Total Hip Replacement
About the Procedure
Total hip replacement is a surgical procedure for replacing the hip joint. This joint is composed of two parts — the hip socket (acetabulum, a cup-shaped bone in the pelvis) and the "ball" or head of the thighbone (femur). During the surgical procedure, these two parts of the hip joint are removed and replaced with smooth artificial surfaces. The artificial socket is made of high-density plastic, while the artificial ball with its stem is made of a strong stainless metal. These artificial pieces are implanted into healthy portions of the pelvis and thighbones and affixed with a bone cement (methyl methacrylate).
An alternative hip prosthesis called a "cementless" total hip replacement has the potential to allow bone to grow into it, and therefore may last longer than the cemented hip. This is an important consideration for the younger patient. In some cases, only one of the two components (socket or stem) may be fixed with cement and the other is cementless and would be called a "hybrid" hip prosthesis.
When is total hip replacement considered?
Total hip replacements are usually performed for severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or avascular necrosis (a condition in which the bone of the hip ball dies). Most patients who have artificial hips are over 55 years of age, but the operation is occasionally performed on younger persons.
Circumstances vary, but generally, patients are considered for total hip replacements if:
- Your pain is severe enough to restrict work, recreation, and the ordinary activities of daily living.
- Your pain is not relieved by anti-inflammatory medicine, the use of a cane or walker and restricting activities.
- You have significant stiffness of the hip.
- Your X-rays show advanced arthritis, or other problems.
What can I expect of a total hip replacement?
A total hip replacement will provide pain relief in 90 to 95 percent of patients. It will allow patients to carry out many normal activities of daily living. The artificial hip may allow you to return to active sports or heavy labor under your physician's instructions. Most patients with stiff hips before surgery will regain near-normal motion, and nearly all have improved motion.
What are the risks of total hip replacement?
Total hip replacement is a major operation. The effect of most complications is simply that the patient stays in the hospital longer. The most common complications are not directly related to the hip and do not usually affect the result of the operation. These include:
- Blood clots in the leg
- Urinary infections or difficulty urinating
- Blood clots in the lung
Complications that affect the hip are less common, but in these cases, the operation may not be as successful:
- Difference in leg length
- Dislocation of hip (ball pops out of socket)
- Infection in the hip
A few of the complications, such as infection or dislocation, may require re-operation. Infected artificial hips sometimes have to be removed, leaving a short (by one to three inches), somewhat weak leg, but one that is usually reasonably comfortable and one on which you can walk with the aid of a cane or crutches.
How long will I be in the hospital after surgery?
The hospital stay usually ranges from three to four days. Patients who live with someone who can assist them are usually able to go home without much problem. However, patients who live alone are encouraged to find someone who can stay with them when they return home. Patients who do not progress well may require a short stay in a rehabilitation center, where they can receive physical and occupational therapy and instruction in how to care for themselves at home independently.
How long will I need crutches or a walker?
Most patients use crutches or a walker for about four to six weeks or until instructed otherwise by a physician.
What activities can I do following hip replacement?
It takes about three months for the hip to recover to a point where you are back to full activity. Obviously, some patients recover faster and others more slowly depending upon age, health status, personal motivation, and response to rehabilitation. The purpose of hip replacement surgery is to relieve pain, allowing you to return to a high level of function. This means that most activities are okay once you have completely healed. However, most surgeons recommend that you avoid "impact" type of activities, such as running, aerobics, cutting or pivoting sports, or other activities that place a high degree of stress on the hip. Walking, bicycling, swimming, cross-country skiing, golf, and bowling are often approved.
How successful is total hip replacement surgery?
Results are generally very good; most people are relieved of all their hip and groin pain and the replaced joint will usually last ten years, depending on patient use and activity levels.
The major long-term problem is loosening of the prosthesis. This occurs either because the cement crumbles (as old mortar in brick building) or because the bone melts away (resorbs) from the cement.
Loose, painful artificial hips can usually, but not always, be replaced. The results of a second operation are not as good as the first, and the risks of complications are higher.