Hip Replacement Surgery
(Total Hip Arthroplasty, Hip Arthroplasty, Total Hip Replacement, Hip Replacement)
What is a hip replacement surgery?
Hip replacement, also called total hip arthroplasty, is a surgical procedure to replace a worn out or damaged hip with a prosthesis (an artificial joint). This surgery may be considered following a hip fracture (breaking of the bone) or for someone who has severe pain due to arthritis.
Various types of arthritis may affect the hip joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the hips. Rheumatoid arthritis, which causes inflammation of the synovial lining of the joint and results in excessive synovial fluid, may lead to severe pain and stiffness. Traumatic arthritis, arthritis due to injury, may also cause damage to the articular cartilage of the hip.
The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged and to relieve hip pain that cannot be controlled by other treatments.
A traditional hip replacement involves an incision several inches long over the hip joint. A newer approach that uses 1 or 2 smaller incisions to perform the procedure is called minimally invasive hip replacement. However, the minimally invasive procedure is not suited for all candidates for hip replacement. The doctor will determine the best procedure for a person, based on that individual's situation.
Anatomy of the hip
Joints are formed where bones meet. Most joints are mobile, allowing the bones to move without friction or discomfort. The hip joint is a ball-and-socket joint, which allows backward, forward, sideways, and rotating movements. The ball part of the hip joint is the head of the femur (thigh bone), and the acetabulum is the socket, a cup-like structure in the pelvis. The hip joint has significantly more bony contact and stability compared with other joints, such as the shoulder.
A hip joint consists of the following:
Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.
Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.
Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
Bursa. A fluid-filled sac located between bones, ligaments, or other adjacent structures that helps cushion joints.
Femur. Thighbone or upper leg bone.
Acetabulum. A socket or cuplike structure that holds the femur head.
Reasons for the procedure
Hip replacement surgery is a treatment for pain and disability in the hip. The most common condition that results in the need for hip replacement surgery is osteoarthritis.
Osteoarthritis is characterized by the loss of joint cartilage in the hip. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain due to degenerative joint disease may be unable to do normal activities that involve bending at the hip, such as walking or sitting, because they are painful.
Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a hip injury, can also lead to degeneration of the hip joint.
Hip replacement may also be used as a method of treating certain hip fractures. A fracture is a traumatic event that may result from a fall. Pain from a fracture is severe and walking or even moving the leg is difficult.
If medical treatments are not satisfactory at controlling pain due to arthritis, hip replacement surgery may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited to, the following:
Glucosamine and chondroitin sulfate
Limiting painful activities
Assistive devices for walking (such as a cane)
There may be other reasons for your doctor to recommend a hip replacement surgery.
Risks of the procedure
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
Blood clots in the legs or lungs
Changes in leg length or gait
Need for revision or additional hip surgery
Nerve injury resulting in weakness or numbness
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Before the procedure
Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
You will be asked to fast for eight hours before the procedure, generally after midnight.
You may receive a sedative prior to the procedure to help you relax.
You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
Stop smoking, as smoking can delay wound healing and slow down the recovery period.
Lose weight if needed.
Perform conditioning exercises as prescribed to strengthen muscles.
Arrange for someone to help around the house for a week or 2 after you are discharged from the hospital.
Based on your medical condition, your doctor may request other specific tests or examinations.
During the procedure
Hip replacement requires a stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Hip replacement surgery is performed while you are asleep under general anesthesia or sedated under spinal anesthesia. Your anesthesiologist will discuss this with you in advance.
Generally, hip replacement surgery follows this process:
You will be asked to remove clothing and will be given a gown to wear.
An intravenous (IV) line may be started in your arm or hand.
You will be positioned on the operating table.
A urinary catheter may be inserted (after you are asleep).
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
The doctor will make an incision in the hip area.
The doctor will remove the damaged parts of the hip joint and replace them with the prosthesis. The hip prosthesis is made up of a stem that goes into the femur (thighbone), the ball (head joint) that fits into the stem, and a cup that is inserted into the socket of the hip joint. The stem and cup are made of metal. The ball may be made of metal or ceramic. The cup has a liner that may be made of plastic or ceramic. The 2 most common types of artificial hip prostheses used are cemented prostheses and uncemented prostheses. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2 types is used to replace a hip.
The incision will be closed with stitches or surgical staples.
A drain may be placed in the incision site to remove fluid.
A sterile bandage or dressing will be applied.
After the procedure
In the hospital
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Hip replacement surgery usually requires an in-hospital stay of several days.
It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.
You will be discharged home or to a rehabilitation center. In either case, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.
Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Notify your doctor to report any of the following:
Redness, swelling, bleeding, or other drainage from the incision site
Increased pain around the incision site
Numbness and/or tingling in the affected leg
You may resume your normal diet unless your health care provider advises you differently.
You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.
It is important that you avoid falls after your hip replacement surgery because a fall can result in damage to the new joint. Your therapist may recommend an assistive device (cane or walker) to help you walk until your strength and balance improve.
Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following:
Proper handrails along all stairs
Safety handrails in the shower or bath
Shower bench or chair
Raised toilet seat
Stable chair with firm seat cushion and firm back with two arms, which will allow your knees to be positioned lower than your hips
Long-handled sponge and shower hose
Long-handled shoe horn
Reaching stick to grab objects
Firm pillows to raise the hips above the knees when sitting
Removing loose carpets and electrical cords that may cause you to trip
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.