What Is Hip Replacement?

Joint replacement surgery is a surgical procedure in which the damaged joint surfaces are replaced with specially designed prosthetic components in order to restore joint function and relieve pain. Hip replacement surgery is preferred when other treatment options fail to relieve hip pain and when daily life activities are significantly limited. It can also be an effective treatment option in cases of late-diagnosed developmental dysplasia of the hip.

Hip replacement surgery is performed in patients whose quality of life is significantly impaired due to hip osteoarthritis (coxarthrosis), post-traumatic cartilage and bone damage, developmental hip disorders and similar conditions.

Who Is Hip Replacement Suitable For?

Hip replacement is performed in patients with irreversible damage of the hip joint and marked limitation in daily activities. Main indications include:

• Hip osteoarthritis (coxarthrosis)
• Untreated or late-diagnosed developmental dysplasia of the hip
• Hip deformities secondary to Perthes disease
• Osteonecrosis (avascular necrosis) of the femoral head
• Post-traumatic joint degeneration after fractures
• Joint damage secondary to oncologic treatments

Hip osteoarthritis is a progressive disease. As age advances, pain and loss of motion gradually increase. Activities such as stair climbing, long-distance walking, standing up from a seated position or putting on shoes can become quite difficult.

Does the Type of Prosthesis Matter?

The type of prosthesis is selected by the surgeon according to the characteristics of the hip joint, the type of underlying disease, the patient’s age and bone quality. During this process, the patient should be informed in detail about the implant to be used. It is valuable for the patient to know the brand and structure of the prosthesis.

Prosthesis brands that meet international standards, are widely used in developed countries and have proven long-term success are critical for the longevity of the implant and the long-term success of the surgery. Therefore, the quality of the implant used in hip replacement surgery is as important as the surgical technique itself.

When Is Hip Replacement Surgery Recommended?

The most important factor in deciding on hip replacement surgery is pain. Pain that persists even at rest, disrupts sleep at night and seriously limits daily activities is a strong indication for surgery. If pain is mild or intermittent, hip-preserving methods should be considered as much as possible.

Another key factor is restriction of movement. Damage to the cartilage tissue in the joint disrupts the harmony and alignment of the hip, leading to limited range of motion and pain during or after movement.

Before making a surgical decision, the following steps should be carefully evaluated:

• Listening to the patient’s complaints in detail
• Performing a thorough physical examination
• Evaluating the hip with X-ray (and additional imaging if necessary)
• Trying conservative methods such as rest, medication, physiotherapy, walking aids and limiting stair climbing

If pain and loss of function continue despite all these measures, hip replacement surgery comes into consideration. The final decision about whether the condition is severe enough to require hip replacement belongs to the patient. If the symptoms are significant and satisfactory results cannot be obtained with non-surgical treatments, planning for hip replacement surgery is appropriate.

Surgical Procedure

Hip replacement surgery can be performed under general anaesthesia or regional anaesthesia. When deciding on the type of anaesthesia, the patient’s comorbidities and expectations are taken into account, as well as the anaesthesiologist’s assessment. Epidural catheter or peripheral nerve block applied before surgery helps with postoperative pain control.

The average duration of surgery is around 2 hours. On the first day after the operation, the patient is usually mobilised with the help of crutches and may begin to meet most personal needs independently.

A personalised rehabilitation and exercise programme is explained in detail after the operation. Complete return to daily life generally takes about 6 weeks. To allow soft tissues time to heal, certain movements such as sitting cross-legged, deep squatting and crossing the legs should be avoided for a period of time.

What Are the Risks of Hip Replacement Surgery?

Due to the changes created in the joint, some complications may occur after hip replacement surgery, although most patients have a smooth recovery. It is important that patients are informed about these possible risks. Examples include:

Infection

Joint infections are among the most serious complications following prosthetic surgery. The risk of infection after hip replacement is approximately 0.3–1.3%. Infection may occur in the early postoperative period or even years after surgery and can sometimes lead to serious consequences requiring prosthesis revision.

In early postoperative infections, surgical cleaning (debridement) of the joint may be sufficient. However, in late infections that develop years after surgery, removal and replacement of the implant may be necessary. Progression of infection can cause recurrence of pain and the need for further surgery.

Prosthetic Dislocation

Dislocation of the prosthesis can occur for various reasons after surgery. It is often associated with sudden movements, extreme positions, falls or trauma. The incidence is around 1–3%.

To reduce the risk of dislocation, it is important to follow the surgeon’s postoperative recommendations, avoid extreme positions of the hip and comply with the positional precautions for the recommended period.

Blood Clots

One of the complications that can be seen after hip replacement surgery is the formation of blood clots (deep vein thrombosis). These clots can obstruct blood flow and damage vessel walls and, in severe cases, may even lead to life-threatening conditions.

If a clot breaks off and travels to the lungs, it may cause a pulmonary embolism, which can be fatal. To reduce this serious risk, patients are mobilised as early as possible after surgery, and blood-thinning medications and, when necessary, compression stockings are used.

Loosening of the Prosthesis

One of the signs of failure after hip replacement is loosening and loss of stability of the implant. Movement of the prosthesis relative to the bone may cause renewed wear in the joint and recurrence of pain.

Treatment of loosening usually requires revision surgery with re-fixation of the prosthesis or replacement of the implant when necessary. Early diagnosis is important for planning appropriate management.

Stiffness

Another possible complication after hip replacement surgery is postoperative stiffness of the joint. Being active and adhering to the recommended exercise programme are crucial. Prolonged inactivity may lead to stiffness of the skin, capsule and soft tissues, limiting joint range of motion.

This may make activities such as climbing stairs or sitting down and standing up from a chair painful again. If exercises recommended after surgery are not followed, additional surgical procedures may be required to address stiffness.

Frequently Asked Questions (FAQ)