When a hip replacement becomes necessary

This pain is usually difficult to tolerate by those inflicted with the condition because the hip is a major weight-bearing joint, works hard on a constant basis and is related to the functions of movement. In some cases, the hip joint will even hurt while the patient is doing nothing or just moving the hip gently. 

In addition to hip pain, patients with this condition will start to hobble. Young sufferers especially are less likely to tolerate any hindrance in their walking. 

In Thailand, there are 2 common causes of hip disease: osteonecrosis (lack of blood supply to the bone), especially from the use of steroids or pain medications, and a degenerative condition, which occurs in old age. Other causes include hip problems from birth and injuries causing hip dislocations or hip fractures.

Hip cancer can develop in 2 ways, metastatic and locally invasive, both of which will cause hip pain at all times in all positions and to a more severe extent than from osteoarthritis. Patients with hip cancer may experience low-grade fever, loss of appetite, and weight loss. Patients with hip infections will also suffer from severe pain and have high-grade fever but without any loss of appetite or weight loss.

A hip replacement is considered based on the needs of each individual patient and condition. Older patients primarily benefit from hip replacement. Hip replacement is not recommended for younger patients because they tend to be more active and the artificial hip joint will be used for an extended period of time. This can cause the joint to wear out before the end of their lifetime, necessitating the hip joint to be replaced several times. In most cases, one hip replacement surgery is performed in patients over 65 years of age and the artificial hip is expected to last for their entire life. However, the life expectancy of the artificial hip joint varies according to how it is used. It can last up to 25 years if it is used only for walking, whereas engaging in more activities will shorten its life expectancy. 

Each patient’s health condition is also taken into consideration when deciding on hip replacement surgery. For example, hip replacement surgery should be performed for young patients if they have an underlying life-threatening disease because the artificial hip will help improve their quality of life and reduce their suffering from severe pain, enabling them to lead a normal active life. 

There are different types of artificial hip joints: cemented and uncemented prosthesis. In an uncemented hip replacement, the surface of the implant is covered in a coating that enables it to be attached to the bone. 

A cemented hip replacement uses a special type of cement to secure the implant to the bone. Although the uncemented hip replacement is expensive, it is durable, safe and requires only simple surgery. 

The type of surgery depends on the surgeon’s expertise and patient’s age and lifestyle. In certain cases, a special technique involving a minimally invasive procedure requiring only a 4.5 cm incision can be used. Patients who are not very heavy will recover quickly and can walk the next day with minimal tissue damage and pain, thereby requiring less postoperative pain medication. Patients who undergo this procedure usually return to work earlier too.

 

 

 

Dr Prakit Tienboon is an Orthopaedic Spine Surgeon at Samitivej Srinakarin Hospital. He can be contacted at the hospital’s Revision Spine Centre by calling (02) 378 9000.