What to Expect when Consulting a Hip Replacement Specialist
Osteoarthritis is generally acknowledged as the single most common reason for painful joints that lead to reduced mobility. It is a condition that can affect most joints, but it tends to be most debilitating when the shoulder, knee, or hip joints are involved, and at some stage, orthopaedic specialists are likely to recommend a prosthetic replacement.
Surgery involving the upper femur and pelvic joint has been undertaken for around three hundred years or more, although the procedures performed remained relatively rudimentary throughout most of that period. With the knowledge of joint structure gained from dissection, these early efforts focused mainly on the surgical treatment of injuries to naval and military personnel wounded in action, and enabled these early orthopaedic surgeons to avoid the sole previous alternative of subjecting such cases to a debilitating amputation.
Today, of course, it has become common practice for specialists to conduct either a partial or total hip replacement, thus enabling their patients to return to their former pain-free and actively mobile lifestyles. So, what might the average patient expect in the event that he or she should find themselves in need of this type of surgery?
In practice, surgery will not be the automatic first choice for a patient who is experiencing pain in the joint under discussion. A preliminary investigation will first be necessary to establish its cause. There are a number of possible explanations for pain in this region, and in addition to the erosion of the articulating surfaces resulting from arthritis, bursitis affecting the trochanter or gluteus medius, or a torn acetabular labrum, as well as femoral fractures or even groin strain, could also be the root of the pain. A hip replacement specialist will not proceed without first confirming the need with a detailed patient history, a thorough physical examination, X-rays and other relevant tests required for a differential diagnosis.
Even when evidence of damage to the articulating surfaces is confirmed, a more conservative approach combining physiotherapy and prescription analgesics will often be the first line of treatment, while steroid injections may later become necessary for pain relief. However, once this regimen proves to no longer be sufficiently effective, the offer of elective surgery will be the natural progression.
The earliest attempt at replacement of a damaged hip joint was not the work of a specialist, so the ivory prosthesis used to replace the damaged head of the femur was simply not strong enough to offer a long-term solution. The surgery itself would have been radical and involved exposing most of the inner structure of the affected joint. It is therefore reassuring for patients in the 21st century to learn that the materials used in the construction of prosthetic joints, their design, and the surgical techniques now employed to implant them have evolved beyond all recognition.
As well as the structure of artificial joints, which includes metal-on-metal, metal-on-polyethylene, and ceramic-on-ceramic combinations, the means of securing them has also evolved. Where screws and bolts once provided the means of attachment, biocompatible cements and direct fusion between the bone and the sponge-like metal surface of the prosthesis are now helping to simplify the task of hip replacement specialists. These are just a couple of the many innovations that have served to make this procedure the most successful surgical intervention in the lengthy history of orthopaedics, and to position it among the most successful in medicine overall.
One of the most exciting developments in arthroplasty from the patient’s viewpoint has been the move to less invasive techniques that no longer require the joint to be fully exposed, thus reducing the risk of infection and intra-operative blood loss, as well as the length of time required for post-operative recovery. Also, a technique known as arthroscopy, in which a tube with a light and camera at its tip relays real-time images of the joint and surrounding tissues, now allows hip replacement specialists to work via a much smaller incision than was previously necessary.
As in many facets of medicine, computers are playing a growing role. As a result, computer-assisted techniques that facilitate the placement of instruments relative to key anatomical structures are already providing surgeons with the means with which to position an implanted prosthetic joint with far greater precision.
The arthroscopy unit lead by Dr Jan De Vos in Wilgers, Pretoria embraces much of the latest state-of-the-art technology and attracts numerous international referrals. However, services vary and should be discussed with individual hip replacement specialists.