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Currently, more than 500 000 total hip replacements are performed annually on a global basis. Replacement of worn hip joints by artificial joints has therefore become a standard treatment performed by most hospitals in the industrialized world, and the orthopaedic surgeons performing the operations have thorough experience in this field.
In order to have a total hip replacement you normally first have to be examined by your regular physician, who will refer you to an orthopaedic surgeon at a hospital or one of the specialty clinics doing orthopaedic surgery. This will vary from country to country. The specialist will then examine you in order to define the most proper treatment and if surgery is necessary.
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Total hip replacement is a planned treatment. The time before you are allowed into surgery will vary from country to country, and between the different hospitals within your country. It may also depend on what kind of insurance you have - if you are entitled to have surgery at a private clinic or have to have surgery at one of the state run hospitals. The practice as to what prostheses are used, vary widely between hospitals and countries. As in other treatments you are entitled to have an opinion of your own.
The surgical procedure is performed by a vertical incision through the skin and muscles at the lateral side of the hip. The different surgeons may choose to make the incision differently - both where and the length of the incision. Earlier it was common to use incisions of up to 30 cm (12 inches). Currently, most surgeons make a shorter incision - often 10 - 15 cm (4 - 6 inches) or less.
During surgery the upper part of the thigh bone (femoral bone) is cut, and the bone marrow of the upper remaining part is removed in order to leave space and support for the femoral stem. This part of the prosthesis will function as an extension of the remaining thigh bone and replace the upper part of this. A ball head is placed on the top of the femoral stem. This ball head will rotate in the artificial cup in the hip bone. The extension of the femoral stem linking this to the ball head is called the prosthesis neck. This is shaped in order to ensure that the thigh obtains the correct position in relation to the hip bone, and to ensure that both legs have the same length.
In addition, the surgeon will make a cavity in the hip bone (pelvic bone) to fit the artificial cup.
When both the femoral stem and the artificial cup are in place, the surgeon will check that the joint functions well and that both legs have the same length. When this is done, he/she is ready to close the wound and the operation is over.
Earlier, a total hip replacement took several hours. Currently, and with modern techniques, it is common to estimate a total time spent in the operating room of 1 – 1,5 - hour. When the operation is over, it is important to start loading the hip carefully as soon as possible. The practice may vary, but in Scandinavia it is common that the patient gets out of bed and start putting weight on the joint no later than the day after surgery.
Length of hospitalization may also vary from country to country. In Scandinavia it is common to expect a total hospitalization period of 4 - 5 days. Younger patients that are well fit may often go straight home from hospital and have their training sessions outside an institution, while older and less fit patients are often referred to an institution for initial retraining. In general, it is very important that the patients as soon as possible after surgery start retraining and putting weight on the joint. This helps them to regain a maximum of muscle strength and flexibility of the joint, and for the surrounding bone to grow quickly into the uncemented prostheses.
It is normal that the patient will have some pain during the first period after surgery. Getting up and loading the limbs will also cause pain to start with. These pains will, be gradually reduced, and most patients will after some time get rid of all pain. They will also experience that they gain much more flexibility and mobility in the joint. This is why total hip replacement is regarded as one of the most successful health treatments. We know former patients that now are active bicycling, skiing, hiking in the forests and mountains, playing golf and otherwise leading a normal and active life.
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