If your doctor suggests hip surgery as a treatment for your injury or arthritis of the hip, you may feel a little scared and unsure about what’s likely to happen to you. Relax. Getting the right information and knowing the options can help you approach your impending treatment in a calm, unstressed state of mind.
This section of our website provides key facts about hip replacement surgery and related issues for patients and their families.
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The long-term goal of a hip replacement is to provide pain relief, restore normal activities of daily living, and enhance your quality of life.
If you are considering hip surgery the following total hip replacement information might help you understand the procedure and implants better.
Your hips work hard during your daily routine, and arthritis of the hip or a hip injury can make it hard for you to perform normal tasks. If your injury or arthritis is severe, you may begin experience pain when you’re sitting down or trying to sleep.
Sometimes a total hip replacement is the only option for reducing pain and restoring a normal activity level. If you and your doctor decide a total hip replacement is right for you, the following information will give you an understanding about what to expect.
A total hip replacement involves cutting away the damaged bone of the hip joint and replacing it with a prosthesis. This "new joint" prevents the bones from rubbing together and provides a smooth hip joint.
In the total hip replacement procedure, each prosthesis is made up of two major parts. The femoral component is a metal shaft with a ball on the end and replaces the top of the femur. The acetabular component replaces the socket side of the joint and is made of a metal cup and plastic liner.
Before you are taken to the operating room you’ll be given medication to help you relax, and the anesthesiologist will talk with you about the medications he’ll be using. In the operating room, you will be placed under full anesthesia.
Once you are "under" the surgeon will begin by making an incision in your leg to allow access to the hip joint. He’ll then expose the joint and place a cutting jig or template on the end of the femur, or thigh bone. This jig allows the surgeon to cut the bone precisely so that the prosthesis fits exactly. Once the femur is cut, the inside of the bone will be prepared so that it closely matches the shape of the femoral shaft your surgeon has selected. Then the the cup portion of the pelvis is prepared with cutting tools so that the metal cup will fit exactly.
Now it’s time to place the prostheses. This begins with the femoral prosthesis. For some patients, an acrylic cement called Polymethylmethacrylate (PMMA) will be used for the fixation. This cement has been used successfully by orthopedists for over 25 years. It is a strong material, well-tolerated by the body and sets or cures within 15 minutes after it is mixed. Before curing, the cement is pressure-injected and the implants are seated.
For other patients, the implants are able to be affixed to the bones without cement. Special surgical instruments are used to precisely prepare the bones so as to enable a press fit. To supplement this joining, suportive screws or pegs are often used. Bone is a living and growing tissue. If an implant coated with metallic beads to form a porous undersurface is placed in very close contact to living bone, tissues can grow into the pores, further locking the implant in place. Porous-coated hip prostheses have been used for many years and have shown excellent results in many patients.
Finally, the incision is closed, a drain is put in, and the post-operative bandaging is applied.
You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees and straighten your knee.
At home you should begin ambulation with a cane as tolerated. Keep your incision clean and dry and watch closely for any signs of infection.
You’ll continue your home exercise program and go to outpatient physical therapy, where you will work on an advanced strengthening program and such programs as stationary cycling, walking, and aquatic therapy.
Your long-term rehabilitation goals are a range of motion from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence in all activities of daily living.
Before deciding on hip surgery, your physician may try several non-surgical, conservative measures to relieve the pain and inflammation in your hip.
The first alternative to hip replacement involves such lifestyle modification measures as weight loss, avoiding activities involving long periods of standing or walking, and the use of a cane to decrease the stress on the painful hip.
Exercise and physical therapy may be prescribed to improve the strength and flexibility of your hip and other lower extremity muscles. Your exercise program may include riding a stationary bike, light weight training and flexibility exercises. An aquatic therapy program is especially effective for the treatment of arthritis since it allows mild resistance while removing weight bearing stresses. For an appropriate exercise program, contact an experienced physical therapist.
Arthritis pain is primarily caused by inflammation in the hip joint. Reducing the inflammation of the tissue in the hip can provide temporary relief from pain and may delay hip replacement surgery. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be prescribed to decrease the inflammation associated with arthritis.
Two dietary supplements, Glucosamine and Chondroitin (commonly available in a combined tablet), may decrease the symptoms of hip arthritis. Glucosamine and Chondroitin sulfate are both naturally occurring molecules, and issues associated with both remain under active research. However, it appears that may people taking these nutrition supplements on a regular basis note a decrease in their arthritis symptoms.
There exist a number of non-surgical alternatives to total hip replacement surgery. Such measures as lifestyle modification, exercise and physical therapy, and medication should be implemented before deciding on surgery. If all of these measures have been exhausted and your orthopedist recommends surgical intervention, total hip replacement surgery can be very successful in decreasing pain and greatly improving function.
The hip joint functions as one of the most important joints in the human body. Designed for both mobility and stability, the hip allows the entire lower extremity to move in three planes of motion, while providing an important shock absorption function to the torso and upper body. The hip is a ball and socket joint, uniting the femur (thigh bone) with the pelvis. As a result of this configuration, the leg moves forwards and backwards, side to side, and rotates to the right and left.
The pelvis features two cup-shaped depressions called the acetabulum, one on either side of the body. The femur, or thigh bone, is the longest bone in the body and connects to the pelvis at the hip joint. The head of the femur, shaped like a ball, fits tightly into the acetabulum, forming the ball and socket joint of the hip.
Embedded within the acetabulum of the pelvis lies an important structure known as articular cartilage; this cartilage has two very important functions. First, the smooth, low friction surface of the cartilage allows the hip joint to move freely in all planes of movement. Second, the articular cartilage cushions the hip during weight bearing activities, providing an important shock absorption function to the entire lower extremity.
The hip joint also features a complex system of ligaments that provide stability for the pelvis and lower extremity. The ligaments of the hip joint connect the femur to the pelvis and are essential to keeping the hip from moving outside of its normal planes of movement.
The muscles of the hip joint have dual responsibilities. They provide the dynamic functions necessary to raise and lower the lower extremity as well as the stabilizing functions required during standing, walking, or other weight-bearing exercises. This complex system of muscles works synergistically to provide the power for the hip to move in all directions, as well as to stabilize the entire lower extremity during weight bearing activities.
Arthritis of the hip is a disease which wears away the cartilage between the femoral head and the acetabulum, the two bones will scrape against each other, raw bone on raw bone. When this happens, the joint becomes pitted, eroded and uneven. The result is pain, stiffness and instability. In some cases, motion of the leg may be greatly restricted.
Osteoarthritis, which is the most common form of arthritis in the United States; it is degenerative and although it most often occurs in patients over the age of 50, it can occur at any age, especially if the joint is in some way damaged.
It is usually confined to the large weight-bearing joints of the lower extremities, including the hips and knees, but may affect the spine and upper extremity joints, too. Patients with osteoarthritis often develop large bone spurts, or osteophytes, around the joint, further limiting motion.
Osteoarthritis of the hip is a condition commonly referred to as "wear and tear" arthritis. Although the degenerative process may accelerate in persons with a previous hip injury, many cases of osteoarthritis occur when the hip simply wears out. Some experts believe there may be a genetic predisposition in people who develop osteoarthritis of the hip. Abnormalities of the hip due to previous fractures or childhood disorders may also lead to a degenerative hip. Osteoarthritis of the hip is the most common cause for total hip replacement surgery.
The first and most common symptom of osteoarthritis is pain in the hip or groin area during weight bearing activities such as walking. People with hip pain usually compensate by limping, or reducing the force on the arthritic hip. As a result of the cartilage degeneration, the hip loses its flexibility and strength, and may result in the formation of bone spurs. Finally, as the condition worsens, the pain may be present all the time, even during non weight-bearing activities.
Before considering total hip replacement surgery, your doctor and you may try various non-surgical therapies. An appropriate weight reduction program may be beneficial in decreasing force across the hip joint. However, weight reduction can be difficult for people with hip arthritis since the arthritis pain precludes them from increasing their activity and burning calories. An exercise program may be instituted to improve the strength and flexibility of the hip and the other lower extremity joints. Lifestyle and activity modification may be undertaken in an attempt to minimize the activities that are associated with hip pain. Finally, various medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and/or nutritional supplements (Chondroitin/Glucosamine) to reduce pain and inflammation associated with the disease may be considered.
Assistive devices like a cane or a crutch can help to reduce the force transmitted through the hip joint during walking and thereby may help to decrease hip arthritis pain. If non-surgical treatment is unsuccessful, you and your surgeon may decide that a total hip replacement is the best available treatment option..
Unlike osteoarthritis which is a "wear and tear" phenomenon, rheumatoid arthritis is a chronic inflammatory disease that results in joint pain, stiffness and swelling. The disease process leads to severe, and at times rapid, deterioration of multiple joints, resulting in severe pain and loss of function.
Although the exact cause of rheumatoid arthritis is unknown, some experts believe that a virus or bacteria may trigger the disease in people having a genetic predisposition to rheumatoid arthritis. Many doctors think rheumatoid arthritis is an autoimmune disease in which the synovial tissue of the joint is attacked by one’s own immune system. The onset of rheumatoid arthritis occurs most frequently in middle age and is more common among women.
The primary symptoms of rheumatoid arthritis are similar to osteoarthritis and include pain, swelling and the loss of motion. In addition, other symptoms may include loss of appetite, fever, energy loss, anemia, and rheumatoid nodules (lumps of tissue under the skin). People suffering with rheumatoid arthritis commonly have periods of exacerbation or "flare ups" where multiple joints may be painful and stiff.
Treatment of rheumatoid arthritis may involve medications such as NSAIDs, aspirin and analgesics. Corticosteroids, such as prednisone may be prescribed, and are effective in decreasing the inflammation associated with rheumatoid arthritis. Side effects can occur with the use of corticosteroids, and close monitoring by a physician is essential. Researchers have made progress in the treatment of rheumatoid arthritis and newer prescription drugs are now available. If non-surgical measures fail, you and your surgeon may decide that total hip replacement is the best treatment option to relieve your pain and help you return to an improved functional level.
When you and your orthopedic surgeon decide that total hip replacement is right for you, here is an idea of what you may expect during the days and weeks leading up to surgery, as well as the day of surgery. Pre-operative procedure
You and your orthopedic surgeon may participate in an initial surgical consultation. This appointment may include preoperative X-rays, a complete medical and surgical history, physical examination, and comprehensive list of medications and allergies. During this visit, your orthopedic surgeon will likely review the procedure and answer any questions you may have.
Your orthopedic surgeon may require that you have a complete physical examination by your internist or family physician as you will need to be cleared medically by your physician before undergoing this extensive procedure. And you may be instructed by your internist on whether you need to donate blood prior to surgery in the event that you will need a blood transfusion post-operatively.
Also, your orthopedic surgeon may ask you to consult a physical therapist to discuss the recovery period, rehabilitation program, and important precautions, as well as instruct you in exercises that you can begin prior to surgery that will make the recovery much easier.
Your physician and hospital may also require that you visit the admissions department prior to surgery to pre-certify the procedure with your insurance company.
Finally, maintaining good physical health prior to surgery will also improve the recovery period and overall post-operative outcome. Preparation for the Hospital
You may want to bring the following items to the hospital for your hip replacement surgery: Clothing: underwear, socks, t-shirts, exercise shorts for rehabilitation Footwear: walking or tennis shoes for rehab; slippers for hospital room Walking aids: walker, cane, wheelchair, or crutches if used prior to surgery Insurance information
You should follow your regular diet on the day before your surgery. DO NOT EAT OR DRINK AFTER MIDNIGHT. Follow your doctor’s instructions regarding use of medication in the days leading to surgery. Finally, try to get a long, restful night’s sleep.
On the morning of the surgery, you will be admitted to the hospital and taken to the appropriate pre-surgical area. The nurse will spend a few minutes preparing you for surgery by taking your vital signs, starting IV fluids, and administering medications as needed. You will be asked to empty your bladder just prior to surgery, and to remove all jewelry, contacts, dentures, etc. You will change into a hospital gown, be placed on a stretcher, and transported to the operating room. The anesthesiologist will meet you and review the medications and procedures used during the surgical case.
After the surgical case is completed, you will be taken to the recovery room for a period of close observation. Your blood pressure, heart rate, respiration, and body temperature will be closely monitored by the recovery room staff. Special attention will be given to your circulation and sensation in the feet and legs. When you awaken and your condition is stabilized, you will be transferred to your room.
Although the protocols may vary from hospital to hospital, you may awaken to some or all of the following:
You will typically be placed on a floor of the hospital with other patients who have had surgical procedures. As a result, the nursing staff is well-trained to manage the post-operative program following total hip replacement.
As with any major surgical procedure, post-operative complications can occur following total hip replacement surgery. Below is a list of some of the more common complications that can occur after hip replacement surgery. This list is not meant to be all-inclusive.
This condition, also commonly referred to as deep vein thrombosis, occurs when blood clots are formed in the large veins of the legs. In some cases, these clots can become dislodged from the veins, travel through the circulatory system, and become stuck in the critical arteries of the lungs. This scenario, called a pulmonary embolism, is a serious medical condition. The following steps may be taken by you and your physician to avoid or prevent thrombophlebitis:
IMPORTANT: If you develop swelling, redness, pain and/or tenderness in the calf muscle, report these symptoms immediately to your physician.
Infections occur in a small percentage of patients undergoing hip replacement surgery. Unfortunately, infections can occur even when every effort is made to prevent them. The following steps may help to minimize the risk of post-operative infections.
A possible side effect of surgery is the development of pneumonia. The following steps may help minimize this risk.
One of the most common problems following total hip replacement is hip dislocation or subluxation. Because the prosthetic ball and socket are smaller than the natural anatomy, the ball can become dislodged from the socket if the hip is placed in certain positions. The following precautions must be taken to prevent hip dislocation.
For more detailed information regarding the prevention of hip dislocation, refer to the hip rehabilitation section.
Hip replacement surgery is a very complex procedure. However, the outcomes following hip replacement are usually very successful. One of the important critical success factors for a successful outcome is following the physical rehabilitation process. In order to help achieve the goals for a successful total hip replacement, you must actively participate in the rehab process and work diligently on your own, as well as the physical therapists, to achieve optimal results.
Your recovery program usually begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement needed during the first few days after surgery.
You may be given a device called an incentive spirometer that you inhale and exhale into. It measures your lung capacity and assists you in taking deep breaths. These exercises reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs following surgery.
The physical therapist will begin sessions one day after surgery, and will teach you some simple exercises to be done in bed that will strengthen the muscles in the hip and lower extremity. These exercises may include:
Your physical therapist will also teach you proper techniques to perform such simple tasks as:
Although these are simple activities, you must learn to do them safely so that the hip does not dislocate or suffer other injury.
Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and your therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance for accident or injury.
The occupational therapist will also visit with you to teach you how to perform activities of daily living safely. They will provide you with a list of hip precautions which are designed to protect your new hip during the first 8-12 weeks following surgery.
Also, the occupational therapist will instruct you in the proper use of various long-handled devices for activities of daily living. These devices may include the following:
The precautions following a total hip replacement must be strictly adhered to in order to prevent dislocation of the hip implant and the possibility of re-operation.
Following surgery, a physical therapist may help you with your rehabilitation protocol. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regularly basis to further strengthen your hip muscles. An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to mange.
Here is a list of potential exercises that you may be asked to perform. If an exercise is causing pain that is lasting, reduce the number of repetitions. If the pain continues, contact your physical therapist or physician.
While at home, you will continue to walk with the assistive device unless directed by your surgeon to discontinue use. You must also remember to strictly follow the hip precautions and weight bearing instructions during the first few months following surgery. It is recommended that you not drive unless you have been approved by your doctor.
Once you have completed your rehabilitation program, you can expect to be able to perform most activities of daily living with little to no pain or assistance. Patients following total hip replacement routinely are able to walk, dress, bathe, drive, garden, cook, and return to work. Although final outcomes may vary from patient to patient, total hip replacement surgery is one of the most successful procedures in modern medicine and most patients return to a full and active life.
Once you have completed the post-operative rehabilitation process, you should have near normal range of movement and adequate strength in your hip to perform most activities of daily living.
Because total hip arthroplasty is one of the most successful procedures in modern medicine, you can expect to return to a high level of function. However, special precautions should be taken by people with hip replacements.
You should avoid high impact activities as running, vigorous walking, downhill skiing, or other high impact activities. Be careful when lifting heavy objects and continue to follow the basic total hip precautions as stated in the rehabilitation page.
Patients having total hip replacement surgery have successfully returned to such activities as walking, driving, swimming, golf, doubles tennis, stationary cycling, and gardening.
Remember to listen to what your body tells you. If you begin to have pain or swelling for over 24-48 hours, contact your healthcare professional for advice.
It is difficult to predict the length of time a total hip implant will last as its lifespan depends on many factors. Unfortunately, in some cases implants last only a short time. However, the vast majority of implants last for many years, providing patients with pain relief and improved function. By following hip precautions and moderating your activity level, you may enhance the function and longevity of your artificial hip.
Surgeons, researchers and implant manufacturers continue to work diligently to improve both the short term and long term outcomes of total hip replacement. Less implant wear may extend the life of the implant and reduce the need for future corrective surgeries.