During a hip replacement, the surgeon removes the damaged parts of the hip joint and replaces them with parts that are usually made of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.
Hip replacement surgery, also called total hip arthroplasty, may be an option if hip pain interferes with daily activities and nonsurgical treatments haven''t helped or are no longer effective. Arthritis damage is the most common reason for the need for a hip replacement.
What is that done
Conditions that can destroy the hip joint and require hip replacement surgery include
Osteoarthritis. Known as wear-and-tear arthritis, osteoarthritis destroys the slippery cartilage that covers the ends of bones and helps joints move smoothly.
Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis results in a type of inflammation that can erode the cartilage and sometimes the bone underneath, which can damage and disfigure joints.
Osteonecrosis. If, as a result of a dislocation or fracture, not enough blood reaches the ball part of the hip joint, the bone may collapse or deform.
You may consider hip replacement surgery if you have hip pain that is
It persists, despite taking pain relievers
It gets worse when you walk, even with a walking stick or walker
affect your sleep
It''s hard to get dressed
Affects your ability to go up or down stairs
Makes it difficult for you to get up from a sitting position
Risks
Risks related to hip replacement surgery can include
blood clots Blood clots can form in the leg veins after surgery. This can be dangerous Because a piece of the blood clot can break off and travel to the lung, heart, or rarely to the brain. Your doctor may prescribe blood-thinning medications to reduce this risk.
infection. Infection can occur at the site of the incision and in the deeper tissues near the new hip. Most infections are treated with antibiotics, but major infections near the prosthesis may require surgery to remove and replace the prosthesis.
fracture. Healthy parts of the hip joint may break during surgery. Sometimes, fractures are small enough to heal on their own, but larger fractures may need to be fixed with wire, screws, and possibly metal plate or bone grafts.
dislocation. Certain positions can cause the ball of the new joint to come out of the socket, especially in the first few months after surgery. If a hip dislocation occurs, your doctor may provide you with a brace to keep your hip in the correct position. If the hip continues to dislocate, surgery is often required to stabilize it.
Change in leg length. Your surgeon takes steps to avoid the problem, but sometimes a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contraction of the muscles around the hip. In this case, gradually stretching and strengthening these muscles may help. You are not likely to notice slight differences in leg length after a few months.
f ness Although this complication is rare with newer implants, the new joint may not become firmly fixed to your bone or may come loose over time, causing hip pain. Surgery may be required to resolve this problem.
nerve damage In rare cases, nerves in the area where the implant is placed can be affected. Nerve damage can cause numbness, weakness, and pain.
The need for a second hip replacement
A hip replacement can wear down over time, especially if you had hip replacement surgery when you were relatively young and active. Then you may need a second hip replacement. However, the new materials make the implants last longer.
How to prepare
Before surgery, you''ll meet with an orthopedic surgeon for an examination. The surgeon will follow these procedures:
Asking about your medical history and current medications
Examine the hip with attention to the range of motion in the joint and the strength of the surrounding muscles
Ordering blood tests and x-rays. MRI is rarely needed
This pre-operative evaluation allows you a good time to ask any questions you have about the procedure. Make sure you know which medications to avoid or continue to take during the week before surgery.
Because tobacco use can hinder your recovery, stop using tobacco products for at least a month before surgery and for at least two months after surgery. If you need help quitting, talk to your doctor.
Do not undergo dental treatment, including dental cleaning, two weeks before surgery.
What you can expect
When you enter surgery, you will be asked to undress and put on a hospital gown. You''ll be given either a spinal block, which numbs the lower half of your body, or a general anesthetic.
Your surgeon may give you a nerve block by injecting an anesthetic around the nerves or in and around the joint to help prevent postoperative pain.
During the operation
The surgery takes a few hours. To perform a hip replacement, your surgeon will
Make incisions over the front or side of the hip through the layers of tissue
Removing diseased or damaged bones as well as cartilage, leaving healthy bones untouched
Implanting a prosthetic socket in the pelvic bones, to replace the damaged socket
He replaces the round ball at the top of the thigh with a prosthetic ball that is installed in the appropriate stem in the thigh bone
Hip replacement techniques are constantly evolving. Surgeons are still developing minimally invasive surgical techniques that can reduce recovery time and pain.
After the operation
After surgery, you''ll be moved to a recovery area for a few hours while the anesthesia wears off. Medical staff will monitor your blood pressure, pulse, alertness, level of pain or discomfort, and your need for medication.
Some people can go home the same day, but most are hospitalized for one or two nights. You will be asked to breathe deeply, cough or blow into a device to help remove fluid from your lungs.
Preventing blood clots
After surgery, you''ll have an increased risk of blood clots in your legs. Possible measures to prevent these complications include:
Walk early. You will be encouraged to sit and walk with crutches or a walker shortly after surgery. This will likely happen the day of surgery itself or the next day.
Add pressure. During and after surgery, you might wear elastic compression stockings or an inflatable air sleeve that resembles a blood pressure collar in the lower legs. The pressure exerted by the inflated sleeve helps prevent blood from pooling in the leg veins, which reduces the chance of clots forming.
blood-thinning medications Your surgeon may prescribe injectable or oral blood-thinning medications after surgery. Depending on how fast you walk, how active you are and the overall risk of blood clots, you may need blood thinners for several weeks after surgery.
natural therapy
A physical therapist may help you with exercises you can do in the hospital and at home to speed recovery.
Being active and exercising should be a regular part of your day to regain the use of your joints and muscles. A physical therapist will recommend strengthening and mobility exercises and help you learn to use walking aids, such as a walker, cane or crutches. As treatment progresses, you''ll usually increase the weight you put on your leg so that you can walk unassisted.
Home recovery and follow-up care
Before you leave the hospital, you and your caregivers will get advice about caring for your new hip. For a smooth transmission:
Coordinate to have a friend or relative prepare some meals for you
Put everyday items at waist level, so you don''t have to bend over or reach up
Consider making some adjustments in your home, such as having a raised toilet seat if you normally have a low toilet
Put the things you need, such as your phone, tissues, TV remote control, medicines, and books, near the area where you will spend most of your time during your recovery
Six to 12 weeks after surgery, you''ll have a follow-up appointment with your surgeon to make sure your hip is healing properly. If the recovery is going well, most people have resumed at least some of their normal activities by this time. Further recovery will often occur with improved strength over a period of six to 12 months.
Results
Expect the new hip joint to reduce the level of pain you felt before surgery and increase the range of motion in the joint. But don''t expect to do all the things you could have done before you had hip pain.
High-impact activities — such as running or playing basketball — may put too much pressure on the artificial joint. But at the same time, you may be able to go swimming, golf, hike or bike comfortably.
