The hip joint is made up of a ball-and-socket. The socket is
made of bone and cartilage, and the ball is the top of the thighbone, also
known as the femoral head.
Hip replacement surgery is an operation used to replace the
damaged ball-and-socket with new and durable artificial synthetic parts that
mimic the ball-and-socket.
Sometimes, either the socket of the hip or the thighbone is
injured or becomes diseased. This can result in pain, trouble with walking, or
difficulty with everyday tasks. You may have already tried pain relief methods such
as medications, physical therapy, supports, or braces. If the pain doesn’t
subside, your doctor may recommend hip replacement surgery.
Needs a Hip Replacement?
According to the American Academy of
Orthopaedic Surgeons (AAOS), most people who have hip joint replacements
are between ages 50 and 80. These surgeries are usually performed for arthritis
of the hip. Arthritis is a disease that breaks down cartilage (the cushion
between bones). Without cartilage, the bones rub against each other, which can
cause severe pain.
A hip replacement may be used for three types of arthritis:
- rheumatoid arthritis — an autoimmune disease that
leads to joint inflammation
- traumatic arthritis — damage to the joint caused by an
- osteoarthritis — a degenerative form of arthritis that’s
most common in older adults
Doctors usually try to control arthritis discomfort with the
use of walkers or canes, a low-impact exercise program, and nonsteroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen. If these measures fail, a hip
joint replacement is the best solution. You should consider a hip joint
replacement if you can’t sleep or sit comfortably because of the pain, or if
your arthritis limits your activities.
Hip replacements can also be used for other health
conditions. For instance, they’re sometimes used if a tumor grows in the hip
joint. Hip replacements may also be used in an emergency to fix a fracture in
the hip joint or the thighbone. A condition called avascular necrosis of the
hip often requires a total hip replacement.
Is the New Hip Constructed?
The replacement hip is made up of four components:
- a metal socket
- a liner to help the ball move easily within the socket
- a metal or ceramic ball to replace the femoral head
- a metal rod used to stabilize the thigh bone to which
the ball is attached
There are different options of joint prosthesis. Most surgeons
use uncemented joint prosthesis, which allows bone to grow into the prosthesis
A cemented prosthesis, on the other hand, is attached to the
hip with bone cement for quicker adhesion. While both options have similar
success rates, they have differences in terms of recovery.
Uncemented joints take longer to attach to the bone, so the
recovery time is longer. Cemented versions, while quicker, are best used for older
adults or for people who are not as active.
Another option to consider is a muscle sparing hip
replacement. Unlike traditional hip surgery, this procedure spares cuts through
the muscles, which reduces pain and recovery time.
Muscle sparing procedures are commonly performed through anterior
or posterior. The main difference between anterior and posterior is the
location of the incision. Anterior incisions are made in the front by the upper
thigh, while posterior incisions are made in the back of the hip.
Educating yourself about hip replacement is crucial. Perhaps
just as important is knowing how to choose the right surgeon for the job.
Oftentimes, a general doctor will refer you to a surgeon. You might consider
interviewing a few candidates on your own to find the right match. Consider
- how many hip replacements they have conducted
- their overall success rate
- if they are open to muscle sparing replacements
- estimated recovery time
- if they will be involved with your aftercare
Is Hip Replacement Surgery Performed?
Unless you are having emergency hip replacement due to an
accident, your surgery will likely be scheduled several weeks in advance. Your
doctor will urge you to use the time to get into the best physical condition
They may suggest that you lose some weight. You will also
need to stop taking any medications, including blood thinners. During this
time, you may also want to rearrange your living space to minimize having to
walk long distances or up and down stairs. For example, you might consider:
- preparing meals in advance and freezing them
- placing everyday items within arm’s reach to avoid
You will not be able to eat or drink anything after midnight
on the day of the surgery. Hip surgery is done in a hospital operating room.
After you check in at the surgery desk, a nurse will take you into a room to be
prepared for surgery. You will take off your clothes and put on a hospital
gown, and the nurse will start an IV in your hand, wrist, or arm. The IV allows
you to receive fluids and medications during the surgery.
When it’s time for your operation to begin, you will be taken
into the operating room. There, you may be given a general anesthetic or a
medicine that makes you sleep through the surgery so you don’t feel pain.
If your surgeon believes that you have other health issues
that might make general anesthesia difficult or risky (such as heart or lung
conditions), they may recommend a localized or regional anesthetic. This is a
small amount of medication injected into your spine that makes everything below
your waist numb. Some people who receive a localized or regional anesthetic are
also given sedatives to help them remain calm during the surgery.
The procedure takes anywhere from one to three hours.
Happens After Your Surgery?
You will wake up in a recovery room. The staff will monitor
your vital signs and give you medicine for your pain. When they are sure that
you are stable, you will be transferred to a room in the hospital.
Your hospital stay will last three to five days. The day
after the surgery, a physical therapist will help you get up and take a few
steps. Some people go home immediately after discharge from the hospital,
although they continue to work with a physical therapist on an outpatient basis.
Other people choose to go to a rehabilitation facility or a skilled nursing
facility to receive additional care and inpatient therapy services.
It’s important to prepare for your recovery, so you are able
to move about easier. For example, you might consider:
- having someone on hand to help you during the first
few weeks of recovery
- arranging for someone to drive you to and from therapy
Full recovery from a hip joint replacement takes about three
to six months. A cemented joint prosthesis has the longest recovery time.
Is the Outlook?
Hip replacements generally have high success rates. In fact,
the AAOS has called
the hip replacement “one of the most successful operations in all of medicine.”
Most people who have the procedure report significantly less hip pain and a
greater ability to perform daily activities.
The most common complication is dislocation of the new joint.
This usually occurs in people who do not let themselves fully recover before
resuming normal activities. It can also occur in people who do not follow
instructions for caring for the hip after surgery. However, with newer
prosthesis, hip dislocation is greatly reduced. Infections and blood clots are potential
complications, but procedures can help prevent these from occurring.
Hip joints last many years, but high-impact activity or
obesity may shorten their lifespan. Some people have to get a second hip
replacement if the first one begins to deteriorate. With newer designs and
materials, however, they may even last several decades.