When is a hip operation necessary?

There are basically two components that usually make hip surgery necessary. First, there is a component of degenerative pathology, which is usually caused by wear and tear or osteoarthritis. Secondly, there are the pathologies of young adults, which are usually pathologies more related to muscular pathology, deformities and malalignment of the bones. Depending on the type of pathology, the type of presentation and age, the treatment ranges from a slightly less aggressive one (osteotomies or arthroscopies) to a more aggressive one, when the joint is more worn out and there is little biological remedy, when a prosthetic treatment is chosen.

What type of patients are more likely to require hip surgery? Is it more common in older people or can it occur in young people?

It can occur in young and older patients but when young patients have to be operated on, hip preservation must be attempted. This consists of early detection of hip shape deformities or other problems that predispose to early osteoarthritis. In the past, this was not studied, but now, for the last 10-15 years, it is being studied much more and attempts are being made to perform corrective surgeries for this deformity, either open (osteotomies) or arthroscopic, in young people. In older people the main problem is degenerative pathology.

What technique will be the one of choice in hip surgery?

The most commonly performed technique is mainly arthroscopy and then prosthetic surgery, when the pathology is a little more advanced. But there is a subgroup of patients who need hip osteotomy. There are really few patients, but the intervention technique will be different.

When will a hip prosthesis be necessary? In what type of injuries?

The hip prosthesis will be necessary in advanced hip pathology, when the joint is so worn out that it does not allow any other type of remedy.

Do the prostheses always adapt well to the joint or can they be customized? What does the “resurfacing” technique consist of?

Nowadays, the limitations of prostheses are not usually due to the biomaterial. They are so well achieved and so well studied, with more than 50 years of experience, that prosthesis failures are not usually due to the type of prosthesis used. The prosthesis must be adapted to the anatomy and age of the patient because there is a cost-effectiveness of the prosthesis. There are prostheses that are for young people that have slightly more expensive alloys that, really, there is no need to put them in a person over 80 years of age, which does not mean that a cemented prosthesis can give excellent results in this patient.

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In the line of young patients there is a subgroup, such as the really young and highly active patient, with a very large bone size, who is a good candidate for resurfacing, for example.

Resurfacing is a technique that consists of respecting the head and neck, without cutting it, and simply putting a “hood” to replace the femoral head, and filing the surface of the bone, hence the name resurfacing. On the other hand, in a total prosthesis, the head and neck are cut and a stem (either short or long, cemented or uncemented) is placed to anchor the bone.

However, the indications for resurfacing surgeries have changed somewhat. There was a boom in this type of surgery 10 years ago, many failed and it was even recommended not to apply this technique. However, it is a technique that is beneficial in a small number of patients, which is the young male under 60 years of age with high activity. It allows the insertion of a large size prosthesis that has been shown to have good survival, since it supports the entire weight of the body. When this type of prosthesis has been applied in young women, of small size, it has been seen to fail.

How long will it take for the patient to recover mobility and what will the results of the surgery be like?

In a hip arthroscopy, although the surgery is relatively simple and the patient is already at home the next day, recovery will take between six weeks and three months, until the patient is fully recovered. It is a slow recovery.

However, the hip prosthesis is a slightly more invasive surgery but does not require as much physical therapy because it really solves the problem. My patients are discharged from the hospital at 48-72 hours and have a good functional level at 2-3 weeks, and practically have a normal life at 6-8 weeks. The postoperative period is about a week, due to the discomfort of the scar, the rest is a simple process.

In order for the patient to be discharged, a special type of anesthesia is used, infiltrations are performed and we try not to give morphine. In other words, there are a series of aids to help the patient recover sooner and not be in discomfort. The physiotherapists also educate the patient before the operation so that they know how to handle the operation, it is a process.