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What is total hip replacement?


 

The hip is a ball and socket joint, linking the "ball" at the head of the thighbone (femur) with the cup-shaped "socket" in the pelvic bone. In a total hip replacement (THR), a prosthesis is surgically implanted to replace the damaged bone within the hip joint.

The total hip prosthesis consists of three parts::

  • A cup that replaces your hip socket. The cup is usually plastic, although some centers are trying other materials like ceramic and metal.
  • A metal or ceramic ball that will replace the fractured head of the thighbone.
  • A metal stem that is attached to the shaft of the bone to add stability to the prosthesis.


Who is a candidate?

Your doctor will assess the degree of disability, impact on your lifestyle and pre-existing medical conditions. The health care provider will also evaluate your heart and lung function.

Hip joint replacement is primarily done in people age 60 and older. The operation is usually not recommended for younger people because of the strain they can put on the artificial hip, causing it to fail prematurely.

What is the surgery like?

The surgery will be performed using general or spinal anesthesia. The orthopedic surgeon makes a surgical cut, often over the buttocks, to expose the hip joint. The head of the thighbone is removed. Then, the hip socket is cleaned out and a tool called a reamer removes all of the remaining cartilage and arthritic bone.

The new socket is implanted, after which the metal stem is inserted into the thighbone. The artificial components are fixed in place, sometimes with special cement. The muscles and tendons are then replaced against the bones and the surgical cut is closed.

What is recovery like?

You will return from surgery with a large dressing on the hip area. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area. Many surgeons also place a knee immobilizer or special pillow between the legs in the operating room to prevent the hip from dislocating.

You will have moderate to severe pain after surgery. The pain should gradually decrease, and by the third day after surgery, painkillers taken by mouth may be sufficient to control your pain.

You will start moving and walking early after surgery. On the first day after surgery, you should get out of bed to a chair. When in bed, you should perform ankle exercises frequently to prevent development of blood clots.

Recovery includes extensive rehabilitation, both while you are in the hospital and for months afterward.

What are the risks?

Along with the typical risks from any major surgery—blood clots, infection and pneumonia—hip replacement can cause problems for your back.

By cutting off the head of the femur and changing the position of the socket, the surgery can create leg length difference. The leg may be shorter than the other. That puts your pelvis out of a neutral position, and your spine goes into abnormal curvature. That's how pain develops over time.

Is THR always necessary?

Before you consider surgery, take the time to find out if your body is out of alignment. Is that what is causing your hip pain? If so, fix those issues first. By taking excess pressure off your hip, your will be amazed at how much better you will feel. There are also supplements available to help regenerate the cartilage that has been worn down by excess wear and tear on the hip joint.

Also, take the time to identify any lower back problems you may have that aren't symptomatic. Remember that surgery changes everything. THR can make those underlying problems more acute and speed symptoms along.

If you do have surgery, make sure you have your legs measured precisely afterward to see if there is a length differential. Tell your physical therapist to explain what happens to the pelvis and spine after THR and how it will affect your pelvis. Make sure your therapy addresses those imbalances to correct any problems.

You may also need to wear some support device to equalize the difference—a heel lift, full-foot orthotic or added support to the bottom of your shoe.

 

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