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Total Hip Replacement (TH...

Questions

What is Total Hip Replacement (THR)?

In Total Hip Replacement (THR), the damaged hip socket (acetabulum), and the damaged femoral sockets are removed and replaced by plastic, metal, or ceramic components depending on the age, needs, and condition. A total hip replacement (THR) is performed in patients with loss of cartilage in the hip joint.

Surgical Technique and Approach Used For THR

·         Total hip replacement (Posterior Approach) or (Anterior Approach).

·         Partial hip replacement.

·         Hip resurfacing.

Fixation Methods Used For THR

Total hip replacement implants consist of the femoral component (inserted down the femoral canal), the bearing surfaces of the implant and the acetabular component (which is fitted into the patient's acetabular pelvic bone with or without cement).

Cemented

·         Used for older or sedentary patients.

·         Cemented acetabular components have been associated with increased rates of loosening. Therefore the use of cemented acetabular components has declined in recent years.

Cement-less

·         This is an ideal choice for younger or more active candidates.

·         The most commonly used composite for cement-less acetabular components is titanium alloy, which allows bone ingrowth. Cement-less acetabular fixation is done to solve the problem of loosening with cemented acetabular cups. A modular bearing surface is inserted into the inner aspect of the acetabular component which locks into place by a mechanism contained within the acetabular component. The acetabular component may accept bearing surfaces, made of ceramic, polyethylene, or metal.

Hybrid technique

·         One part or both parts are inserted without cement. The artificial joint components are fixed into the bone with acrylic cement.  The procedure where only one part is fixed with cement (usually the socket) is known as a hybrid hip replacement.

Causes For Total Hip Replacement (THR)

Disabling hip pain with functional impairment and significant bony changes and failed conservative measures are the indication for THR, these causes may include:

·         Injury

·         Ankylosing spondylitis

·         Bone tumor

·         Degenerative joint disease

·         Developmental dysplasia of the hip

·         Fracture or dislocation

·         Avascular necrosis

·         Fusion or pseudoarthrosis

·         Hemophilia

·         Legg-calve Perthes disease

·         Osteomyelitis

Pathology of THR

Total hip replacement is also known as hip arthroplasty, it is the reconstruction surgery of the arthritic or the damaged hip joint. The end of the bone is capped by metal or plastic material. This surgery is done in patients suffering from severe arthritis or hip injury. The joint cartilage and also the surrounded bone of the hip are damaged. There is inflammation, which leads to stiffness and severe pain.

Diagnosis of THR

X-RAYS

X-rays help to determine the extent of joint damage.

 

MRI

MRI helps to determine the bone, muscular or ligamentous damage

Conservative Treatment For THR

Medication

Ibuprofen, Tylenol, vancomycin, Toradol (should be taken as prescribed by the doctor).

 

PHYSIOTHERAPY TREATMENT FOR THR

The physiotherapist uses the following techniques and modalities for regaining the functionality of the hip joint.

 

Cryotherapy:

Cryotherapy in combination with PROM exercises, elevation, and massage is used to decrease edema, developed due to inactivity or loss of voluntary movements.

 

Thermotherapy:

Thermotherapy can be used in combination with ROM exercises (twice daily) with sustained stretching technique (20 – 30minutes).

 

Nmes:

Neuromuscular stimulations facilitate voluntary motor control and muscle strength.

 

Laser:

Cold laser is an effective treatment used for reducing pain thus increase joint range of motion.

 

Ultrasound:

Ultrasound decreases pain, increases range of motion, and decreases inflammation.