Total hip replacement is a widely performed surgery in Spain to treat advanced hip osteoarthritis. Fortunately, in an intervention with a fantastic track record in a history of almost 50 years and one of the most successful surgeries that exist. The worn bone is replaced by fixing two artificial implants in the acetabulum (pelvis) and the femur. Your surgeon will decide the type of implant to use depending on your age, bone shape (anatomy), activity level, and bone quality among other factors. The choice of implants requires careful planning and studies (routinely X-rays) before surgery to choose the appropriate implants for your bone shape. This planning is an essential step for the success of the surgery.
In general, there are two types of total hip replacement in Spain: standard total hip replacement and hip resurfacing arthroplasty. The implant most frequently used and with a record of excellent long-term results is the total hip replacement. Both implants are fixed to the acetabulum and the femur and only differ in the method of fixation and amount of bone cut initially.
In Spain standard hip replacement can be fixed to the bone by cementing the implants or not. Not cemented implants have become standard of care almost worldwide but cemented femoral implants have almost an equally good record. The uncemented hip prosthesis consists of two titanium implants: a cup fitted into the pelvis (the acetabulum) and a stem implanted within the proximal part of the femur after resection of the head and neck of the femur. The surface of these implants is rough and designed to adhere (biologically integrate) to the bone. The fixation of the implants initially depends on a very precise mechanical preparation and impaction, but the long-term result depends on correct biological osseointegration between the bone and the implant.
The articular interface between the acetabulum and the femoral stem consists of a specially hardened plastic (polyethylene) and a round head (of ceramic or cobalt chrome). This surface is called the bearing interphase and can be of metal on polyethylene, metal on metal, ceramic on polyethylene, ceramic on ceramic, etc. There are small differences currently between the different bearing surfaces selected and its selection depends on the different factors such as age, activity levels, etc. Dual mobility bearings are a kind of interphase that reduce the risk for dislocation.
Cemented total hip replacement is an option sometimes used for femoral implant fixation. Its use is indicated due to the characteristics of the shape and quality of the bone and there are no differences in the functional or survival results of the implants currently between the two systems (cemented or non-cemented).
Total Hip Surface Replacement (Resurfacing) in Spain
Hip resurfacing prosthesis is a specially designed metal prosthesis made of cobalt and chrome used for total hip replacement in Spain. It has the advantage of resecting far less bone from the patient and thus preserving more bone for the future. Its use is indicated mainly in young, active and tall men due to better survival results in this group of patients. It is considered to perform better at high demand with a more ¨physiological¨ reconstruction. However, its generalized use has been severely restricted due to the potential harmful effects related to the cobalt and chromium ions released within the joint. These ions are generated within the joint interphase by the friction between the femur and the acetabulum (it does not have plastic between the surfaces) of one metal to another. They caused early loosening and bone lysis when the implants were poorly positioned or in poorly selected patients. It is a demanding technique performed by only a few surgeons and is not indicated for all patients.
Risks associated with hip replacement
The risks involved in any procedure with anesthesia are allergic reaction to medications, respiratory, heart or urological problems, neurological problems with regional anesthesia, adverse reactions to medications, etc. The risks involved in any surgical procedure are bleeding, infection, thrombosis, etc. Risks specific to a hip replacement may be: bleeding within the joint (hemarthrosis) from vascular injury, bone fractures around the implant, nerve injury to the femoral or sciatic nerve, infection or dislocation or dislocation of implants, asymmetry or difference in length between the legs, problems with healing, failure of surgery to relieve symptoms, death, etc. The most frequent late complications are infection, loosening due to wear of the prosthesis, fractures around the prosthesis or dislocation of the prosthesis.
Expectations after total Hip Replacement in Spain
No surgery has a 100% success rate and no implant will last forever. The survival or duration of any artificial implant is related to its correct implantation. Many studies have confirmed greater survival rates when surgeries are undertaken by experienced surgeons and in specialized high-volume centers. Wearing out of the prosthesis is a normal process over time and in a simplistically is related to its use. The prosthesis is designed to improve the patients quality of life to perform their daily activities and sports in a pain free fashion. Therefore, its duration varies with a patients age, sporting and work activities, weight, etc. Implant survival declines over the years with a success rate of around 90 and 85% at 10 and 15 years.
Inmediate Postop and Convalescence
In hip prosthesis performed using rapid recovery protocols, the patient is able to walk on the day of surgery, go up and down stairs almost immediately and be independent pretty quickly. Patients are admitted to hospital for between 24 and 72 hours on average. Full recovery is usually about at about 4 to 6 weeks although this will vary greatly in each patient. The patient will need a pair of crutches for approximately 4 to 6 weeks. This is to avoid weight and pressure on the joint until the swelling and bruising in and around the hip subsides. The level of pain is moderate and is controlled with oral analgesics and anti-inflammatories in the postoperative period. Like most interventions of the lower limb, anticoagulants are used for about 4 weeks to avoid the risk of deep vein thrombosis or embolism of the operated leg. Patients are discharged from the hospital on crutches but walking independently at the time of discharge. The patient is discharged with dressings to cover the incision during the first days or until the first control visit.
The patient will be able to walk with full weight bearing requiring crutches for approximately 3 to 6 weeks and then gradually returning to normal without a cane or crutches. Full recovery after total hip replacement in Spain is approximately 3 months, but may take up to six months to return to high-demand sports and activities.
Dr Malik: Experienced Orthopedic Surgeon and Traumatologist with Specialization in Hip and Knee Surgery and Research
Hospital Universitari Sagrat Cor in Barcelona
Hospital Universitari Sagrat Cor is a tertiary care hospital and the largest privately owned in Barcelona with first-rate medical technology that offers all medical and surgical specialities.
Due to the quality of its medical team and the hospital’s aim to improve healthcare through learning, teaching, and research, Hospital Universitari Sagrat Cor is accredited as a teaching hospital by the Faculty of Medicine of the University of Barcelona and by the Spanish Ministry of Health to train specialist doctors (MIR), pharmacists (FIR) and nurses (EIR). Every year, Hospital Universitari Sagrat Cor contributes to the education of more than 800 healthcare professionals.
The hospital counts a team of 1,100 professionals that pursue approximately 25,000 surgical operations every year and treat more than 400,000 patients annually.