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Hip Prostheses: Guide to Conditions, Procedures, and Rehabilitation

The hip is one of the body's major and crucial joints.

When everything functions correctly, we can sit, bend without pain, run, jump, walk—essentially, bear the body’s weight in movements.

Along with the shoulder, it’s one of the joints with the greatest range of motion.

The hip connects the lower limb to the pelvis.

The hip joint is formed by the femur (thigh bone) and the acetabulum, a hemispherical socket in the pelvis that cradles the femur head like a cup.

Surrounding both structures is cartilage, providing a smooth surface to cushion impacts and friction between bones, allowing them to glide freely.

The joint is lubricated by synovial fluid, produced by the membranes surrounding the joint, further reducing friction between bone parts.

In addition to bones, the hip has various sturdy ligaments providing stability despite the broad range of motion.

Lastly, it is associated with numerous muscles in this body region that enable joint movement.

In this article, we will discuss:

  1. Conditions Resolved with Hip Prosthesis Surgery
  2. Hip Prosthesis Surgery
  3. Minimally Invasive Hip Prosthesis: Benefits and Recovery
  4. Rehabilitation and Return to Daily Life

1. Conditions Resolved with Hip Prosthesis Surgery

The hip joint can suffer from gradual or rapid degeneration.

Four main types of conditions that may require hip prosthesis surgery are:

Coxarthrosis (Hip Osteoarthritis): Characterized by cartilage degeneration, causing intermittent severe pain.

Osteonecrosis: Disruption of blood supply to the femoral head leads to bone death and cartilage deterioration, resulting in intense, sometimes acute, pain.

Rheumatoid Arthritis: A chronic inflammatory disease causing cartilage deterioration due to immune system attacks.

Post-Traumatic Arthritis: Cartilage damage resulting from joint fractures or altered joint function due to non-directly joint-involved fractures.

When pain from these conditions persists despite pain management or when the benefits of conservative treatments diminish, and daily pain relief becomes necessary, surgery should be considered.

2. Hip Prosthesis Surgery

An orthopedic specialist conducts a thorough examination to identify risk factors and potential benefits. The decision is based on disease severity, patient age, and psycho-physical characteristics.

The surgery aims to improve movement and enable a return to normal activities. It is a safe and effective procedure. Modern, smaller-sized, biocompatible prostheses allow for minimally invasive surgery, accelerating recovery times.

Composition of Hip Prosthesis:

Ceramic head on a metal stem replaces the damaged femoral head.

Metal acetabular cup replaces worn-out cartilage.

Polyethylene or ceramic insert between the head and cup provides a smooth sliding surface.

The choice of cemented or non-cemented hip prosthesis depends on bone quality.

Hip Prosthesis Surgery Process:

Pre-hospitalization involves anesthesia and cardiology assessments.

X-ray guides prosthesis selection.

Anesthesia typically involves spinal injection.

Traditional surgery requires a 20-30 cm incision, but minimally invasive techniques use a smaller incision, around 10 cm, closed with glue, preserving bone, especially on the femur.

3. Minimally Invasive Hip Prosthesis: Benefits and Recovery

Total hip prosthesis involves replacing the damaged joint with an artificial prosthesis. Advanced minimally invasive techniques allow for successful implantation through smaller incisions.

This approach reduces pain, bleeding, eliminates stitches, restores mobility, and facilitates a quick return to normal life. Minimally invasive prostheses, combined with modern pain therapy and reduced bleeding, enable patients to walk shortly after surgery, leading to immediate recovery.

Recovery benefits include:

  • Ability to walk independently within days.
  • Short hospital stay.
  • Rapid return to normal activities.
  • The success rate of hip prosthesis surgery is high in orthopedic departments in Italy.

Recovery from Minimally Invasive Prosthesis:

  • Implemented through the Rapid Recovery method.
  • Patients can stand and walk a few hours post-surgery, with minimal pain and support (2 crutches).
  • No need for a urinary catheter.
  • Reduced pain and bleeding.
  • Faster recovery compared to traditional prosthetic surgery.

4. Rehabilitation and Return to Daily Life

Rehabilitation and physiotherapy exercises are crucial for physical and psychological recovery after hip prosthesis surgery, ensuring a swift return to complete independence.

A healthy lifestyle and balanced diet are essential to maintain weight and protect surgery outcomes.

Post-operative recovery includes hospital exercises and continued home and gym exercises.

Rehabilitation Highlights:

  • Early post-surgery exercises: ankle flexion, isometric contractions of quadriceps, gluteus medius, and adductors, bridge exercises, and passive range of motion.
  • Individualized gym rehabilitation.
  • Final physiotherapeutic evaluation and a home exercise protocol before discharge.
  • Main Rehabilitation Exercises:
  • Range of motion recovery exercises (active and passive).
  • Gait training.
  • Muscle strengthening exercises.
  • Movements and Gestures to Avoid Post-Operation:
  • Flexion of the hip with an angle greater than 90°, especially if combined with internal rotation.
  • Crossing the legs.
  • Walking extensively on uneven terrain.
  • Patient recovery times:
  • Independence for postural passages and walking: 3-5 days.
  • Independence for daily life activities: 10-15 days, depending on age, weight, physical fitness.
  • Walking without crutches: 12 days to 1 month.
  • Driving: 3 weeks to two months.
  • Return to work: 45 days to three months, depending on the job.
  • Return to normalcy: 2 to 4 months.

Sports Activity After Prosthesis:

  • No contraindications for modern hip prostheses.
  • Suggested gradual resumption of activities like swimming, golf, cycling, dance, skiing, hiking, bowling, gentle gymnastics, rowing, sailing, and walking.
  • Discouraged activities include contact sports like football, rugby, and basketball.