Hip replacement (also known as total hip replacement or total hip arthroplasty) is a surgical procedure that is performed to replace damaged cartilage in the hip joint. The operation involves removing the damaged ball and socket joint and replacing it with artificial materials made of metal, polyethylene (plastic) and/or ceramic.
What is hip replacement surgery?
Hip replacement surgery involves a metal rod (stem) being placed in the thighbone (femur) and a metal cup being placed in the socket of the pelvis (acetabulum). Between the two metal parts is a bearing surface that takes the place of the damaged cartilage. This bearing surface may be made of a ceramic ball in a plastic or ceramic liner or a metal ball in a metal or plastic liner.
When do you need hip replacement?
A hip replacement is performed when someone has severely damaged cartilage in a hip joint. The hip joint is a ball-and-socket joint located in the groin area, and when it’s damaged, it may cause groin pain, buttock pain and/or pain on the side of the hip. Pain from a damaged hip joint may also radiate down the thigh and cause referred pain to the knee joint on the same leg.
Hip replacements are performed for arthritis and degenerative conditions of the hip when nonsurgical treatments, such as over-the-counter anti-inflammatory drugs, physical therapy and/or cortisone injections, no longer help the pain.
The conditions most commonly treated with hip replacement surgery are:
Osteoarthritis (wear and tear of the cartilage in the joint)
Inflammatory arthritis (such as rheumatoid arthritis or psoriatic arthritis)
Osteonecrosis/avascular necrosis (a condition where the bone loses its blood supply, resulting in damaged bone and cartilage in the joint)
Post-traumatic arthritis (when the hip joint is damaged from a prior fracture and then develops cartilage damage)
Degenerative hip conditions in adults resulting from prior childhood hip disorders, including:
Developmental dysplasia, which is when the socket is shallow at birth/early childhood
Legg-Calve-Perthes disease, which is when the ball of the ball-and-socket joint (head of the femur) becomes spontaneously damaged in early childhood
Slipped capital femoral epiphysis, which is when the growth plate of the ball of the hip joint (femoral head) slips and may cause a misshapen femoral head, resulting in arthritis/damaged cartilage later in adulthood
Hip replacement benefits
Hip replacement surgery is among the most successful of surgical procedures. The operation reliably alleviates pain due to arthritis and other degenerative conditions of the hip.
Patients living with hip arthritis may have severe pain that interferes with their ability to engage in activities they enjoy, such as walking, playing with their kids or grandkids, and playing sports. Severe arthritis makes it difficult to even perform fundamental activities of daily living, including walking, bending, sitting for long periods and performing tasks required at a job.
Hip replacement surgery is an operation that enables patients to maintain their independence and return to comfortably doing the activities they both need to do and love to do in life.
Hip replacement surgery risks
Total hip replacement surgery is a very successful operation. Complications after hip replacements occur very rarely (less than 1-2%). However, complications may be very serious and include infection whereby bacteria can stick to the implant and require further surgery to wash out the infection or even remove the prosthesis. Other risks include a blood clot in the leg (called deep vein thrombosis) or pulmonary embolism (where a clot travels to the lungs).
There are ways to prevent complications after hip replacement surgery. Infections are associated with poorly controlled diabetes, obesity and smoking. Patients are advised to lose weight and quit smoking prior to surgery and consult their doctor to better control diabetes. To prevent blood clots after surgery, all patients must be on a blood thinner (such as aspirin or other blood thinners, depending on their individual risk of clotting) for about 4 weeks following surgery and walk as much as possible immediately after surgery to improve circulation.
How to prepare for hip replacement surgery
Prior to hip replacement surgery, you should undergo a course of physical therapy to work on balance, gait, joint range of motion and strength, which will help your recovery after surgery.
In addition, you will need to ensure your dental cleaning is up to date. Poor dental hygiene may result in bacteria traveling from your mouth into your bloodstream, causing a serious infection in your hip implant that could require further surgery and compromise the function of the joint.
A well-balanced, healthy diet is also necessary to help recovery and minimize infection.
You will be given an antibacterial soap to shower with in the 3-5 days leading up to surgery to also reduce infection risk. If you are on any blood thinning medications, including nonsteroidal anti-inflammatory medications, you will be required to stop these prior to surgery as instructed by your doctor to minimize risk of bleeding during surgery. If you take prescription, over-the-counter or herbal medications of any kind, your surgical team will instruct you to either take them or hold them prior to surgery.
Hip replacement surgery: What to expect
You will arrive at the hospital on the day of your surgical procedure and enter the pre-operative area. You will be given an intravenous (IV) line to infuse fluids and medications.
The most common type of anesthesia for hip replacement surgery is a spinal (regional) anesthesia, which is a less invasive type of anesthesia that allows faster recovery after surgery and potentially less side effects, such as nausea and vomiting and breathing complications, which may happen more commonly with general anesthesia. You will be given sedation and will not feel any pain during surgery.
After surgery, it is very important to walk as soon as possible to avoid blood clots. You will undergo physical therapy on the same day after surgery. Many people may be discharged on the same day, a few hours after surgery or the following day.
Hip replacement recovery
After hip replacement surgery, patients should walk as much as possible and climb stairs on the same day following surgery. Patients go home the same day or the day after surgery. Most patients are given crutches or a walker for balance after surgery, though full weight-bearing begins immediately.
Pain medications include small doses of multiple medications, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) and, if needed, small doses of opioid medication for a few days. A blood thinner will be started after surgery, such as aspirin or more potent blood thinners for patients at higher risk of clotting or those already on a blood thinner prior to surgery for another medical condition. Typically, a waterproof dressing is applied that has anti-infection properties that allows for showering right after surgery and is removed in the first week after surgery.
Patients will start a course of physical therapy for 4-6 weeks to help with walking and strengthening, and they may get back to low-impact sports after 6-12 weeks. People with sedentary jobs may return to work within 2 weeks. Those who have more standing or heavy lifting may stay out of work for 6-12 weeks depending upon how physically demanding the job is.
How long does a hip replacement last?
As chief of hip and knee replacement surgery at Boston Medical Center, I’ve found that hip replacements may fail and need to be redone or “revised” due to infection, wear and loosening, fracture of the bone around the implant (called “periprosthetic fracture”) or dislocation (when the ball pops out of the socket). However, the likelihood of these complications is extremely low. Hip replacement surgery is among the most successful surgeries that get patients back to doing the activities they love to do. Modern hip replacements are very durable, and in more than 95% of people, they will last 15-20 years.
Copyright © 2024 HealthDay. All rights reserved.