Hip Replacement Surgery Procedure

Hip replacement surgery, also known as hip arthroplasty, is a highly successful and highly effective procedure involving the removal of damaged hip joint and replacing it with an artificial implant (prosthesis) to relieve pain, improve function and improve quality of life.   

Hip replacement in Cuba is carried out by highly skilled and highly experienced orthopaedic surgeons for patients who are suffering from hip pain that has not responded to conservative treatments and / or whose pain disrupts daily activities. Patients with conditions such as the ones below are candidates for hip replacement.  

• Osteoarthritis: Degenerative joint disease characterized by the breakdown of cartilage. 

• Rheumatoid Arthritis: An autoimmune condition causing inflammation and joint damage. 

• Post-Traumatic Arthritis: Arthritis following an injury to the hip joint. 

• Avascular Necrosis: A condition where the blood supply to the hip bone is reduced, causing bone tissue death. 

• Hip Fractures: Severe breaks in the hip bone that may not heal properly with other treatments. 

• Hip Dysplasia: A condition where the hip joint doesn’t develop normally, leading to early arthritis.  

Indications for Hip Replacement Surgery  

Patients who benefit most from hip replacement surgery often have:  

• Severe hip pain that limits daily activities. 

• Pain that persists even with medication and physical therapy. 

• Stiffness in the hip joint restricting movement. 

• Persists, despite pain medication 

• Pain that worsens with walking, even with a cane or walker 

• Pain that disrupts sleep 

• Pain that affects the ability to do up and down stairs 

• Paint that makes it difficult to rise from a seated position 

• Decreased quality of life due to hip discomfort.  

Benefit of Hip Replacement  

Hip replacement procedure provides a number of benefits for individuals suffering from severe hip pain and dysfunction.   

• Significant pain relief. 

• Improved mobility and function. 

• Increased independence. 

• Reduced risk of complications from prolonged immobility. 

• Cost-effectiveness in the long run. 

• Enhanced quality of life.  

Types of Hip Replacement Surgery  

• Total Hip Replacement (THR): The damaged hip joint is removed and replaced with a prosthetic implant.  

• Partial Hip Replacement (PHR): The damaged femoral head of the hip joint is removed and replaced with an artificial implant.  

• Hip Resurfacing: The damaged surfaces of the hip joint are capped with metal prostheses, preserving more of the patient’s natural bone.  

Bilateral Hip Replacement:    

While the need for bilateral hip replacement may arise, the risks associated with performing both surgeries simultaneously are substantial. A staged approach, with an adequate waiting period between procedures, offers a safer and more effective path to recovery.  

• Increased Risk of Infection: Performing two hip replacements at the same time heightens the chances of postoperative infections, which can complicate recovery and lead to further medical interventions.  

• Excessive Blood Loss: The potential for substantial blood loss is greater when both hips are operated on concurrently, which can result in the need for blood transfusions and increase the overall risk to the patient.  

• Prolonged Surgery Time: Longer surgical durations increase the likelihood of complications related to anesthesia and overall patient stress. Extended time under anesthesia can lead to more significant postoperative issues.  

• Anesthesia Complications: Extended exposure to anesthesia during double hip replacement surgery can lead to adverse effects and complications, particularly in older or medically fragile patients.  

• Phlebitis and Thrombosis: The risk of developing blood clots in the leg veins, such as phlebitis (inflammation of a vein) and thrombosis (formation of a blood clot), is higher with bilateral procedures due to the increased immobility and stress on the body.  

• Extended Recumbency: Prolonged bed rest required after simultaneous surgeries can lead to additional health issues, such as pressure sores, muscle atrophy, and decreased lung function, making recovery more challenging.  

• Challenging Rehabilitation: Recovering from two hip surgeries simultaneously is more demanding and requires intensive rehabilitation, which can be physically and mentally exhausting for the patient. This can delay overall recovery and affect the success of the surgeries.

Given these challenges, surgeons usually recommend against performing bilateral hip replacements in a single session. Instead, they advocate for a staged approach, with a minimum waiting period between procedures, which offers several advantages:  

• Adequate Healing Time: Allowing a gap of at least four weeks between surgeries gives the body sufficient time to heal and recover from the initial surgery before undergoing the second operation. This reduces the overall stress on the body and improves the chances of a successful recovery.  

• Focused Rehabilitation: Patients can concentrate on rehabilitating one hip at a time, making the recovery process more manageable and effective. This focused approach helps in regaining strength and mobility more efficiently.  

• Reduced Complication Risks: Staggering the surgeries helps to minimize the risks associated with excessive blood loss, infections, and anesthesia-related complications. This approach ensures a safer recovery process.  

• Better Overall Outcomes: By addressing each hip separately, patients can achieve better overall outcomes, both in terms of physical recovery and mental well-being. The staged approach allows for a more tailored and patient-specific rehabilitation plan.  

Hip Replacement Procedure  

Before procedure:  

• Patient Assessment: Consultation with orthopaedic surgeon, comprehensive evaluation of the patient’s medical history, physical examination, and imaging studies (X-rays, MRI, CT scans) to determine the extent of the deformity and plan the surgery.  

• Anesthesia Consultation: The procedure is typically performed under general anesthesia.  

• Blood Tests: Blood tests may be conducted to rule out infections, rheumatoid arthritis, or other underlying conditions that could contribute to hip pain.   

During the procedure:   

• Positioning: The patient is positioned on the operating table, typically lying on their side or back.  

• Incision: An incision over the hip joint is made. The length and location of the incision depend on the surgical approach (posterior, lateral, or anterior).  

• Muscle and Tendon Management: The muscles and tendons are moved aside to expose the hip joint. In some approaches, certain muscles may be detached and later reattached. 

• Femoral Head Removal: The damaged femoral head is removed.  

• Acetabulum Preparation: The hip socket(acetabulum) is cleaned and prepared to receive the new socket component. Damaged cartilage and bone are removed.  

• Acetabular Component: The artificial socket is implanted into the prepared acetabulum. It may be secured with or without bone cement.  

• Femoral Component: The femoral stem is inserted into the thigh bone (femur). The new femoral head is attached to the top of the stem. The femoral component may also be secured with or without bone cement.  

• Component Alignment: The surgeon ensures that the components are properly aligned and fit together smoothly.  

• Range of Motion Testing: The hip joint is moved through its range of motion to confirm stability and proper function.  

• Reattachment of Muscles and Tendons: Any muscles or tendons that were detached are reattached to their original positions.  

• Suturing: The incision is closed in layers using sutures or staples. Dissolvable sutures may be used for deeper layers.  

After the Procedure     

• Physical Therapy: Physical therapy typically begins within the day of surgery to promote mobility and prevent complications such as blood clots. 

• Assistive Devices: The patient may use crutches, a walker, or a cane to aid in walking and reduce stress on the new hip joint.