Hip replacement surgery, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts.
The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.
Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment.
A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently the most successful and reliable orthopaedic operation.
Hip Replacement Candidates
For you to be considered a candidate for hip replacement surgery, your orthopedic surgeon must see evidence of significant damage to the articular cartilage (firm tissue covering hip bones) on an X-ray. Although the surgery increases range of motion and significantly reduces hip joint pain, it is not a quick fix for everyone with chronic hip pain.
Signs that you may be a candidate for hip replacement surgery include:
- Pain deep in the groin, buttock or upper thigh
- Pain that keeps you awake at night or prevents you from doing enjoyable activities
- Little or no relief after using pain and anti-inflammatory medications
- Difficulty walking up and down stairs or putting on shoes and socks
- Trouble standing up from a seated position
Hemiarthroplasty is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture the neck of the femur (a hip fracture). The procedure is performed by removing the head of the femur and replacing it with a metal or composite prosthesis.
The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a composite of metal and HDPE which forms two interphases (bipolar prosthesis) has also been used. The bipolar prosthesis has not been shown to have any advantage over monopolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the acetabulum.
Hip Resurfacing is an alternative to hip replacement surgery. It is a bone conserving procedure that places a metal cap on the femoral head instead of amputating it. There is no long stem placed down the femur so it is more like a natural hip and may allow patients a return to many activities, including marathons and triathlons, some patients have even completed Ironman and Ultraman competitions following hip resurfacing surgery although patients must have good bone quality to qualify for it.
Some believe the future of osteoarthritis treatment is bioengineering, targeting the growth and/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal stem cells in one patient. It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits.
Benefits of Hip Replacement
Expect your new hip joint to reduce the pain you felt before your surgery and increase the range of motion in your joint. But don’t expect to do anything you couldn’t do before surgery. High-impact activities — such as running or playing basketball — may never get your doctor’s approval. But in time, you may be able to swim, play golf, walk or ride a bike comfortably.
The goal of hip replacement surgery is to relieve pain and increase the mobility and function of a damaged hip joint. If a stiff, painful hip joint has forced you to cut back on everyday activities, successful surgery may allow you to resume them.
Before thinking about surgery, though, your doctor may recommend other treatments, such as pain medications, physical therapy, exercise, and using a cane or walker. If these treatments are not enough, hip replacement may be the right option for you.
Symptoms that can be relieved:
- Pain that keeps you awake at night
- Little or no relief from pain meds or aids
- Difficulty walking up or down stairs
- Trouble rising from a seated position
- Having to stop activities because of pain
Conditions that can be repaired:
- Rheumatoid arthritis
- Broken hip
- Bone tumor
- Osteonecrosiswhich occurs when there is inadequate blood supply to the ball portion of the hip joint
Prepare for Hip Replacement
Before surgery you’ll meet with your orthopedic surgeon for an examination.
The orthopedic hip surgeon will:
Ask about your medical history and current medications
Do a brief general physical examination to make sure you’re healthy enough to undergo surgery
Examine your hip, paying attention to the range of motion in your joint and the strength of the surrounding muscles
Order blood tests, an X-ray and possibly an MRI
Your doctor or surgeon may also recommend that you begin an exercise program in preparation for your surgery. Some doctors believe that people who have an established muscle-building and flexibility program before surgery have better outcomes and faster recovery time following surgery. Preoperative exercise programs may have less effect in those with advanced osteoarthritis, however. Talk to your doctor before starting any exercise program.
Hip Replacement Overview
When you check in for your surgery, you’ll be asked to remove your clothes and put on a hospital gown. The first member of the medical team to visit may be the anesthesiologist. You’ll be given either general anesthesia or a spinal block, which numbs the lower half of your body.
Because infection and blood clots are possible complications of hip replacement surgery, your surgeon may order preventive medications — antibiotics and blood thinners — to be given before the surgery begins.
First, the surgeon will make an incision over the side of your hip, through the layers of tissue. Diseased and damaged bone and cartilage are removed, leaving healthy bone intact. Next, the prosthetic socket is implanted into your pelvic bone to replace the damaged socket. Then, the surgeon replaces the round top of your femur with the prosthetic ball, which is attached to a stem that fits into your thighbone. Your new, artificial joint is designed to mimic the natural, gliding motion of a healthy hip joint.
In recent years, various techniques have evolved for performing hip replacements. Some of these techniques are referred to as minimally invasive hip replacements, although this can refer to many different types of hip replacement procedures. The hope is that less invasive techniques reduce the recovery time and pain compared with standard hip replacements. However, studies comparing the outcomes of standard hip replacement with those of minimally invasive hip replacement have had mixed results. All hip replacement surgeries have benefited from newer anesthetic techniques that result in better pain management, speeding the traditional recovery time.
Hip Replacement Recovery
After surgery, you’ll be moved to a recovery area for a few hours while your anesthesia wears off. Nurses or other anesthesia aides will watch your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.
After your surgery, you’ll be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:
You’ll be encouraged to sit up and even try walking with crutches or a walker as soon after surgery as possible, usually after one day of recovery.
Both during and after surgery, you may wear elastic compression stockings or inflatable air sleeves similar to a blood pressure cuff on your lower legs. The pressure exerted by the inflated sleeves helps keep blood from pooling in the leg veins, reducing the chance that clots will form.
Your surgeon may prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you may need blood thinners for several more weeks after surgery.
Hip Replacement After Care
A physical therapist may help you with some exercises that you can do in the hospital and at home to speed recovery.
Activity and exercise must be a regular part of your day to regain the use of your joint and muscles. Your physical therapist will recommend strengthening and mobility exercises and will help you learn how to use a walking aid, such as a walker, a cane or crutches. As therapy progresses, you’ll gradually increase the weight you put on your leg until you’re able to walk without assistance.
When You Return Home
Before you leave the hospital, you and your caregivers will get tips on caring for your new hip.
For a smooth transition:
- Arrange to have a friend or relative prepare some meals for you
- Place everyday items at waist level, so you can avoid having to bend down or reach up
- Consider making some modifications to your home, such as getting a raised toilet seat
- About six to eight weeks after surgery, you’ll have a follow-up appointment with your surgeon to make sure your hip is healing properly.
- If recovery is progressing well, most people resume their normal activities by this time — even if in a limited fashion.
Hip Replacement Possible Risks
Hip replacement surgery is generally safe, but as with any surgery, complications can occur. Although some complications are serious, most can be treated successfully. Complications of hip replacement include:
Clots in your leg veins can form as a result of decreased movement of your leg after surgery, as well as from injury to the veins during surgery. Your doctor usually gives you blood-thinning medications after your surgery to try to prevent clots from forming. Compression devices, such as elastic stockings, and exercise to increase blood flow through the veins in your legs also can reduce your risk.
Infections can occur at the site of your incision and in the deeper tissue near your new hip. Most infections are treated with antibiotics, but a major infection near your prosthesis may require surgery to remove and replace the prosthesis.
During surgery, healthy portions of your hip joint may fracture. Sometimes, the fractures are so small that they heal on their own, but larger fractures may be corrected during surgery with wires, cables or bone grafts.
Certain positions can cause the ball of your new joint to become dislodged. To avoid this, it is often recommended that after surgery you don’t bend more than 90 degrees at the hip and don’t let your leg cross the midline of your body. If the hip dislocates, your doctor may fit you with a brace to keep the hip in the correct position. If your hip keeps dislocating, surgery is often required to stabilize it.
Over time your new joint may loosen, causing pain in your hip. Surgery might be needed to fix the problem. Though rare, your artificial hip can break several years after surgery. Another surgery would be required to replace the broken joint.
Your surgeon takes steps to avoid the problem, but occasionally your new hip may make your leg longer or shorter than the other one. Sometimes this is caused by weakness in the muscles surrounding your hip, also placing the hip at risk of dislocation. In this case, progressively strengthening and stretching those muscles can make it more stable.
Sometimes the soft tissues around your joint harden (called ossification), making it difficult to move your hip. This usually isn’t painful. If you’re at risk of ossification, your doctor may recommend medications or radiation therapy to prevent it from happening.
Your prosthetic hip joint may wear out eventually, so if you have hip replacement surgery when you’re relatively young and active, you may need a second hip replacement within your lifetime. However, new materials are making implants last longer, so a second replacement may not be needed for many years.