The hip joint is formed by a ball inserted into a cavity. 
The concave part that contains the femur is a pelvic bone called the acetabulum, whose shape is similar to a glass, while the sphere is the head of the femur. 
Total hip replacement involves the surgical removal of the bone portions that form the joint and its replacement by a metal or ceramic prosthesis.

Hip movement test

The femoral part is inserted as a rod in the bone of the femur to about half its length, while the part of C-shaped hip opa  replaces the acetabulum. 
After insertion of the prosthesis, the central nucleus of the femur is fixed with a bone cement called methylmethacrylate . 
Alternatively, the nonaccelerated prosthesis has microscopic pores that allow bone growth of the femur within the prosthesis stem. The cemented prosthesis has a longer duration and is considered especially for younger patients. 
Replacement is taken into account when the pain becomes so severe that it impairs normal hip function, despite the use of anti- inflammatory and / or analgesic drugs.


When to operate?

The orthopedic surgeon recommends surgery when the hip has severe arthrosis and pain in the hip does not allow sleeping or performing the normal activities of daily living.

What is the preparation for hip prosthesis surgery?

In the weeks before surgery, you  should follow some preparation steps. 
To increase the chances of success  of the intervention it is advisable to carry out a physiotherapy program with exercises of muscle stretching and strengthening of the lower limbs. 
An improvement in cardio circulatory systems  allows for a faster recovery after the operation. 
The surgeon may prescribe to perform the blood collection because you may need a blood transfusion after implanting the prosthesis. 
A consultation  is done by the doctor before orthopedic surgery.
To prevent infection, you should avoid dental extractions or dental surgery in the first few months postoperatively, so it has to be performed before the operation. 
The medications the patient is taking should be  reported to the orthopedist  for him to decide whether to stop taking or changing the dosage. 
In the days leading up to the surgery, you should do the blood and urine tests, if necessary, the doctor prescribes an electrocardiogram and a chest x-ray. 
It is important to prepare for the post-operative period, where you have to change the type of shoes and furniture in the house, you have to buy Canadian crutch and the walker for the first 2 months after surgery.


How is the surgery?

Hip replacement can be performed in a traditional way or with a less invasive technique. 
The main difference between the two processes is the size of the incision. 
During hip replacement surgery, the doctor performs general anesthesia  to relax the muscles and causes a deep temporary sleep. 
This way, it prevents you from feeling pain or being aware during the surgery. 
Spinal anesthesia (partial or local) may be an alternative to general if the patient’s condition allows. 
The doctor makes an incision on the outer side of the hip and moves the muscles that are inserted into the upper part of the femur to expose the joint. 
Subsequently, the femoral bone head is removed by cutting with a saw.
An artificial joint is attached to the femur with cement or with a special material that allows the bone residues to adhere to the new joint.

After replacing the femoral part, the orthopedic surgeon prepares the joint surface of the pelvis (acetabulum), removes all damaged cartilage and inserts the  concave partinto the pelvis. 
Subsequently, the new head of the femur fits into the hip acetabulum. 
The surgeon can do a drainage to help drain the fluid (body fluid). 
In the end, the orthopedic surgeon reconnects the muscles and closes the surgical cut. 
Although most hip replacement surgeries are performed using the standard technique (20cm cutting along the outer side of the hip), in recent years, some surgeons have used a less invasive technique.
This approach allows the orthopedist to perform one or two cuts of 2 to 5 centimeters in length. The same surgical procedure is performed through these small cuts during standard surgery.

Hip Prosthesis Intervento Scar

Small cuts are performed to reduce blood loss, relieve hip pain after surgery, shorten hospitalization, reduce post-surgical scar size and healing speed. 
However, it is important that the surgeon be highly skilled in this technique. 
Scientific studies have shown that the outcome of less invasive surgery may be worse than standard surgery if the surgeon is not very experienced in this technique. 
Because bleeding is possible during hip replacement surgery, you may need a blood transfusion, so it is best to donate your own blood before the procedure.


What should I do after hip prosthesis surgery?

For a period of about 10 days, the patient must remain hospitalized and need to be followed by the team that performed the operation, also begins the process of rehabilitation with the physiotherapist. 
You need to hold a pillow between your legs when lying on the bed to keep the new hip joint in the correct position and avoid the risk of dislocation.

During the first days after the operation, physical therapy consists of initiating movements of the lower limbs without load, exercises for the ankle, knee and hip. 
It is essential that the patient learn to perform daily movements and activities in different ways. 
All surgeons prohibit internally rotating the hip. Some orthopedic do not allow flexion beyond 90 °, the risk is to displace the implanted hip only.

As soon as the orthopedist puts you in the position, the patient can get off the bed, learn to walk properly, sit and get up from the chair, get in and out of the car and go to the bathroom. 
The infirmary inserts a catheter into the bladder to urinate. 
Rehabilitation should begin the day after surgery and within a few days you can walk with a walker, crutches or walking sticks. 
We should continue physical therapy at home or at the clinic for a few months after the surgery. 
In the first 2-3 months you have to pay attention to the movements of flexion, adduction and internal rotation of the hip, but when the prosthesis is fixed permanently, the orthopedist gives permission to perform all movements without limitations.
After discharge, it is important that the patient does not stop moving and walking because he or she may not recover completely. 
A great exercise in physiotherapy is the bicycle, initially you have to run with the seat high and then return to normal.

Considering the patient’s age, rehabilitation in water or hydrotherapy is not always possible . 
In the vast majority of cases, the non-operated limb stays shorter. 
This is because both suffer from arthrosis , then the normal limb has less cartilage that acts as an elevator, so you will need to use a shoe with a higher sole, about 2/3 inches more than the limb operated.

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