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Hip osteoarthritis

Hip

What is osteoarthritis?

This is the progressive wear and tear of the cartilage until the bone surfaces are exposed. This results in rough friction between bones, accompanied by pain and inflammation of the hip. The joint gradually stiffens, and the pain progressively reduces walking distance. In advanced stages, this condition leads to an increased risk of falls and limits the patient's independence.

The natural progression of untreated osteoarthritis leads to permanent hip deformity, which alters the posture of the entire body. This process is irreversible.

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What are the consequences?

The hip is stiff and offers less and less respite between painful flare-ups. Limping is common. The stiffness becomes debilitating in certain daily activities, such as putting on shoes.

The pain is usually located in the groin and buttock, but sometimes extends down to the knee and can mimic knee pain. Posture and gait are altered. Other joints, such as the knee and lower back, are affected by the lack of hip mobility and also suffer.

What tests need to be done?

A clinical examination by an orthopedic surgeon and radiological assessment are sufficient in most cases. Further examinations, such as a CT scan or MRI, may be useful to confirm the diagnosis or plan surgery.

Medical treatments

To treat pain, analgesic drugs, anti-inflammatories, infiltrations (injections into the joint) and physiotherapy can provide more or less lasting relief.
In cases of advanced osteoarthritis, the benefit of these measures is often temporary.

Surgical treatment

Depending on the severity of the pain and disability caused by osteoarthritis, the surgeon may recommend hip replacement surgery. The decision to proceed with this surgical procedure is made jointly by the patient and the surgeon.

Your surgeon will choose the prosthesis that best suits your anatomy and lifestyle.

Hip prosthesis

What is a hip prosthesis?

The principle of a hip replacement is to replace the diseased joint with metallic implants. One is placed in the femur (the stem) and the other in the pelvis (the acetabulum). The connection between these two implants (bearing couple) is ensured by a metal or ceramic ball and a polyethylene or ceramic insert.
Thanks to improvements in materials and the evolution of surgical techniques, currently implanted hip prostheses have a lifespan of several decades.

Anesthesia

You will have an appointment with one of the clinic's anesthesiologists before your operation. You will be able to discuss and decide with them the type of anesthesia that will be offered to you on the day of your surgery. Your referring physician will have previously informed them about your health. If necessary, the assessment will be supplemented by other tests (blood tests, electrocardiogram).

The operation itself

The incision is approximately twelve centimeters long and is located at the front of the thigh (anterior approach) or on the side towards the buttock (posterior approach). Once the joint is exposed, the surgeon cuts the femoral neck with a saw. This bone cut is made at a precise height according to a pre-planned procedure. Once the femoral head is removed, the acetabulum of the pelvis is accessed. The damaged cartilage in this cavity is then removed using hemispherical burrs to prepare for the implantation of the acetabular cup in the acetabulum.
The surgeon then prepares the femoral cavity with rasps of varying sizes until satisfactory stability is achieved. After checking the joint's mobility and stability with temporary implants, the permanent implants are inserted and the joint is reduced. The joint is then thoroughly irrigated, and all structures are closed.
A drain (small tube) may be inserted to drain the surgical area. Finally, for the scar, a suture (absorbable or non-absorbable) or staples may be used, depending on the surgeon's preference.

Pains

Pain associated with osteoarthritis usually disappears relatively quickly after surgery. It's possible to experience some lingering pain in specific areas, especially if the hip was very stiff and damaged before the operation. This pain is generally related to the muscles and tendons surrounding the joint and will eventually subside.

Expected results

The main benefits one can expect after this operation are pain relief and the ability to walk freely again. It still takes a few months to regain full mobility and feel comfortable walking in all situations. However, it is possible to walk flat-footed the very next day, putting weight on the hip, and one can generally stop using crutches after a few weeks.
We recommend a recovery period of 2 to 3 months. While things can progress more quickly, a surgically repaired hip needs to be protected. Adapt your leisure activities, avoid strenuous sports and heavy lifting to enjoy them for as long as possible. The return to work varies depending on age and occupation.
Ideally, you should eventually forget that you had hip surgery.

The follow-up

You must strictly follow your surgeon's instructions. Attend all scheduled appointments and undergo follow-up examinations (X-rays). This is important. It allows us to monitor the progress of your hip, adjust the treatment, and ensure the prosthesis is properly secured in the bone.

Risks and complications

Infections

The most feared risk in prosthetic surgery is prosthesis infection. Procedures are in place to minimize this risk as much as possible during the pre-, intra-, and post-operative periods.
To reduce the risk of infection, it is absolutely essential to check before the operation that there is no latent infection (dental, skin, urinary, for example).

Venous thromboses

Prevention of the risk of thrombosis or pulmonary embolism is systematic after any lower limb prosthesis operation.
Depending on your health status and risk factors, the surgeon will adapt the treatment for optimal prevention.
The appearance of any symptoms is monitored by healthcare staff and during various follow-up consultations.

Hematomas

Bruising is common, but a hematoma can sometimes appear on the thigh and cause pain. In most cases, the blood is gradually reabsorbed, and this situation does not require any special treatment other than applying ice.

Vascular or nerve damage

The risks of vascular or nerve damage, although rare, are inherent to any hip surgery. A decrease in sensation around the scar may sometimes occur and usually disappears within a few weeks.

Post-operative anemia

Significant blood loss can occur and sometimes needs to be replaced. Today, a blood recovery system (Cell Saver) is available in the operating room. Therefore, the need for a blood transfusion other than your own blood is rare.

Dislocation

All implanted prostheses carry a risk of dislocation. This risk decreases after six weeks, which is the time required for proper tissue healing. This complication has become rare thanks to improved techniques and advancements in implants. The surgeon and physiotherapists at the clinic will explain the movements and positions to avoid.

Leg length

A difference in leg length can sometimes exist in cases where greater muscle tension is required to ensure joint stability or to correct a pre-existing difference. The patient may also perceive a change in gait angle.

Fracture

The risk of fracture is no higher in patients with prostheses. However, in the event of a fracture, the consequences can be more serious and sometimes require the replacement of part of the prosthesis.

Wear and loosening

Hip prostheses can wear out and no longer fit perfectly, sometimes requiring replacement. However, the success rate of this type of surgery has improved considerably over time thanks to advancements in implants, the quality of materials used, and improvements in surgical techniques. Wear on currently implanted hip prostheses is becoming less and less noticeable, and, barring technical problems, the prosthesis is designed to last a lifetime without needing replacement.

Medicol Specifics

2D and 3D Planning

Before the procedure, your surgeon will order X-rays and a CT scan to plan your prosthesis using specialized software. The planning is done in both 2D and 3D, allowing for precise planning to better anticipate potential surgical difficulties and choose the appropriate implant size. The goal is to position the prosthesis as closely as possible to the original anatomy of the hip for each patient.

Custom-made prosthesis

In most cases, there is no need to produce a custom-made prosthesis. Thanks to 3D planning, a standard prosthesis will adapt perfectly to the patient's anatomy, and a wide variety of options are available.
However, in rare cases, planning a standard prosthesis is impossible, particularly in cases of malformation or unusual anatomy, or after a previous fracture that has altered the shape of the bone. In such cases, a custom-made prosthesis perfectly adapted to the patient's femur is recommended. This procedure, reserved for a minority of patients, is relatively expensive.

Robotic surgery and artificial intelligence

Robotic surgery and artificial intelligence are gradually being integrated into operating rooms. Currently, robots in orthopedics aim to improve the precision of movements so that the surgical procedure corresponds as closely as possible to the planned outcome. These technologies are progressing rapidly, and it is undeniable that in the future, they will be an integral part of surgery, which is not yet the case today.
Our surgeons are currently training in the use of robots in orthopedics.

Back to sport

We place great importance on returning to an active life, and in particular returning to sport, after the fitting of a prosthesis.
During the rehabilitation phase, it's important to adapt activities to your own pace of progress. Every individual is different, and it's pointless to over-prescribe the resumption of activities. Initially, the main goal is to regain a smooth, balanced gait without limping.
Once you have regained a normal gait with a straight upper body and good arm swing, you will be comfortable going down stairs without holding on. Then you will be able to resume your sports or leisure activities.
You should start with what you enjoy and are good at. Gentle activities can be resumed quickly, and as you gain confidence, it's possible to consider other activities, especially if you practiced them before the operation.
High-impact sports or those requiring a wide range of motion should be avoided in the first few months. Eventually, once the prosthesis is well integrated into the bone, there should be no restrictions if the hip is properly controlled by the muscles (proprioceptive recovery).
Speak to your surgeon to get their advice.

Care and follow-up

After the consultation with the surgeon, you will have a pre-hospitalization consultation with a resident physician to discuss the information received, check that everything is properly organized, that the pre-operative health assessment is complete with the list of medications, etc.
You will still be able to ask all your questions during this interview.
To document our results, we use questionnaires and referenced scores that are recorded in your file. The purpose of collecting this data is to assess the quality of care and your satisfaction level.
The prosthesis is also registered in the SIRIS register (federal register of implants).

Frequently Asked Questions

How long does the operation take?
Approximately 1 hour 30 minutes to 2 hours
What is the lifespan of prostheses?
Currently, we can speak of an implant survival rate greater than 90% after 20 years.
What is the prosthesis made of?
Generally, uncemented implants are made of titanium at the prosthesis/bone junction, and the titanium is treated to promote bone regrowth, which ensures the implant's permanent fixation. Cemented implants are made of cobalt-chromium.
What is the length of the incision required for hip replacement surgery?
The length generally depends on the surgical approach used, measuring between 8 and 14 cm. The hip can be approached anteriorly or posteriorly, anterolaterally or posterolaterally. The choice of approach depends primarily on the bone structure of the hip and the surgeon's preferences.
When can I start driving?
Driving is permitted in an automatic car from the 10th day after surgery if the left hip was operated on. For a manual car, a waiting period of 3 weeks is required for the left hip. For the right hip, it is at the end of the 4th week. However, driving is only permitted once there is excellent control of the lower limb, allowing the driver to brake suddenly if necessary without hesitation.
How long should I keep the rods?
It is important to regain a smooth, limp-free gait with a symmetrical step and good lumbar-pelvic alignment. To this end, it is advisable to continue using crutches until you are able to walk normally, which typically takes 4 to 7 weeks.
Will I set off the alarms when going through airports?
Yes, generally, as it is a fairly large metallic implant, it is detectable at the airport gate and we will give you an implant carrier card for this purpose.
Do I need to take antibiotics when I go to the dentist?
Antibiotic prophylaxis may sometimes be recommended during extensive dental cleanings or in cases of dental abscesses. For other treatments, the need for antibiotic prophylaxis should be assessed on a case-by-case basis.
When will I be able to start playing sports again?
Resuming sports activities should be gradual. Activities such as Nordic walking, cross-country skiing, or brisk walking can be resumed from the 6th week; skiing, tennis, or golf can be resumed after three months. Activities like running are not recommended.
How long does a prosthesis last?
Currently, if we refer to orthopedic medical literature, the duration of implants far exceeds 20 or even 30 years (implant survival rate of more than 95% at 15 years).
Which movements are prohibited?
Depending on the surgical approach, certain postures that can lead to instability should be avoided. With a posterior approach, always maintain a distance between your knees, especially when rising from a low seat. If you need to pick something up from the floor while seated, do so by reaching between your legs, not sideways. Finally, crossing your legs is not recommended.
Can I have a normal sex life?
Total knee replacement has been shown to improve quality of life, including sexual function. It is simply important to avoid extreme bending positions and to always maintain a distance between the two knees.

Summary

Ouchy Orthopedic Center in Lausanne

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1006 Lausanne

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+41 21 510 33 48

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