Effective Treatments Towards Recovery
Dr Chua is an Orthopaedic Surgeon whose practice focuses on the surgical and non-surgical treatment of the hip, including total hip replacement, screws fixation, core decompression and more.
What you need to know:
Total Hip Replacement
Total hip replacement is usually recommended to patients who, despite being prescribe non-invasive treatments and medications to treat ailments of the hip, still experiences pain or difficulty enjoying normal, everyday activities.
According to the Agency of Healthcare Research and Quality, each year in the United States of America alone, more than 300,000 total hip replacement surgeries are performedFirst performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since then, technology and surgical techniques have greatly improved, and thus increased the effectiveness of total hip replacement.
Candidates for Surgery
There are no absolute age or weight restrictions for total hip replacements, instead recommendations for surgery are based on an individual patient’s condition, pain severity and disability. Total hip replacement is most commonly used to correct hip osteoarthritis and osteonecrosis of the hip.
There are many types of designs and materials used as artificial hip joints, all of them consist two basic components – the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup made of plastic, ceramic or metal, which may have an outer metal shell).
These prosthetic components may be press fitted into the bone to allow the bones to grow onto the components, or they may be cemented in place, or it may be a combination of both methods. The way it is fitted will be based on a few factors, such as the quality and strength of the patient’s bone.
The surgery takes a few hours, and the orthopaedic surgeon will remove the damaged cartilage and bone, then position the new metal, plastic or ceramic prosthetics to restore the alignment and function of the affected hip.
Screw fixations are often used to surgically treat fractures of the hip that fail to be treated by non-operative management. How exactly to fix the fracture will be based on the area of the hip that is broken and the surgeon’s familiarity with the different systems that are available to manage these injuries. With hip screw fixation, individual screws are used to stabilise fractures with little to no compression across the fracture, with the goal of putting your fractured bones back into place to allow them to heal properly.
Repairing an intracapsular fracture with individual screw fixation
Candidates for Surgery
Patients who will benefit from hip screws fixation usually have a fracture that involves the head and neck of the femur (intracapsular fracture). If the head of the femur alone is broken, management will be aimed at fixing the cartilage on the ball that has been injured or displaced. Screws fixation is a surgical treatment choice in younger patients and children.
The individual screws used in screw fixation for hip fractures (percutaneous pinning) come in a wide range of diameters and lengths to be used in various indications and circumstances. In intracapsular fractures, the blood supply to the head of the femur may have been damaged at the time of injury, thus even though the fracture is realigned and fixed into place, the cartilage and underlying support bone may not receive adequate blood, causing intense pain or painful arthritis over time, which may require hemiarthroplasty (replace the head of the femur) or total hip replacement in the future.
Compression Hip Screw or Intramedullary Nail
Compression hip screw surgery to treat hip fractures involves using a single larger screw that slides within the barrel of a plate, this will allow the fracture to become more stable by having the broken area impact on itself. Occasionally, a secondary screw may be added for stability.
Intramedullary nails on the other hand, are nails that are placed directly into the marrow canal of the bone through an opening made at the top of the greater trochanter. A lag screw is then placed through the nail and up into the neck and head of the hip, resulting in impaction of the fracture on itself.
Candidates for Surgery
Compression hip screws and intramedullary nail surgery is usually effective in treating intertrochanteric fractures and subtrochanteric fractures. Sometimes it may be used in intracapsular fractures as well, depending on the condition and severity of the fracture.
In compression hip screw surgery, the implant is a single larger screw that slides within the barrel of a pain area. In intertrochanteric fractures, the compression hip screw is fixed to the outer side of the bone with bone screws and has a large secondary screw (called a lag screw) that is placed through the plate into the neck and head of the hip. Such design allows for impaction and compression at the fracture site, increasing the stability of the fractured area and promote healing.
Repair of an intracapsular fracture with a single compression hip screw
In comparison to the compression hip screw, an intramedullary nail is planted into the hollow cavity of the femur (thighbone) rather than on the side. When using an intramedullary nail to treat subtrochanteric fractures, Interlocking screws are sometimes placed at the end of the nail to make the fixation more secure, and to keep the bones from rotating around the nail. In certain cases, the surgeon may choose to use a plate instead of interlocking screws.
Interlocking screws placed at the end of an intramedullary nail to make the fixation more secure
A locking plate may be used for more difficult to treat fractures
When osteonecrosis of the hip is diagnosed early, core decompression is sometimes successful in preventing the collapse of the femoral head and the development of arthritis. This procedure involves drilling one larger hole, or several small holes into the femoral head to relieve pressure in the bone, and to create channels for new blood vessels to nourish the affected areas of the hip.
Core decompression is often combined with bone and cartilage grafting to help regenerate healthy bone and support cartilage at the hip joint.
Candidates for Surgery
Core decompression is a surgical procedure that functions to prevent osteonecrosis from progressing to severe arthritis, and the need for hip replacement in certain cases. Hence, patients who will benefit from core decompression the most are those at the early stages of osteonecrosis, before the bone completely collapses. When osteonecrosis is diagnosed after collapse of the bone, core decompression is usually not successful in preventing further collapse.
Osteochondral (bone and cartilage) Grafting
Core decompression is often combined with bone and cartilage grafting. A bone graft is transplanted from a healthy bone tissue to the affected area where it is needed. After surgery, it takesa few months for the bone to heal.