Hip Replacement

Who is hip replacement for?

Hip replacement is usually considered once other therapies, such as pain medications, have failed. Most people undergo hip replacement as a result of osteoarthritis of the hip joint. But you might also consider hip replacement if you experience severe pain, loss of motion or deformity of your hip joint. Hip replacement is also used in people with hip injuries, rheumatoid arthritis and other medical conditions, such as a bone tumor or bone loss due to insufficient blood supply (avascular necrosis).

Symptoms that might lead you to consider hip replacement include:

* Pain that keeps you awake at night
* Little or no relief from pain medications
* Difficulty walking up or down stairs
* Trouble standing from a seated position
* Having to stop activities you enjoy, such as walking, because you're in too much pain

Hip replacement used to be an option primarily for adults age 60 and above. But improved technology has made strong and longer lasting artificial joints that are feasible for more active people, including younger people. However, active people face the possibility of another surgery to replace worn out artificial hip joints after 15 or 20 years.

How do you prepare for hip replacement?

Before surgery you'll meet with your orthopedic surgeon for an examination. The surgeon will ask about your medical history to make sure you're healthy enough to undergo surgery and will also ask about any medications you're taking. The surgeon will physically examine your hip, paying attention to the range of motion in your joint and the strength of the muscles around your hip. Also expect blood tests and an X-ray.

This preoperative evaluation is a good opportunity for you to ask questions about the procedure. And if you have any concerns about the surgery, be sure to ask.

Blood loss during surgery can occur, and having surplus blood on hand minimizes the chances for complications. For this reason, your surgeon may recommend that you have blood drawn and stored before surgery. This way, your own blood can be used for the transfusion if needed.

How is hip replacement performed?

Hip replacement surgery involves replacing the femoral head — the "ball" of your thighbone — with a metal ball. The metal ball attaches to a metal stem that fits into your thighbone. A plastic and metal socket is implanted into your pelvic bone to replace the damaged socket. The prosthetic parts, which mimic the natural design of your hip, fit together and function like a normal hip joint.

Artificial hip joints come in many varieties. Generally your surgeon decides which hip joint is the best for you. Materials used in making the prostheses include a combination of durable, wear-resistant plastic and metals, including stainless steel and titanium. Implants are biocompatible — meaning they're designed to be accepted by your body — and they're made to resist corrosion, degradation and wear.

Hip replacement surgery usually takes two to three hours, during which time you'll be under general or regional anesthesia. During the operation, the surgeon separates your thighbone from the socket. Working between the large hip muscles, the surgeon removes the diseased or damaged bone and tissue, leaving healthy bone and tissue intact. The artificial socket is pressed into place. The top end of the thighbone is hollowed out to allow insertion of the metal stem with the attached ball. The ball and the socket join to form the new hip joint.

After surgery you're moved to a recovery area for a few hours while your anesthesia wears off. Nurses or other anesthesia aides watch your blood pressure, pulse, alertness, pain or comfort level and your need for medications.


What happens after hip replacement surgery?

You'll likely stay in the hospital for a few days while you recover. As early as the day after your surgery, you may be encouraged to sit up and even try walking with crutches or a walker. A physical therapist may help you with some exercises that you can do in the hospital and at home to speed recovery. Before you leave the hospital, you and your caregivers will get tips on caring for your new hip.

Planning ahead can make it easier for you to recover at home. For example, arrange to have a friend or relative prepare some meals for you. You might also need to make some modifications to your home, such as getting a raised toilet seat.

Activity and exercise must be a regular part of your day to regain the use of your joint and muscles. Your physical therapist will recommend strengthening and mobility exercises and will help you learn how to use a walking aid, such as a walker or crutches. As therapy progresses, you'll gradually increase the weight you put on your leg until you're able to walk without assistance.

About six to eight weeks after surgery, you'll have a follow-up appointment with your surgeon to make sure your hip is healing properly. If recovery is progressing well, most people resume their normal activities by this time — even if in a limited fashion.


Results of hip replacement surgery

The odds of a successful recovery are in your favor. Hip replacement surgery is successful more than 90 percent of the time.

Expect your new hip joint to reduce the pain you felt before your surgery and increase the range of motion in your joint. But don't expect to do anything you couldn't do before surgery. High-impact activities — such as running or playing basketball — may never get your doctor's approval. But in time, you may be able to swim, play golf, walk or ride a bike comfortably.
Risks of hip replacement surgery

Hip replacement surgery is generally safe, but as with any surgery, complications can occur. Although some complications are serious, most can be treated successfully. In rare circumstances, complications can include:

* Blood clots. These clots in the leg veins can form as a result of decreased movement of your leg after surgery, as well as from injury to the veins during surgery. Your doctor usually gives you blood-thinning medications after your surgery to try to prevent clots from forming. Compression devices, such as elastic stockings, and exercise to increase blood flow through the veins in your legs also can reduce your risk.
* Infection. Infections can occur at the site of your incision and in the deeper tissue near your new hip. Most infections are treated with antibiotics, but a major infection near your prosthesis may require surgery to remove and replace the prosthesis.
* Dislocation. Certain positions can cause the ball of your new joint to become dislodged. To avoid this, don't bend more than 90 degrees at the hip and don't let your leg cross the midline of your body. Surgery usually isn't necessary to relocate your hip joint.
* Loosening. Over time your new joint may loosen, causing pain in your hip. Surgery might be needed to fix the problem.
* Breakage of the prosthesis. Though rare, your artificial hip can break several years after surgery. Another surgery would be required to replace the broken joint.
* Change in leg length. Your surgeon takes steps to avoid the problem, but occasionally your new hip may make your leg longer or shorter than the other one. Sometimes this is caused by weakness in the muscles surrounding your hip. In this case, strengthening those muscles can resolve the issue.
* Joint stiffening. Sometimes the soft tissues around your joint harden, making it difficult to move your hip — a process called ossification. This usually isn't painful. If you're at risk of ossification, your doctor may recommend medications or radiation therapy to prevent it from happening.

Talk with your surgeon about any concerns you might have before surgery. He or she can help you understand your risk of complications.