This page provides a brief introduction to hip
replacement. It can help you make a list of questions to ask your
doctor, but it is not meant to provide complete information. Check
with your surgeon's office about more comprehensive resources and
patient education materials.
Teach me a little about the hip.
The hip joint is commonly known as a ball and
socket joint and is formed where the rounded head of the thigh bone
joins the pelvis. The joint is surrounded and lined by cartilage,
muscles, and tendons. It relies on these tissues for support,
stability, and ease of movement.
What is total hip replacement?
In a total hip replacement surgery, the painful
parts of the damaged hip are replaced with artificial hip parts
called a prosthesis, a device that substitutes or supplements a
joint. The prosthesis consists of steel components: a socket, ball,
and stem. The outer shell of the socket is usually made of metal
and the inner shell consists of plastic, or the entire socket may
be plastic. When the metal ball is joined with the socket, the new
hip can allow for smooth, nearly frictionless movement.
Two Types of Hip Fixation
There are two main types of fixation
philosophies-cemented and porous. Both can be effective in the
replacement of hip joints. The physician (and the patient) will
choose the best solution that is specific to the patient's
needs.
Cemented Hip Implants
The cemented hip implant is designed to be
implanted using bone cement (a grout that helps position the
implant within the bone). Bone cement is injected into the prepared
femoral canal. The surgeon then positions the implant within the
canal and the grout helps to hold it in the desired position.
Porous Hip Implants
The porous hip implant is designed to be
inserted into he prepared femoral canal without the use of bone
cement. Initially, the femoral canal is prepared so that the
implant fits tightly within it. The porous surfaces on the hip
implant are designed to engage the bone within the canal and permit
bone to grow into the porous surface. Eventually, this bone
ingrowth can provide additional fixation to hold the implant in the
desired position.
How do I prepare for hip replacement
surgery?
If you and your surgeon decide that total hip
replacement is right for you, a date will be scheduled for your
surgery. Several things may be necessary to prepare for surgery.
For example, your surgeon might ask you to have a physical
examination by your primary care physician. This will help to
ensure that other health problems you may have, such as diabetes or
high blood pressure, will be identified and treated before
surgery.
You doctor may suggest that you lose weight and
initiate an exercise program. If you smoke, be sure to speak with
your doctor about it, as smoking can dangerously increase surgical
risks and slow down the healing process.
You should also finish any dental work that may
be underway to prevent germs in your mouth from entering the
bloodstream and infecting the joint. It is likely that you will
need blood during hip surgery, and your surgeon may place an order
with the blood bank in case a transfusion is needed. If you prefer,
or if your surgeon feels it is needed, you may want to donate your
own blood ahead of time to reduce the risk of your body reacting to
the blood transfusion.
What happens during hip replacement
surgery?
On the day of surgery, an intravenous tube will
be inserted into your arm to administer necessary medications and
fluids during surgery. You will then be taken to the operating room
and given anesthesia.
The surgery usually takes two to four hours,
although this is dependent upon the severity of the arthritis in
your hip. In the operating room, a urinary catheter will be
inserted and left in place for one or two days. Compression
stockings and pneumatic sleeves will be put on both legs.
The procedure is performed through an incision
over the side of the hip. The ball-end of the thighbone (femur) is
cut and replaced with the new metal ball and stem component. It may
be stabilized with or without cement. The damaged surface of the
socket is smoothed in preparation for the insertion of the new
socket. The ball and socket are then joined. When the surgeon is
satisfied with the fit and function, the incision will be cleaned
and covered with dressings. You will also find small drainage tubes
coming out of the hip to drain fluid from the wound.
You will be sent to the recovery room and as
the anesthesia wears off you will slowly regain consciousness. A
nurse will be with you, and may encourage you to cough or breathe
deeply to help clear your lungs. You will also be given pain
medication and will find a foam wedge or pillows placed between
your legs to help hold your joint in place. When you are fully
conscious, you will be taken back to your hospital room.
What can I expect after surgery?
When you are back in your hospital room you
will begin a gentle rehabilitation program to help strengthen the
muscles around your new hip and regain your range of motion. On the
day of surgery you may be asked to sit on the edge of the bed and
dangle your feet. You will also learn how to protect your new hip
while doing daily activities.
As soon as possible, usually within the next 24
hours, your physical therapist will help you start walking a few
steps at a time. As you heal you will progress from walker to
crutches and then a cane. Before you are dismissed from the
hospital, an occupational therapist will also show you how to
perform daily tasks at home with your new hip. For example, he or
she will instruct you on how to go to the bathroom, how to dress
yourself, how to sit or stand, how to pick up objects and many
others.
After about two to four days, or when your
surgeon determines that you have recovered sufficiently, you will
be discharged. You may be transferred to a rehabilitation facility
for a few more days, as determined by your surgeon. Upon returning
to your home, you will need to continue taking your regular
medications and continue exercising as directed by your surgeon or
physical therapist. Walking, remaining active and practicing the
required exercise are the quickest ways to full recovery.
How long will a joint replacement
last?
Longevity of the prosthetic hip varies from
patient to patient. It depends on many factors, such as a patient's
physical condition, activity level, and weight, as well as the
accuracy of implant placement during surgery. It is useful to keep
in mind that prosthetic joints are not as strong or durable as a
natural, healthy joint, and there is no guarantee that a prosthetic
joint will last the rest of a patient's life.
Today, total hip replacement has become a
common and predictable procedure. Many patients enjoy relief from
pain and improved function, compared to their status before
surgery. As a result, some patients may have unrealistic
expectations about what the prosthetic hip can do and how much
activity it can withstand. As with any mechanical joint, the ball
and socket components move against each other. Natural fluid in the
joint space, called synovial fluid, helps to lubricate the implants
just as it lubricates the bones and cartilage in a natural joint.
Still, the prosthetic components do wear as they roll and slide
against each other during movement. As with car tires or brake
pads, the rate of wear depends partly on how the hip joint is used.
Activities that place a lot of stress on the joint implants, as may
be the case with heavier and more active patients, may reduce the
service life of the prosthesis. Implant loosening and wear on the
plastic portions of the implant can lead to the necessity for
revision surgery to replace the worn components, or all of the
components. Your doctor will be in the best position to discuss
these issues with you, taking into account your particular clinical
circumstances, the type of implants used, and your post-surgical
lifestyle.
Talk with your doctor about the following
points, and how they might affect the longevity and success of your
hip replacement:
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Avoiding repetitive heavy lifting
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Avoiding excessive stair climbing
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Maintaining appropriate weight
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Staying healthy and active
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Avoiding "impact loading" sports such as
jogging, downhill skiing and high impact aerobics
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Consulting your surgeon before beginning any
new sport or activity
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Thinking before you move
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Avoiding any physical activities involving
quick stop-start motion, twisting or impact stresses
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Avoiding excessive bending when weight bearing,
like climbing steep stairs
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Not lifting or pushing heavy objects
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Not kneeling
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Avoiding low seating surfaces and chairs.
