Hip Replacement Surgery
Hip replacement (total hip arthroplasty) is a surgical procedure to replace a worn-out (typically by arthritis) or damaged hip joint. In this procedure, the orthopedic surgeon replaces the old hip joint with an artificial joint (prosthesis). This surgery may be a choice after a hip fracture, for prolonged hip pain, or because of loss of mobility due to arthritis.
Hip replacement surgery is one of the most successful operations in all of medicine. Since the early 1960s, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 450,000 total hip replacements are performed each year in the United States.
At Aptiva Health, we offer same-day and walk-in appointments for hip injuries and conditions to evaluate, diagnose, and make the appropriate referral for additional treatment based upon your specific hip injury or condition. We treat these conditions in our General Medicine, Orthopedics, Sports Medicine, Pain Management, and Physical Therapy departments.
Candidates for Total Hip Surgery
There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
Hip pain that limits everyday activities, such as walking or bending
Hip pain that continues while resting, either day or night
Stiffness in a hip that limits the ability to move or lift the leg
Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
Description of 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 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.
Recovery
The success of your surgery will depend in large measure on how well you follow your orthopedic surgeon's instructions regarding home care during the first few weeks after surgery.
Pain Management
Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.
Be aware that, although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
Wound Care
You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.
Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
Diet
Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.
Activity
Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.
Your activity program should include:
A graduated walking program to slowly increase your mobility, initially in your home and later outside
Resuming other normal household activities, such as sitting, standing, and climbing stairs
Specific exercises several times a day to restore movement and strengthen your hip. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery
Possible Complications
The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.
Infection
Infection may occur superficially in the wound or deep around the prosthesis. It may happen within days or weeks of surgery. It may even occur years later.
Minor infections of the wound are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood Clots
Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopedic surgeon will outline a prevention program which may include blood thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early mobilization.
Leg-length Inequality
Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.
dislocation
This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.
Loosening and Implant Wear
Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a second surgery called a revision may be necessary.
Other Complications
Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. A small number of patients continue to experience pain after surgery.
Outcomes
How Your New Hip Is Different
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.
Protecting Your Hip Replacement
There are many things you can do to protect your hip replacement and extend the life of your hip implant.
Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
Make sure your dentist knows that you have a hip replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.