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Magazine
HEALTHWATCH
No pain, more action
DR. S.K.S. MARYA
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New developments in techniques and implants lead to improved outcomes for hip replacement surgery.
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Improved flexibility: With younger patients, the range of activity is also more.
Hip replacement used to be an option primarily for adults aged 60 and above. But recent technological advancements have led to strong and longer lasting artificial joints that are feasible for more active or younger people.
Most people undergo hip replacement for osteoarthritis of the hip joint. The procedure is also considered if one experiences severe pain, loss of motion or deformity of the hip joint. Hip replacement is also offered to people with hip injuries, rheumatoid arthritis and other medical conditions, such as a bone tumours or bone loss due to insufficient blood supply (avascular necrosis).
Providing answer
When other therapies fail to provide relief from the pain of hip arthritis, hip replacement may be the answer. Hip replacement — called total hip arthroplasty — can relieve pain and give the patient the range of motion that is required to go about daily tasks.
Conventionally hip replacement surgery involves replacing the femoral head — the “ball” of the thighbone — with a metal ball. The metal ball is attached to a metal stem that fits into the thighbone. A plastic and metal socket is implanted into the pelvic bone to replace the damaged socket.
The prosthetic parts mimic the natural design of the hip; so they fit together and function like a normal hip joint. The socket can be lined with plastic, metal, or ceramic. The components can be cemented into place or have a biological material coating that induces bone to grow into it.
Hip replacement surgery usually takes one to two hours, during which time the patient is under general or regional anaesthesia. During the operation, the surgeon dislocates the thighbone from the socket. Working between the large hip muscles, the surgeon removes the diseased or damaged bone and tissue, leaving healthy bone and tissue intact. The artificial socket is pressed into place. The top end of the thighbone is hollowed out to allow insertion of the metal stem with the attached ball. The ball and the socket join to form the new hip joint.
Many people delay hip replacement due to fear, misinformation, or lack of awareness about treatment options. They live with unnecessary physical pain, stiffness and reduced mobility that affects daily life and limits activities. Hip replacement is among the most commonly performed orthopaedic procedures, and is successful in more than 90 per cent of the cases though it wears out more quickly in younger, more active patients.
Minimally invasive
Joint replacement is often the answer if the patient has constant pain and can’t move the joint well; for example, trouble with walking, climbing stairs, and taking a bath. To a person who has been putting off surgery and suffering debilitating pain, new developments offer great hope.
Intelligent hip surgery is an approach that places equal importance on maximising survivorship, optimising function and accelerating recovery. Its success is founded upon the development of high performance bearings, clinically established implants and effective minimal invasive techniques.
Scientists and engineers have been studying the science of joint replacements to find the best options for improving movement and flexibility. They have also been looking at new implant materials and ways to improve surgery. Recent developments like Delta ceramic on ceramic and XL metal on metal implants as against the commonly used metal or plastic ones offer an excellent option due to the decrease in the wear and tear. This, in turn, leads to longer life of the implant after the surgery.
New technique
A new technique is being used for some hip replacement surgeries. Minimal incision hip replacement uses the same prosthesis to replace the hip joint, but the surgery is performed in a way that requires only a three- to five-inch incision — a departure from the current 10-12-inch incision. Studies have shown that people who undergo minimally invasive hip replacement have an easier and less painful recovery, spend less time in the hospital and have fewer complications.
Proxima is a hip replacement prosthesis that fulfils all the requirements of Intelligent Surgery. Compatible with all the high performance bearing options, it is an evolution of the Santori stem, which has 11 years of successful clinical heritage and is the first implant specifically designed for the MIS (Minimally Invasive Surgery) hip procedure.
By using Proxima, more bone is preserved, as the size of the stem is smaller than the one normally used in conventional surgery. The design of the implant helps achieve a more natural, anatomically correct distribution of weight to the thighbone. Hence it reduces the potential for proximal stress shielding and eliminates thigh pain. The implant allows the femur to flex in a more physiological manner.
With the above developments in technique and implant quality, hip replacement can be performed in younger patients. With technological advancements, the implant can last even up to 20 years. The new hip joint will help reduce the pain felt before the surgery and increase the range of motion in the joint. Now, the patient may be able to swim, play golf, walk or ride a bike again.
The writer is an orthopaedic surgeon based in New Delhi.
Benefits of Proxima
Shortened hospital stay
Reduced recovery time
Reduced post-operative pain
Preserves soft tissues and bones
Smaller incisions
Smaller, less noticeable scars
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