Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft
CPT4 code
Name of the Procedure:
Total Hip Arthroplasty (THA) Commonly known as hip replacement surgery, which may involve acetabular and proximal femoral prosthetic replacement with or without the use of autograft or allograft.
Summary
Total hip arthroplasty is a surgical procedure aiming to replace a damaged hip joint with a prosthetic implant. The procedure involves removing the arthritic or damaged bone from both the acetabulum (hip socket) and the femoral head (top of the thigh bone) and replacing them with artificial components.
Purpose
Medical Condition/Problem it Addresses: This procedure is primarily used to treat severe osteoarthritis, rheumatoid arthritis, hip fractures, and other hip joint damage that causes pain and restricts movement.
Goals/Expected Outcomes:
- Alleviation of chronic hip pain
- Improved joint functionality
- Enhanced quality of life and mobility
Indications
- Persistent hip pain that interferes with daily activities and sleep
- Limited mobility or functional impairment
- Ineffective response to conservative treatments like physical therapy, medications, and injections
- Severe joint damage visible on X-rays
Preparation
Pre-procedure Instructions:
- Fasting for 8-12 hours before surgery
- Adjusting or stopping certain medications, as advised by your doctor
- Preoperative physical examination and medical history review
- Imaging tests like X-rays or MRI scans
- Blood tests and possibly a preoperative cardiac evaluation
Procedure Description
- Anesthesia: General or spinal anesthesia is administered.
- Incision: A surgical incision is made along the side of the hip.
- Joint Exposure: Muscles and soft tissues are carefully moved aside to expose the hip joint.
- Bone Removal: The damaged femoral head and acetabulum are removed.
- Implant Placement:
- The acetabulum is shaped and fitted with a prosthetic cup.
- The femoral canal is prepared to receive the prosthetic femoral stem and head.
- Joint Assembly: The new prosthetic components are placed and secured.
- Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.
- Recovery: The patient is moved to the recovery room for observation.
Duration
The procedure typically takes 1.5 to 2 hours, depending on the complexity.
Setting
Total hip arthroplasty is performed in a hospital or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
- Physical therapists (for post-operative care)
Risks and Complications
Common Risks:
- Infection
- Blood clots
- Leg length discrepancy
- Hip dislocation
- Prosthetic loosening or wear
Rare Complications:
- Nerve injury
- Blood vessel injury
- Allergic reaction to materials
- Fracture of surrounding bone
- Osteolysis (bone loss around the implant)
Benefits
- Significant reduction in hip pain
- Improved hip function and mobility
- Enhanced ability to perform daily activities
- Long-lasting relief, with prosthetics often lasting 15-20 years or more
Recovery
Post-procedure Care:
- Pain management with medications
- Physical therapy for rehabilitation
- Wound care and monitoring for infection
- Avoiding high-impact activities
- Using walking aids initially
Expected Recovery Time:
- Initial recovery in 6-8 weeks
- Full recovery and return to normal activities in 3-6 months
Follow-up:
- Regular follow-up appointments to monitor prosthetic status and overall recovery.
Alternatives
- Conservative treatments: Physical therapy, medications, corticosteroid injections.
- Hip resurfacing: Partial replacement that preserves more bone.
- Osteotomy: Bone realignment surgery.
- Pros and Cons: Alternatives typically offer shorter recovery but may not provide the same level of pain relief and mobility improvement as THA.
Patient Experience
During Procedure:
- Surgery is performed under anesthesia, so the patient will not feel pain during the procedure.
After Procedure:
- Initial postoperative pain managed with medications
- Possible sensation of stiffness or discomfort around the incision site
- Gradual improvement in mobility and pain with physical therapy and recovery activities
- Support from medical staff to ensure comfort and effective pain management
By providing the required information in a clear, structured format, patients can better understand what to expect from total hip arthroplasty and prepare adequately for the procedure and recovery process.