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Total Hip Replacement

Total Hip Replacement by Maria Adams, MS, MPH Loading image. Please wait...

Anatomy and Physiology
The hip joint is made up of two main parts: the femur, which is your thigh bone, and the pelvis, which is your hip bone. The femoral head at the top of the femur fits right into the acetabulum, a cup-shaped bone in your pelvis.

Cartilage between the femoral head and acetabulum provides cushioning between the bones and allows for smooth movement. Loading image. Please wait...

Reasons for Procedure
The most common type of hip damage is caused by osteoarthritis, in which the cartilage gradually wears away, exposing the bone beneath. Osteoarthritis often occurs with aging, but other risk factors include being overweight, previous hip injury, and performing repetitive movements that put stress on the joint.

Symptoms and signs of hip osteoarthritis include: joint pain and stiffness, joint swelling, reduced range of motion, and/or limping.

To accurately diagnose your condition, your doctor will conduct a physical exam and most likely take x-rays. He or she may also order blood tests, which may indicate the presence of other kinds of arthritis.

Treatments
Treatments for arthritis of the hip joint depend on the cause and the severity of the arthritis. The first line of treatment should always consist of non-surgical methods, including: if needed, weight loss to reduce ongoing stress on the joint, physical therapy, or other prescribed exercises that strengthen the muscles supporting the hip joint, walking aides.

To relieve pain and inflammation, many people find relief with: pain medications such as acetaminophen, non-steroidal anti-inflammatory medications, such as aspirin, ibuprofen, or a prescription brand, corticosteroid injections, which can reduce inflammation, but can weaken the bones if used too often.

If non-surgical methods are unsuccessful, a total hip replacement may be considered. A total hip replacement is generally performed when damage to the hip causes so much pain and stiffness that it limits normal activities.

In a total hip replacement, a surgeon replaces the damaged hip joint with an artificial, or prosthetic, joint. A prosthetic hip is made up of the acetabular component, or cup, and the femoral component, or ball and stem.

Procedure
During the time leading up to your procedure: If you are overweight, try to lose some weight in order to decrease the amount of stress on your new joint and make the surgery easier to perform. Make home modifications to help smooth your recovery period, such as installing a raised toilet seat, removing throw rugs, and purchasing a firm-back chair that allows the knees to remain lower than the hips. Arrange for temporary help at home once you return from your operation. Consider donating your own blood weeks in advance to be used if a transfusion is required at the time of your surgery.

Also, just prior to your procedure: Arrange for a ride to and from the hospital. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, herbs, or dietary supplements, ask your doctor if and when you need to temporarily discontinue them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor. You may be given antibiotics to take before coming to the hospital. You may be given laxatives and/or an enema to help clear your intestines.

Most hip replacement surgeries take 2-4 hours. Before your procedure, an intravenous line will be started to provide you with fluids, antibiotics, and medications to help you relax.

A total hip replacement is usually performed under general anesthesia, which will put you to sleep for the duration of the procedure. A breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation. A catheter will be inserted in your bladder to collect your urine.Loading image. Please wait...

Your surgeon will begin by making an incision in the skin over your hip joint and separating the muscles and ligaments to expose the joint. He or she will then dislocate the femoral head from the acetabulum, and remove the damaged femoral head.

Next your surgeon will shape the acetabulum until it fits perfectly with the artificial cup prosthesis. Depending on the type used, the prosthesis will either be secured with two very tight screws or a special type of cement.

After the acetabular component is securely in place, your surgeon will shape the femur and place the artificial ball and stem prosthesis into position. Depending on the type used, the prosthesis will be held in place with or without cement.

When both components are secure, your surgeon will insert the femoral head of your prosthesis into the acetabular component. He or she will then test the movement of your new hip joint and take an x-ray to ensure that the fit is correct.

Your surgeon will then close the incision with stitches or staples, leaving a drain in your hip to collect excess fluid. He or she may also place a pillow between your legs to prevent your hip from dislocating.

Risks and Benefits
Possible complications of a total hip replacement include: infection in the joint, blood clots in the legs that could travel to the lungs, excessive swelling or bleeding, injury to the nearby nerves or blood vessels, adverse reactions to the anesthesia, and/or loosening or dislocation of the prosthesis.

Benefits of a total hip replacement include: returning to the activities you used to enjoy without pain, reducing or eliminating the need for pain medication, resuming regular exercise along with all its health benefits, long life of the prosthesis: usually 10-15 years with typical use.

In a total hip replacement, or any other procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.

After the Procedure
After your procedure, your breathing tube will be removed and you will be taken to a recovery area for monitoring. The usual hospital stay is 3-6 days.

While in the hospital: you will be given pain medication. You will continue to receive IV antibiotics and will be given a blood thinner to help prevent blood clots. Depending on the amount of blood lost during your surgery, you may receive a blood transfusion. Any surgical drains will be removed.

You should expect to begin walking with the help of a walker starting the day after your surgery. In addition, you will be asked to: place a V-shaped pillow between your legs when lying down to help maintain the correct positioning of your hips. Avoid crossing your legs, flexing your hips more than 90 degrees, or turning your feet very far inward or outward.

Many patients begin a physical therapy program while in the hospital, which they continue after discharge. Most patients go home once they are able to walk with the aid of a crutch or walker. For some people, a short stay in a rehabilitation unit can help with walking progression and overall recovery.

Once you are home, be sure to contact your doctor if you experience: signs of infection such as fever and chills, increasing redness, swelling, or pain at the site of the surgery, bleeding or discharge from the wound, cough, shortness of breath, or chest pain, blood in the urine or stool, pain, burning, urgency, or frequency of urination, persistent nausea and/or vomiting, pain and/or swelling in your feet, calves, or legs.

Sources:

  • A patient's guide to total hip replacement surgery. Health Pages.org. Available at: http://www.healthpages.org/ahp/library/hlthtop/thp/index.htm. Accessed August 11, 2003.
  • Arthritis. Medical Encyclopedia. Medline Plus. National Institutes of Health. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001243.htm. Accessed June 14, 2004.
  • Hip Implants. American Academy of Orthopaedic Surgeons. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=271&topcategory=Hip. Accessed July 1, 2004.
  • Hip Joint Replacement. Medical Encyclopedia. Medline Plus. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002975.htm. Accessed August 12, 2003.
  • Total Hip Replacement: A Guide for Patients. University of Iowa Department of Orthopaedics. Available at: http://www.vh.org/adult/patient/orthopaedics/hipreplace. Accessed August 11, 2003.
  • Total Hip Replacement. Queensland Government. Available at: http://www.health.qld.gov.au/informedconsent/ConsentForms/Ortho/total_hip_arthroplasty.pdf. Accessed June 14, 2004.
  • Questions and Answers About Hip Replacement. National Institute of Arthritis and Musculoskeletal and Skin Diseases. National Institutes of Health. Available at: http://www.niams.nih.gov/hi/topics/hip/hiprepqa.htm. Accessed July 1, 2004.


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