What is a total hip replacement?
Most hip damage is a result of osteoarthritis of the hip. With this type of arthritis, the cartilage cushion between the joints wears away. As the cartilage wears away, the bones rub together resulting in pain and decreased mobility. Total hip replacement is often a treatment for people with other types of hip damage, including damage caused by hip fractures, bone tumors, or diseases where poor blood supply to the bones causes damage.
Your doctor may try other treatments for your hip problem before suggesting surgery. Your doctor may first have you try physical therapy, medicine, or using a cane (or other aid) to help you walk. Surgery for total hip replacement may be a good idea if you’ve tried these things but still have too much pain and stiffness to do your daily activities.
What are the benefits?
Total hip replacement has these benefits:
- Reliable relief from hip pain when other treatments haven’t worked
- Ability to get back to the daily activities you haven’t been able to do because of your hip pain and stiffness. Many patients return to sports and recreation after successful total hip replacement.
- Improved joint mobility. Simple daily activities like getting dressed and tying your shoes will be much easier.
What are the risks and/or side effects?
Total hip replacement is generally considered a very safe surgery. Any surgery, though, comes with some risks. These are the risks for total hip replacement:
- Infection. Infections can occur with any surgery. Surgeons are very careful about keeping things sterile and clean during surgery, but there is always a chance of infection. While the chance of infection is low, if infection happens around a hip replacement it usually requires returning to the operating room. Infection after total hip replacement happens in less than 1% of cases.
- Blood clots. Sometimes the surgery can change the way blood flows around the surgery site. A blood clot can form in the veins of the legs. A blood clot in the legs can cause pain and swelling. It is possible for a blood clot to move up into the lungs causing serious damage. Blood clots occur less than 1% after total hip replacement.
- Different leg lengths. Most patients have some minor leg length differences before surgery. It is possible to inadvertently change the length of the leg in surgery. Most surgeons use imaging during the surgery to evaluate leg length. The surgeon will try to keep them even, but sometimes may need to make the leg slightly longer to make the new hip stable.
- Dislocated hip. Sometimes the new artificial ball can slip out of the socket. This is a painful event that almost always requires a return to the hospital. This risk is greatest in the first few months after surgery, but is not very common.
- Reaction to anesthesia. Some people don’t react well to anesthesia and may have nausea and vomiting.
- Pain. While pain from any surgery is to be expected, there is a risk that the surgery may not completely alleviate the pain in the hip, especially if there is pain coming from somewhere else.
- Wear and tear on the parts. The new hip parts can wear out over time. Most contemporary hip replacements can be expected to last 20-30 years, even in active individuals.
How is it done?
Your total hip replacement surgery will be done in the hospital or a surgery center. A total hip replacement takes 1 to 2 hours.
While you can expect to be asleep for the surgery, most hip replacements are performed with a spinal block to numb the legs prior to going to sleep. The incision is usually 4-6 inches over the side of the hip. The surgeon will remove the damaged parts of your hip and put the new replacement parts in. After the surgery you will go to a recovery room for an hour until you fully wake up. Some patients feel numb for an hour or so after surgery.
There are a variety of ways hip components can be placed safely in the body. A ‘surgical approach’ refers to how a surgeon gets into the joint to place the artificial hip. Posterior, or direct anterior approaches are the 2 most common ways to safely get into the hip joint. Direct superior or lateral approach are less common approaches. There is not one approach that is best for all patients. There are unique advantages and disadvantages of each approach. You can talk to your surgeon about the pros and cons of each approach.
‘Minimally invasive’ hip replacement simply refers to minimizing trauma to the tissue surrounding the hip joint. All surgeons strive to minimize the damage to surrounding tissue. The length of the incision is often dictated by the patient’s body shape.
After surgery, you will be transferred to the recovery room to wake up relaxed and pain free. Your legs may be numb for an hour or so after you wake up. Once you have been monitored in the recovery room, you will be taken to a hospital room to continue your recovery. You will eat as soon as you are awake and alert.
Pain medicine is given as feeling in your legs return and you start to feel pain. Patients are expected to walk with assistance the same day as their operation. Some patients can safely return home the same day if they are cleared to go home by physical therapy. Depending on the timing of surgery and the needs of the patient, spending one or occasionally two nights in the hospital is common.
Physical therapy is helpful but most exercises are simple and can be performed at home. Hip replacement does not require as much formal physical therapy as some other surgeries.
How to Prepare & What to Do Once You Get Home
How to Prepare
This surgery will work best when you are as healthy and strong as possible. If you are overweight, the doctor may work with you on weight loss before surgery. If you smoke, you will be asked to stop smoking before the surgery. If you are diabetic, you will need to have your blood sugar well controlled. Below are some other ways to prepare for your surgery.
- Follow Instructions. The doctor or nurse will tell you how to prepare for your surgery. Most likely, you will have instructions about not eating or drinking before the surgery. Pre surgery blood tests may be ordered. You should be as clean as possible before the surgery to help prevent infection. The doctor may also tell you to stop taking some of your medicines or vitamins before surgery. Make a Plan for Getting to the Hospital and Back Home. Have a plan for who will take you to the surgery and who will take you home. Family and companions can stay with the patient when they arrive to the hospital room.
- Make a Plan for Recovery. The first weeks after you get home are very important. Plan for who will help you in the days following your surgery. Set up your house so that it’s easy to get everything you need without having to go up and down stairs. Decide where you will do your physical therapy and exercises. Call ahead and make an appointment to follow up with your doctor and your therapist after surgery. Have food in the cupboards or a plan for someone to bring meals. Consider making some meals and freezing them.
What should I expect once I'm home?
Alternatives to a Total Hip Replacement
Total Hip Resurfacing
In a total hip replacement, the surgeon removes the head of the thigh bone and the damaged hip socket. These bones are then replaced with a new head and socket. The head is usually metal and the socket hard plastic.
Hip resurfacing is just a variation on a total hip replacement. In a hip resurfacing procedure, the femoral head is left in place but is trimmed down and covered with a smooth metal piece. It is similar to how a dentist would cap a tooth. Hip resurfacing surgeries are uncommon and usually reserved for younger patients who would be expected to need a second surgery in the future.