesthetic and other drugs into tissue during surgery which leads to great reduction in pain after surgery
  • Other measures taken may be in the form of epidural pump, patient control analgesia (PCA) and a mix of certain drugs. You should inform when in pain. Pain Management Team is there to offer assistance at any given time
DVT Prevention
  • Adequate measures are taken for prevention of thrombosis, such as DVT pump (pressure cuff around the calf), certain drugs and early mobility
Discharge from hospital
  • You may be ready for discharge from the hospital 4-5 days after surgery in case of single hip replacement and 7-8 days if both hips are operated
What precautions should be taken after surgery?
  • Temperature should be monitored. Please inform if it goes above 100.5 degrees Fahrenheit
  • Please inform if there’s excessive swelling, redness around the operated     area or discharge from the wound
  • Use of walking aid is recommended until advised otherwise
  • Low chairs or commodes should not be used
  • After hip replacement, the surrounding muscles and tissues take some time to heal. After this, you may be able to resume normal activities. It is important that following movements are avoided for the first 12 weeks to reduce the risk of hip dislocation:                                                                                                         1.Bending the hip beyond an ‘L’ shape .                                                             2.Crossing the leg or moving the operated leg across the midline of the .               body                                                                                                                      3.Twisting the operated leg                                                                                 These precautions should be taken even in long run
Long-term precautions
  • Antibiotic cover should be taken while undergoing any dental / surgical procedures. Doctor should be kept informed
  • High impact exercise such as jumping, running should be avoided
  • Please inform if there’s pain, swelling or instability
Care at home
  • The toilet seat at home should have a high commode attachment or a high commode chair should be used
  • Physiotherapy should be done as adviced to facilitate walking and strengthening of muscles
  • You should mobilize as much as comfortably possible
Putting hip precautions into practice

You should use a chair with arms and avoid sitting on a low chair. To get out of a chair, push the body to the front edge, place the operated leg slightly forward and push up on the arms of the chair, taking most of the body weight on the non-operated leg. Regain balance and then get the crutches / walking aid. Reverse the procedure to sit down. The same method to be used while getting on / off the toilet seat

Getting in / Out of bed

It is advisable to continue sleeping on the back for first six weeks following surgery. A pillow between the legs will help. If possible get off the bed on the same side as the operated hip. When getting on / off the bed, avoid twisting the hip. Try to keep the toes pointing to the ceiling while moving the operated leg across the bed. Push up from the bed with the hands, taking the weight on the non-operated leg

Stairs

Once you are walking well, you will be taught how to manage stairs or a step

  • Take one step at a time
  • Going upstairs: Use the banister on one side and the crutch / stick on the other side leading with the non-operated leg, place the foot on the step and then let the operated leg follow
  • Going downstairs: Use the banister on one side and the crutch / stick on the other side. Place the crutch / stick first on the step, then put the operated leg onto the step and then let the non-operated leg follow onto the same step
  • Remember: “good leg up, bad leg down, i.e. non-operated leg first while going up and operated leg first while coming down”
What are the risks / complications of the procedure?

All types of surgical procedures and anaesthetics carry some risks. Our team has been trained to make sure that these are minimized and the treatment is carried out safely. There are some specific risks related to hip surgery that patients need to be aware of. However, chances of immediate complications are less than2 %

These will be discussed with you in detail

  • Superficial Infection
  • Deep infection
  • Dislocation
  • Loosening of the prosthesis
  • Persistent pain
  • Deep Vein Thrombosis (DVT)
  • Pulmonary Embolism
  • Other recognised risks of knee surgery include fracture, bruising, some other less common complications like Complex Regional Pain Syndrome etc. and risks associated with anaesthesia, blood transfusion
How soon can you expect to recover from surgery?
  • After single hip replacement, you can stand with assistance of physiotherapist 1-2 days after surgery and start moving with the help of a walking aid
  • You can use toilet seat (raised) 3-4 days after surgery
  • By the time you get home, you should be able to go to toilet independently with the help of a walking aid
  • You will need to use crutches or walking frame for 4-6 weeks
  • It will take 8-12 weeks to achieve full benefits of surgery
  • In case both the hips were replaced together, recovery process is a little slower but same principles would apply in this condition as well
Frequently asked questions
Q. Do I need hip replacement?

A. It depends on the extent of pain and difficulty in walking. Advice will be given           after examining and analyzing X-ry findings. It is you who’s suffering from pain       and you are as much a part of decision making as me.

Q. Can I get both hips operated at the same time?

A  It depends on how badly both hips are affected. If a patient is young, with good       medical status, then both hips can be replaced in one sitting. In case of the                 elderly, hips are replaced one at a time.

Q. Is hip replacement painful?

A. There are modern methods available for pain relief, such as continuous epidural       anaesthesia, patients controlled anaesthesia (PCA) and a combination of certain       drugs that can control pain very effectively. I inject a special mix of drugs in               knee joint at the time of surgery which is very helpful in reducing pain.

      Applying cold compresses around the hip also help in reducing swelling and               pain

Frequently asked questions
Q. Can I sit cross-legged on the floor?

A. It is generally not recommended as sometimes the hip can dislocate. Also this,          puts abnormal stress on the bonding of implant to bone.

Q. Do I need physiotherapy?

A. Physiotherapist will teach you exercise and way to mobilize. Very soon you can        do your own exercises.

Q. For how long should a commode or raised toilet seat be used?

A. It is a good to use a raised toilet seat for at least 3 months and even longer.

Q. How frequently do I need to visit the hospital?

A. You will be required to visit the hospital 10 days after surgery for stitch removal.      After that you may be asked to return in 2-4 weeks to monitor your progress.            Subsequent visits are required only after 3 months and I year of surgery- unless        medical condition dictates otherwise.

Q. Is hip replacement detected by a metal detector?

A. You should collect a credit card shaped certificate from my secretary certifying           that you’ve had hip joint replacement. This can be shown to the security staff.

I WISH YOU FREEDOM FROM PAIN