What is Complex Hip Reconstruction Surgery?
Complex hip reconstruction surgery is a surgical procedure employed to treat hip structures with complex hip fractures or traumatic hip injuries, deformities, structural issues, and damage from diseases such as arthritis. The main objective of complex hip reconstruction surgery is to alleviate hip pain and stiffness, improve range of motion, and restore normal functioning of the hip joint to help you resume your normal activities and improve your quality of life.
Complex reconstructive hip surgery may comprise any of the following approaches:
- Hip Resurfacing: A surgical procedure in which the head of the femur bone and hip socket is resurfaced with smooth metal after removing the damaged bone and cartilage of the hip joint to improve mobility and reduce pain.
- Hip Osteotomy: A surgical procedure in which the damaged hip bone is cut, reshaped, and fixed in a brand new position. This realignment assists in the distribution of weight more uniformly, reducing wear and tear and strain.
- Hip Arthroscopy: A minimally invasive surgical procedure in which small key-hole incisions are made to insert an arthroscope and miniature surgical instruments to repair bone or cartilage damage in the hip joint.
- Hip Arthroplasty (Hip Replacement): A surgical procedure in which worn-out or damaged portions of the pelvis and femur (thighbone) that form your hip joint are removed and replaced with an artificial joint (prostheses).
- Hip Labral Reconstruction: Sometimes, traditional debridement and repair surgery may not be able to fix hip labral tears, necessitating the damaged labrum to be reconstructed. In such instances, hip labral reconstruction is performed in which the torn or damaged portion of the labrum is replaced with a tissue graft, which acts as a platform for the new labrum to grow on.
Anatomy of the Hip
The hip joint is the largest weight-bearing joint in the human body. It is a ball-and-socket joint formed by the round end of the femur (thighbone) and the cup-shaped socket of the acetabulum (part of the pelvis). The joint surface is covered by a smooth articular cartilage, which acts as a cushion and enables smooth movements of the joint. Stability of the hip joint is achieved by the labrum (a strong fibrous cartilage that covers the acetabulum and seals it), ligaments (tissues connecting bone to bone), and tendons (tissues connecting muscle to bone) that encase the hip and support the hip movements.
Indications for Complex Hip Reconstruction Surgery
Some of the indications for complex hip reconstruction surgery include:
- Treatment of severe arthritic conditions, such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis of the hip joints
- Traumatic hip injury or hip fracture
- Significant hip joint pain that limits your daily activities (such as walking, bending, getting up from a chair, or climbing stairs)
- Moderate to severe pain even while resting that affects sleep
- Stiffness in the hip due to joint degeneration, limiting movement
- Failure of conservative treatments to alleviate hip symptoms
Preparation for Complex Hip Reconstruction Surgery
Preoperative preparation for complex hip reconstruction surgery may 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, anaesthesia, 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.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after complex hip reconstruction will involve the following steps:
- You will be transferred to the recovery area to be monitored until you are awake from the anaesthesia.
- 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 anaesthesia, 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.
Risks and Complications
Complex hip reconstruction surgery 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
- Failure of the graft
- The need for revision surgery