During hip replacement, a surgeon removes the damaged sections of your hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.
Also called total hip arthroplasty, hip replacement surgery might be an option for you if your hip pain interferes with daily activities and nonsurgical treatments haven’t helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement.
Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.
If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier.
What Is Hip Replacement Surgery?
The hip is a ball-and-socket joint. This type of joint allows a good range of movement in any direction.
The ball of the hip joint is known as the femoral head, and is located at the top of the thigh bone (the femur). This rotates within a hollow, or socket, in the pelvis, called the acetabulum.
Hip replacement surgery involves removing parts of the hip joint that are causing problems – usually the ball and socket – and replacing them with new parts made from metal, plastic or ceramic.
The most common reason for having a hip replacement is osteoarthritis. Other possible reasons include rheumatoid arthritis, a hip fracture or hip dysplasia; a condition where the hip joint hasn’t developed properly.
Many thousands of people have hip replacement surgery each year. It usually brings great benefits in terms of reduced pain, improved mobility and a better quality of life.
But as with all surgery it’s important to think about the possible risks and to discuss them with your surgeon before you decide to go ahead.
Types of Hip Replacement Surgery
Surgeons perform hip replacements by using a posterior approach or an anterior approach. With a posterior hip replacement, the incision is made at the side or back of the hip. During anterior hip replacement, the surgeon makes the incision at the front of the hip.
The posterior approach is more common in part because it allows better visibility of the hip joint, though the anterior approach is becoming more prevalent. There is no significant difference between the procedures as far as recovery from surgery, but the anterior procedure may pose a higher risk of nerve damage that could cause numbness in the outer thigh.
Patients who are younger than 50, have a normal body mass index or who are in overall good health may be candidates for minimally-invasive surgery. During this surgery, the incision is smaller and recovery time after the surgery is shorter.
Special bone cement is commonly used to hold hip implants in place, but some surgeons use a cementless fixation technique. Devices that do not require cement have a textured surface that allows the bone to grow onto the implant and secure it. A hybrid total hip replacement involves implanting the cup without cement and setting the ball in place with cement.
Total Hip Replacement
Total hip replacement is the most common hip surgery. It uses artificial components to replace the entire hip structure. During the procedure, surgeons insert a stem into the patient’s femur, or thighbone, for stability. They replace the head of the femur with a ball and replace the natural socket in the hip joint with an artificial cup.
Partial Hip Replacement
Partial hip replacement removes and replaces the patient’s femoral head, which is the ball at the top of the femur, or thighbone. It does not replace the socket. A ceramic or metal ball is attached to the top of a stem that’s inserted into the hollow center of the femur. Surgeons typically perform this surgery to repair certain types of hip fractures.
Hip Resurfacing
Hip resurfacing helps relieve pain from cartilage loss. A surgeon trims damage from the natural bone ball at the top of the thighbone. He or she then resurfaces it with a smooth metal covering. The surgeon also lines the natural bone socket of the hip with a metal lining or shell.
Bilateral Hip Replacement vs. Staged Hip Replacements
If both hips require replacement, surgeons may choose a staged hip replacement. They replace one hip at a time, letting the patient recover from the first surgery before doing the second one. Alternatively, the patient may undergo a bilateral hip replacement in which both hips are replaced at the same time.
A bilateral hip replacement can mean a single trip to the operating room and the potential for less overall recovery time. But it doesn’t work for all patients.
The risk of blood loss during surgery is greater with bilateral hip replacement and patients are under anesthesia for twice as long — up to four hours. Patients are also more likely to require longer hospitalization or inpatient rehab.
Bilateral replacements usually involve younger, healthy and active patients who can handle more rigorous physical therapy and exercise following hip replacements.
Common Causes of Hip Pain
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
Osteoarthritis: this is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
Rheumatoid arthritis: this is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed “inflammatory arthritis”.
Post-traumatic arthritis: this can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
Post-traumatic arthritis: this can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
Childhood hip disease: some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
Description
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
- The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone.
- A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
- A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
Why Might I Need Hip Replacement Surgery?
Hip replacement surgery is a treatment for pain and disability in the hip. Osteoarthritis is the most common reason for hip replacement surgery.
Osteoarthritis causes loss of joint cartilage in the hip. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain from a degenerative joint disease may not be able to do normal activities that involve bending at the hip. These activities include walking and sitting.
Other forms of arthritis such as rheumatoid arthritis and arthritis that results from a hip injury can also damage the hip joint.
Hip replacement may also be used to treat certain hip fractures. A fracture is an injury often from a fall. Pain from a fracture is severe. Walking or even moving the leg causes pain.
If other medical treatments don’t control your arthritis pain, your healthcare provider may recommend a hip replacement. Some medical treatments for a degenerative joint disease may include:
Anti-inflammatory medicines
Glucosamine and chondroitin sulfate
Pain medicines
Limiting activities that are painful
Assistive devices for walking such as a cane
Physical therapy
Your healthcare provider may have other reasons to recommend a hip replacement surgery.
Preparing For Surgery
Medical Evaluation
If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.
Tests
Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for treatment to improve your skin before surgery.
Medications
Tell your orthopaedic surgeon about the medications you are taking. He or she or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.
Weight Loss
If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.
Dental Evaluation
Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.
Urinary Evaluation
Individuals with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before having surgery.
Social Planning
Although you will be able to walk with a cane, crutches or a walker soon after surgery, you may need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.
If you live alone, a social worker or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.
Home Planning
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:
- Securely fastened safety bars or handrails in your shower or bath
- Secure handrails along all stairways
- A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
- A raised toilet seat
- A stable shower bench or chair for bathing
- A long-handled sponge and shower hose
- A dressing stick, a sock aid, and a long-handled shoehorn for putting on and taking off shoes and socks without excessively bending your new hip
- A reacher that will allow you to grab objects without excessive bending of your hips
- Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
- Removal of all loose carpets and electrical cords from the areas where you walk in your home
Description Of The Procedure
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components:
- The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow centre of the femur. The femoral stem may be either cemented or “press fit” into the bone;
- A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed;
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place;
- A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
What Happens After Hip Replacement Surgery?
You will likely stay in the hospital for four to six days and may have to stay in bed with a wedge-shaped cushion between your legs to keep the new hip joint in place. A drainage tube will likely be placed in your bladder to help you go to the bathroom. Physical therapy usually begins the day after surgery and within days you can walk with a walker, crutches, or a cane. You will continue physical therapy for weeks to months following the surgery.
Recovery
When you leave the operating theatre, you’ll be given any fluids and drugs you need through a tube and a needle in your arm, sometimes called a drip. You may also have plastic tubes in your hip to drain away any fluid produced as your body heals.
You’ll be taken to a recovery room or a high-care unit until you’re fully awake and your general condition is stable. Then you’ll be taken back to a ward, which may be a different one from the admission ward, often with a pad or pillow strapped between your legs to keep them apart.
You’ll need painkillers to help reduce pain as the anaesthetic wears off. These may include:
- painkilling liquids or tablets to swallow
- a local anaesthetic given around the joint during the operation
- patient-controlled analgesia (PCA) – a system where you can control your own supply of painkiller going into a vein by pressing a button
- a nerve block injection or epidural.
The hospital team will try to get you walking as soon as possible, often on the same day as your operation. To begin with, you’ll be using a walking frame, followed by elbow crutches or sticks.
The drip and any drains are usually removed within 24 hours.
Physiotherapy and occupational therapy
A physiotherapist will see you in hospital after the operation to help get you moving and advise you on exercises to strengthen your muscles. They’ll also help you to learn how to walk on your crutches and use stairs safely before you go home.
A physiotherapist or an occupational therapist may offer advice on how best to get in and out of a bed, a chair, the shower etc. They may also offer advice on things to avoid.
Before you leave hospital, an occupational therapist will assess your physical ability and your situation at home, and they may arrange special equipment for you, such as a raised toilet seat or gadgets to help you dress.
Going home
How soon you can go home depends on how well the wound is healing and whether you’ll be able to get about safely. Most people will be ready to leave hospital within four to eight days.
If the surgeon feels it’s right for you, they may include you in an enhanced recovery programme (ERP). The enhanced recovery programme focuses on making sure you take an active part in your own recovery. It aims to get you walking and moving within 12–18 hours and home within one to three days.
Once you’re back at home you’ll have a routine check-up, usually six to 12 weeks after the operation, to make sure your recovery is going well. You may also be offered follow-up physiotherapy if your doctors feel that this will help your recovery.
The district nurse will change your bandages and take out any stitches. If you have any problems with your wound healing, then you should tell the hospital staff straight away.
If you were told to stop taking or change the dose of any of your regular drugs before the operation, ask your healthcare team when you should restart your medication.
Looking after your new hip joint
You need to take care, especially during the first eight to 12 weeks after the operation, to avoid dislocating the hip. You may not be able to bend your leg towards your body as far as you’d like to. Your therapist will advise you about any movements that you need to take special care with. Don’t be tempted to test your new joint to see how far it will go.
However, it’s important to continue with the programme of muscle-strengthening exercises recommended by your physiotherapist.
