Hip joint which is also known as a ball & socket joint is a special type of joint. While the cup side of the joint is known as acetabulum, the ball side is recognized as the head of femur. Part of the thigh bone (femur bone) is replaced with a metal component which is inserted into the lower part of femur in upper-end femoral replacement surgery. Acetabulum is then replaced with another plastic component. Patients will be encouraged to mobilize as soon as possible following proximal femoral hip replacement surgery. For this purpose, adequate pain relief is invariably prescribed in order to make this possible. However, patients must ensure that they stock up plenty of painkillers at home & while they are in hospital. They should make it a point to speak to nurses & doctors in case they feel pain is beyond control.
Generally, patients are encouraged to get out of bed on the day after surgery with assistance & help of a walking aid. However, they will only be initially allowed to partially bear weight through the affected leg. This effectively means that patients can only take about half the body weight through the operated leg & not the entire weight. Mobility will gradually be progressed through sessions with the physiotherapist. Physiotherapists will advise patients as to how far they should be mobilizing & which walking aids are appropriate for them. Normally, patients initially start with a walking frame & subsequently progress to crutches. It is also considered important that patients should carry out some exercises regularly in order to strengthen muscles around the damaged hip. Physiotherapists may often also advise patients to perform additional exercises which may also be beneficial. However, due to the position of the wound, there exists a slight risk of hip dislocation until the soft tissues surrounding the new hip heal completely. Patients should heed the physiotherapist’s advice so as to help reduce this risk & be able to gain maximum benefits from the new hip.
In order to reduce risk of dislocation following proximal femoral hip replacement surgery, patients must take the following precautions for at least a period of 3 months.
Following exercises need to be regularly performed throughout the day in order to reduce risk of developing chest infection or blood clots in calf. Moreover, patients who have undergone proximal femoral hip replacement surgery should start these exercises as soon as it is possible following the operation.
Following exercises should be started on the day after proximal femoral hip replacement surgery & should be performed 10 times each, for 4 times every day with each leg. Physiotherapists can practically help patients & help explain how to perform them.
Once proximal femoral hip replacement surgery patients are mobile with help of a frame or crutches, they can then progress to the following exercises. However, they should make sure that they are holding onto a firm surface while they are performing all standing exercises. They should also be performing 10 of each of these exercises for 4 times every day.
Proximal femoral hip replacement surgery patients while standing to use frame must pay attention to the following.
Some pain may persist for a few weeks after proximal femoral hip replacement operation & therefore patients must use these instructions as guide while increasing daily activities. Moderate type of ache which quickly settles is acceptable, but severe pain taking hours to settle is unacceptable. Patients should immediately stop all activity in case they are experiencing sharp pain. Moreover, in case these symptoms persist, they should contact the general physician for advice. They should also immediately contact the general physician in case area around the wound is turning red, increasingly becoming more painful, discharging pus or when the patient is unwell or running high temperature.
Swelling in leg operated upon for hip replacement surgery may remain for up to 3 months of time following the procedure. Patients must have their legs kept elevated while resting in bed for at least a few hours every day & which will help them control swelling.
Proximal femoral hip replacement surgery patients are usually discharged when the healthcare team feels they are ready to do so. They will subsequently either move to a rehabilitation center or to home depending upon medical requirements. However, before leaving the hospital, physiotherapists would discuss with them as to which exercises they should be continuing to do at home & how to systematically progress with their mobility.
Salvaging the hip diseased with severe proximal femoral bone loss can be a challenging task. With an ever increasing number of hip arthroplasties which are performed around the globe among an advancing age of target population, arthroplasty surgeons are faced with more severe instances arising of this difficult situation. There are numerous factors contributing to eventual loss of femoral bone stock, including periprosthetic fracture & osteolysis infection. In cases where proximal femur is severely deficient, treatment options are drastically limited.
Resection arthroplasty allows patients to have limited walking ability & function due to the short limb. Other surgical options in such cases include use of cemented or cementless long femoral stems which are intentionally designed to bypass the deficient proximal femur, impaction graft with cement & use of allograft-prosthesis composite. Last option however, is a major undertaking for the elderly frail patient which requires a substantial period of protective weight-bearing following the operation. Moreover, this can also be followed by escape of greater trochanter, junctional nonunion & graft resorption.
Segmented modular replacement system or MRS in short is also known as ‘Megaprosthesis’ was initially developed as a replacement for proximal femur patients with neoplastic conditions. These implants come in both, cemented & cementless versions & are modular so as to allow for replacement of exact length of femur which is deficient. These implants also have an inherent advantage over other options which typically serve to address severe proximal bone loss, like the allograft-prosthesis system. These include availability of implant & avoidance of risk of disease transmission which is generally associated with use of allografts. Even though a number of research papers have addressed functional outcomes of patients who have undergone proximal femoral replacement for severe bone loss, they do not specifically address quality-of-life outcomes of patients receiving modular replacement system. MRS can generally improve quality of life among patients with severely compromised bone stock. However, special attention needs to be given towards stability of the hip intraoperatively along with a constrained acetabular liner which should be used whenever risk of postoperative dislocation is high.
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