What is Short-Stay and Fast-Track Hip Replacement?
Short-stay and fast-track hip replacement is a minimally invasive surgical procedure in which worn-out or damaged surfaces of the hip joint are removed and replaced with prostheses. This method of treatment is known as a synchronized perioperative approach directed at decreasing surgical stress and promoting quicker postoperative recovery. The main goal of this treatment method is to reduce the necessity of hospitalization to no more than 3 days while maintaining very high patient satisfaction and few complications.
Anatomy of the Hip
The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and the pelvis join. It is a ball-and-socket joint in which the head of the femur forms the ball and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint.
Indications for Short-stay and Fast-Track Hip Replacement
Patients indicated for short-stay and fast-track hip replacement experience moderate to severe hip arthritis, such as rheumatoid arthritis, osteoarthritis, and post-traumatic arthritis, all of which cause pain and interference with activities of daily living including:
- Moderate to severe pain even while resting that affects sleep
- Difficulty in walking or bending, or climbing stairs
- Stiffness in the hip due to joint degeneration, limiting movement
- Severe injury or fracture of the hip joint
- Failure of conservative treatments to alleviate hip symptoms
Preparation for Short-Stay and Fast-Track Hip Replacement
Preoperative preparation for short-stay and fast-track hip replacement will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Short-Stay and Fast-Track Hip Replacement
The procedure is mostly performed arthroscopically under anesthesia and involves the following steps:
- After adequately sterilizing the surgical area, your surgeon will make 2 to 3 small incisions of about 1/4 inch in length around the hip joint.
- Through one of the incisions an arthroscope - a narrow tube with a tiny video camera on the end - is inserted to view the damaged hip joint.
- A sterile solution is pumped into the joint to expand the joint area and create room for the surgeon to work.
- The larger image on the television monitor allows your surgeon to visualize the joint directly and determine the extent of damage and the required treatment.
- Miniature instruments are inserted through other small incisions and the supporting structures of the hip are gently moved out of the way, allowing removal of damaged cartilage and bone tissue from the hip joint.
- Your surgeon prepares these surfaces appropriately to insert specifically-sized prosthetic components to your hip joint, which are secured with the use of bone cement or screws.
- With all the new components in place, the hip joint is tested through its range of motion.
- All surrounding tissues and structures are restored to their normal anatomic position and the scope and instruments are removed.
- Finally, the incisions are closed with sutures and sterile dressings are applied.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after short-stay and fast-track hip replacement will involve the following steps:
- You will be transferred to the recovery area to be monitored until you are awake from the anesthesia.
- Your nurse will monitor your blood oxygen level and other vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed.
- Medications will also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea.
- Antibiotics are prescribed to address the risk of surgery-related infection.
- It is important to keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- You will be placed on assistive devices such as a splint or crutches for walking for the first few weeks with instructions on restricted weight-bearing. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- You are advised to keep your leg elevated while resting to prevent swelling and pain.
- Refrain from smoking as it can negatively affect the healing process.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- Refrain from strenuous activities and lifting heavy weights for the first couple of months. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol is designed to help strengthen your hip muscles and optimize hip function.
- You will be able to resume your normal activities in a couple of months; however, return to sports may take 4 to 6 months or longer.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Advantages of Short-Stay and Fast-Track Hip Replacement
Some of the advantages of short-stay and fast-track hip replacement include:
- Minimal surgical incision
- Less postoperative pain
- Short recovery period
- Shorter hospital stay
- Minimal blood loss
- Minimal damage to surrounding tissues
Risks and Complications
Short-stay and fast-track hip replacement is a relatively safe procedure; however, as with any procedure, possible risks and complications may include:
- Failure to relieve pain
- Blood clots
- Injury to nerves and blood vessels
- Implant wear and loosening
- The need for revision surgery (to address a faulty or problematic prior implant)