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October 6, 2010

Hip replacement surgery – step by step

Prof Nemec, orthopedic surgeon in Croatia

If you are considering Hip replacement surgery in Croatia, here you’ll find Step by Step illustrations regarding your procedure and rehabilitation.

Step 1. Diagnosis of Hip Arthritis

Hip arthritis is a common cause of hip pain. If hip arthritis becomes severe, a hip replacement procedure may be recommended. Hip arthritis causes the cartilage of the joint to wear out over time.

The hip joint is a ball-and-socket joint — the ball rotates within the socket to allow hip movement. The ball and the socket are covered with a layer of smooth cartilage. This cartilage allows for the hip joint to move freely. When the cartilage lining of the joint wears out, hip movements become stiff and painful.

Step 2. Removing the Worn Out Hip Joint Ball

The first step of a hip replacement surgery is to remove the damaged cartilage and bone. The hip joint has two sides, a ball (the femoral head), and the socket (the acetabulum). When the hip joint becomes arthritic, the normally smooth cartilage surface is worn away. To remove the worn out ball of the ball-and-socket hip joint, the bone is cut to remove the femoral head. In order to insert a new joint, the damaged bone and cartilage must first be removed.

Step 3. Removing the Worn Out Hip Joint Socket

Once the arthritic ball is removed, the worn out socket can be addressed. Unlike the ball, this bone cannot be cut off — the socket of the hip joint is part of the pelvis bone.

In order to remove the arthritis of the hip socket, a special tool called a reamer is used to scrape away the damaged cartilage and bone. This leaves a smooth, perfectly rounded surface to accept the new hip replacement implant.

Step 4. Placement of the Acetabular Component

Once the damaged bone has been removed from the acetabulum, the new socket of the hip replacement can be inserted. The socket of the pelvis is called the acetabulum, and the part of the hip replacement inserted into the socket is called the acetabular component. Some people also call this component the “cup.”

The acetabular component is held tightly in the pelvis by making the socket slightly smaller than the acetabular component, and wedging the implant into the bone. The implant has a rough surface to allow bone to grow into the surface of the implant over time.

Step 5. Preparing the Femur

Now that the socket has been addressed, attention can turn to the ball of the ball-and-socket hip joint. The ball is supported with an implant inserted down the hollow center of the thigh bone (femur). This implant is called the femoral stem.

Like the acetabular socket, the femoral stem must be held tightly in the bone. Special tools are used to shape the center of the thigh bone to accommodate the femoral stem.

Step 6. Placement of the Stem

With the bone prepared to accept the stem of the hip replacement implant, the femoral stem is inserted. The stem can be held in the bone with or without cement.

When the bone is held with cement, the cement is inserted in a liquid form, and the stem is then placed. Within a few minutes, the cement permanently hardens to hold the implant fixed within the bone.

When no cement is used, the implant is called “press-fit.” This means that the implant is wedged tightly into the bone. A rough surface covering the implant allows bone to grow into the implant over time.

Step 7. Insertion of the Ball

With the stem inserted down the center of the thigh bone, the ball of the ball-and-socket hip joint can be inserted on top of the stem. A metal ball is tightly fit onto the top of the stem.

Step 8. Final Hip Replacement Implant

With the socket, stem, and ball all inserted, the hip replacement can be placed in final position. With the parts in place, the ball is placed back into the socket — called reducing the hip.

It is important to ensure the hip replacement implants are stable. Hip replacement implants that are not stable may dislocate, a serious complication of hip replacement surgery.

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Illustrations: Medical Multimedia Group

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