Total Hip Replacement

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If common activities such as walking, sitting and standing become painful and difficult it may be because your hip has been damaged by arthritis, a fracture, or some other conditions. This may also cause your hip to be stiff making it difficult to put on socks and shoes.  You may even feel discomfort while resting.

If you’ve already tried medications, walking supports and changes to your daily activities and seen no changes, then it might be time to consider hip replacement surgery.  Today’s hip replacement surgery is a very common and effective method to relieve your pain, increase lost motion, and  basically get you back to your normal daily activities and enjoying life again.

Since the first hip replacement surgery in 1960, improvements in both surgical techniques and prosthetic technology have improved the effectiveness of total hip replacement surgery making it one of the most successful procedures in all of medicine.  It is estimated by the Agency for Healthcare Research and Quality that more than 285,000 total hip replacements are done each year in the U.S. alone

Anatomy of a Normal Hip:

The hip is one of the largest joints of the human body and is a ball-and-socket joint.  The socket is formed by a part of the pelvis bone known as the acetabulum, while the ball is formed by the upper part of the thighbone (femur) known as the femoral head.

Articular cartilage, a smooth tissue that covers the bone surfaces of the ball and socket, serves as a cushion as well as enabling the bones to slid and move easily.  Additionally, the hip joint is surrounded by another tissue called the synovial membrane.  This membrane produces a joint fluid which lubricates the cartilage eliminating most friction during hip movement.

This entire ball-and-socket joint is held together by a series of ligaments (the hip capsule) that give the joint stability.
Normal Hip

Most Common Causes of Hip Pain and Disability:

Arthritis is the most common cause of disability and pain in the hip.  While there are many types of arthritis the three most related to hip pain are Osteoarthritis, Rheumatoid Arthritis and Post-Traumatic Arthritis.

Osteoarthritis: Typically seen in patients who are 50 and older (though it can occur in younger patients), osteoarthritis is due to age-related wear of the cartilage that cushions the hip.  As this cartilage ages and succumbs to normal use, it softens and begins to wear away causing the bones to rub against each other creating friction that then leads to hip pain and stiffness.

Rheumatoid Arthritis:  When the thin synovial membrane that surrounds the hip and releases the joint fluid that lubricates the cartilage becomes chronically inflamed and thickened, it begins to damage the hip cartilage.  This damage causes abnormal wear and loss of the cartilage which in turn leads to stiffness and pain.  Since this is an “inflammatory disorder” it is often treated first with anti-inflammatory medications.

Post-Traumatic Arthritis: Serious damage to a hip such as a fracture can cause damage to the cartilage that covers the bone ends (articular cartilage) that leading over time can lead to stiffness and pain.

Avascular necrosis: A hip injury such as a fracture or dislocation could damage or limit normal blood supply to the femoral head (the ball), resulting in a lack of nourishment to the bone and a possible collapse.

General Description of a Hip Replacement Surgery:

A total hip replacement surgery removes the damaged bone and cartilage of the hip joint and replaces them with prosthetic components.  There are 4 components to a hip replacement surgery.

  • The damaged femoral head (the ball) is detached and then a metal stem is inserted into the femur (thighbone)
  • A ceramic or metal ball is attached to the upper section of the stem, replacing the femoral head that was previously removed.
  • The damaged surface of the socket (acetabulum), is removed and replaced with a prosthetic metal socket that is either screwed or cemented in place.
  • A smooth spacer/liner (made of plastic, metal, or ceramic) is placed between the new ball and socket serving as a gliding surface and allowing for frictionless motion.

Are you a candidate for a Hip Replacement Surgery?

While most patients who have hip replacement surgery are between the ages of 50 and 80, there is no absolute age or weight restriction.  Hip replacement surgery has been successfully done on patients of all ages from teenagers to the elderly.  The criteria for this surgery are based on pain and disability of the patient, not their age.

There are many reasons an orthopedic surgeon would recommend a patient for hip replacement surgery. Those people who would most benefit often present with:

  • Hip stiffness and pain so severe that it limits them from doing everyday activities such as: walking, going up and down stairs and getting in and out of chairs.
  • Hip pain that persists even when resting
  • Failure of the hip to respond to non-surgical treatments such anti-inflammatory medications, injections, physical therapy or rest.
  • Stiffness that restricts mobility of the leg(s)

The Surgery Itself:

Hip Replacement Surgery is a procedure that is performed in a hospital and requires the patient to be admitted.  While the surgery itself takes several hours to complete, the patient’s hospital stay will be for several days.

After the surgery and during the recovery in the hospital, it is common for the patient to have some post-surgical pain.  The surgeon will prescribe medication to make the patient feel comfortable, but this pain is important to the recovery process.  Most patients begin physical rehab the day of or the day after surgery with standing first that some walking with the help of a physical therapist and of a walking support.  The patient’s pain levels are used as a guide to increasing movement and activity and when to rest.

Potential Complications:

Complication rates after a hip replacement surgery are very low with serious complications like infections of the hip joint occurring in fewer than 2% of patients.  Even less frequent are major medical complications such as stroke or heart attacks.  As stated previously, though rare the most common complications of surgery are:

Infection: As with any surgery, the potential of infection is very real and is addressed during the surgery.

Blood clots: It is common in hip replacement surgery for blood clots to form in the pelvis or leg veins.  These clots can be life-threatening hence why often blood thinning medication is used for a short period prior to and after surgery.  Additionally, your doctor will have a prevention program to increase circulation that may include support stocking and leg exercises.

Implant issues: Although implants are meticulously designed and tested and surgical techniques have greatly advanced, on very rare occasions the components can loosen and the ball comes out of the socket.  The greatest risk for a dislocation is in the first few months after surgery will the tissues are healing.  Again, dislocations are very rare.

Leg-length Asymetry: After hip replacement surgery, patients sometimes feel that one leg is now longer than the other.  While surgeons make every effort to make both legs even, stability of the hip joint and its biomechanics are more important.  Some patients find relief using a shoe lift after surgery.

Pain: While rare, a small number of patients continue to have post-surgical pain, most patients experience great relief.

Outcomes:

Today, most hip replacements last a lifetime.  For most patients, a hip replacement results in a dramatic reduction of pain as well as substantially increased mobility.  After a few weeks, the initial stiffness and skin numbness at the incision site goes away, especially if they do their recommended rehab and home exercises.

Note:  Your new prosthetic hip is likely to set off airport metal detectors.  Your orthopedic surgeon can provide you with a card confirming that you have metal in your hip.

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