What Hip replacement procedure entails

A team of Orthopedic surgeons and nurses and take a patient through a hip replacement surgery at Nanyuki hospital. [File, Standard]

Hip replacement is a surgery where part of the hip joint is replaced with implants.

There are several types of the procedure:,

Total hip Replacement- The hip joint is removed and replaced with a hip implant.

Partial hip replacement -Common in the elderly. The socket of the hip joint is not replaced Instead, the ball of the joint is replaced.

Hip resurfacing- surgery that takes less bone from the joint. It's only really effective in younger adults with stronger bones.

Dr. Kiran Bhokry an orthopaedic surgeon at Diani Beach Hospital says that one of his patients (Jecinta) required a total hip replacement because once there's a fracture in the head of the femur the blood supply is cut off.

Total Hip Replacement is also called Hip Arthroplasty. In this procedure, the surgeon removes the damaged bone and cartilage and replaces it with prosthetic implants.

The hip replacement surgery can be total where the Femoral (the bone in the thigh) head and the part of the hip bone are replaced or partial (hemiarthroplasty) where just the Femoral head is replaced by a prosthetic implant.

A day after the surgery Dr Kiran says they would advise the patient to walk." They would be able to put the weight on the leg without any problem, on the 2nd or 3rd day we make them go down the stairs and, on the 4th, or 5th day we discharge the patient after making sure the patient is now independent."

Dr Kiran says that complications are the same just like in any other surgery, however, they try as much as possible to take care of infections.

Dr Kiran says the life span of the implants ranges from 20-25 years others 30-40 years.

"If a patient is younger, we use a long lasting hip replacement. We make sure we do a hip surgery once in one's lifetime, but sometimes due to some complications we will have to revise it," he says

He adds that if a patient is around 80 years old they would go for a simpler implant.

The surgery takes around one and a half to two hours, done under epidural anaesthesia. This is the method of medication administration in which a medicine is injected into the epidural space around the spinal cord.

Types of Implants

According to The Medical Director at Diani Beach Hospital, Dr Rajgopal V, they are different kinds of implants depending on the patient's budget.

"We are using extremely good quality implants that would be used in developed countries like the US or UK. We have various choices for them," he says.

They include:

Stainless steel implants

Titanium implants

Dr Rajgopal says that implants never grow old, in most cases implants outlive people.

The cost

"The procedure costs between Sh500,000-800,000, and NHIF covers around Sh300,000," he says

In 2021 The Kenya Medical Practitioners and Dentists Council (KMPDC) however said that surgeons in public hospitals should not charge more than Sh80,000 as a professional fee for hemiarthroplasty, the replacement of one hip joint, and not more than Sh180,000 for the total hip replacement.

This came after the former Nairobi Governor who was admitted at Nairobi Hospital under stringent police protection needed to be released to go for hip replacement surgery in South Africa. Sparking a debate on whether the procedure cannot be done in the country.

Arthritis

Dr Kiran says that arthritis is another condition that might require a hip replacement.

"These implants were designed to cure arthritis. However, hip replacement is not the only answer for arthritis we have different kinds of treatment depending on the type of arthritis and the stage they are in.

Arthritis is a disease of the joint, affecting more than 350 million globally.

The most common arthritis include:

• Osteoarthritis (OA).

occurs after the age of 60 years but can also occur in some women in their 40s. It is more prevalent in overweight and obese individuals. OA can be Primary - occurring for the first time (mostly in elderly patients) or can be secondary to some form of injury to the joint. Affects the larger joints like knees and hips but can also be seen in the smaller joints of the hands.

• Rheumatoid Arthritis (RA).

generally seen in the age group of 30-50 and affects women more than men. It can also occur in children, teenagers and younger adults.

Affects smaller joints generally. Patients with RA in addition to joint stiffness and deformities experience fever, inflammation of eyes, mouth, heart, lungs, blood vessels and have anemia.

• Psoriatic Arthritis.
• Gout

Causes Of Arthritis:

• Wear and tear of the joint from overuse.
• Age.
• Obesity.
• Injuries.
• Muscle weakness.
• Family history (more common in RA).
• Smoking (increases risk of RA).
• Joint infections.

Management Of Arthritis:

The management of Arthritis is often multidimensional. Depending on the stage and severity of the disease your doctor will suggest numerous steps in the management. These include:

• Medications and supplements.
• Physical therapy.
• Occupational therapy.
• Regular exercises.
• Weight loss, if obese.
• Hot and cold compresses.
• Mobility assistance devices like canes and walkers.
• Surgery.