Hip replacement surgery, or arthroplasty, is a surgical procedure, used to remove a diseased or fractured hip joint and replace it with an artificial joint or prosthesis. It is a very common surgery that helps to minimize pain and rigidity in the hip joint. Total hip replacement surgery has evolved over the years as advances in technology have made it possible to improve surgical techniques.
Osteoarthritis is one of the most common factors for hip diseases. Structures within the hip (such as the cartilage or bony joint surfaces) may get damaged due to overuse, trauma, or certain conditions, such as rheumatoid arthritis, osteoporosis and tumors. This may lead to degenerative changes within the hip that can lead to osteoarthritis. Total hip replacement procedures include primary hip reconstruction, partial hip reconstruction and hip resurfacing.
In primary hip reconstruction, the femoral head and acetabular hip socket are both removed and replaced. The hip implant consists of three components: a femoral stem, a femoral head, and an acetabular cup. The femoral stem is placed down the shaft of the femur and a metallic head is connected to the metal femur, which then moves against the acetabular hip implant (cup). The acetabular cup can be cemented or, more commonly, cementless. Cementless total hip implants are expected to dominate the market in 2017, with a share of 74.6% of the global hip replacement market.
A partial hip reconstruction is performed when only femoral component of hip joints is to be replaced. A partial hip replacement involves replacing the femur (thigh bone) head with a prosthetic component. This surgery involves making incisions on the anterior (top), lateral (side), and/or posterior (back) of the hip. This type of implant uses similar modular components to a total hip replacement, however, either a unipolar or bipolar head along with femoral stem is used for this type of surgery. A partial hip prosthesis is comparatively less expensive and consumes less time for implant than a total replacement.
The global hip reconstruction devices market was valued at $4.8 Billion in 2014 and is expected to reach $5.9 Billion by 2020. North America accounted for the largest share of the global hip reconstruction devices market in 2014. The increasing number of patients suffering from osteoarthritis, rheumatoid arthritis, and osteoporosis are some of the major factors for market growth. Further, favorable reimbursement, technological advancements, growing health awareness among the public, and the increase in spending power are also major factors. However, price pressure, risk of complications after surgery, and waiting time for surgery in hospitals are some of the major adverse factors affecting market growth.
The current trend towards minimally invasive surgery is also one of the important factors for the growth of the hip reconstruction market as the surgery reduces the amount of soft tissue distraction during a procedure, speeds patient recovery, minimizes discomfort, reduces hospital stays, and shortens rehabilitation time. Computer-assisted total hip replacement surgery is also one of the latest revolutions in this area.
Hip resurfacing techniques are used to treat hip fractures while avoiding total hip replacement procedure. In hip resurfacing, the femoral head is not removed but is instead trimmed and capped (resurfaced) with a smooth metal covering. The damaged bone and cartilage within the acetabular hip socket are removed and replaced with a one piece metal shell which moves against the resurfaced head. Hip resurfacing surgery involves lesser bone removal as compared to total hip replacement surgery and reduced risk of hip dislocation. Hip resurfacing surgery is commonly performed on patients suffering from severe osteoarthritis.
Preference given by healthcare professionals to hip resurfacing surgery and innovations in the hip surgery industry is driving the growth of hip resurfacing implants market. However, emerging alternative technologies and competition between manufacturers are hindering growth of this market. Mergers and acquisitions taking place in the market is one of the major developments in the hip resurfacing implants market that has resulted in market consolidation and high competitive rivalry among the existing players.
Recovery & Rehabilitation
After hip replacement surgery, the orthopedic surgeon may advise the patient to perform activities with the following cautions:
- Avoid bending more than 90 degrees during an activity.
- Avoid twisting of the hip.
- Do not swivel on the ball of the foot.
- Take small steps when turning around.
- Do not apply pressure on the incision site.
- Avoid lying on the surgical hip.
- Do not cross legs.
- Avoid forcing the hip to do anything that causes severe pain.
- Avoid low chairs and toilet seats.
- Avoid bathing or showering until the staples/sutures are removed (usually within 7-14 days)
- Use an icepack for 10-15 minutes several times each day to relieve pain.
During the first few weeks of recovery, a therapist will assist with performing specific hip strengthening and flexibility exercises. There may be some discomfort when performing exercises, but this activity is necessary to prevent blood clot formation, improve circulation, prevent stiffness, and return to normal hip range of motion. There are four phases of rehabilitation:
- Phase 1 – Mobility and initial exercise
- Phase 2 – Intermediate exercise and stabilization
- Phase 3 – Advanced exercise and neuromotor control
- Phase 4 – Return to usual activity
It generally takes 4-6 weeks to return to normal activities.