What is total hip replacement surgery?

Total hip replacement is a step-by-step surgery to replace the hip socket and the ball at the top of the thighbone (femur).

Doctors use metal, ceramic, or plastic replacement parts. The parts may be attached to the bones in one of two ways. They may be:

• Cemented to the bone.
• Uncemented. These parts have a porous coating that the bone grows into.

Your doctor may use regional anesthesia. This means you can't feel the area of the surgery. You'll have medicine that makes you unaware and lightly asleep. Or a doctor may use general anesthesia. This means you'll be asleep during surgery. Which type of anesthesia you get depends on your doctor and your overall health. Your doctor might also ask what you prefer.

Hip replacement surgery is done through one or two cuts (incisions). The cuts may be toward the front (anterior) of your hip. Or they may be on the side or toward the back (posterior). Your doctor will talk with you about which type of surgery might be best for you.

Hip replacement surgery is done through one or two cuts (incisions). The cuts may be on the side of your hip or toward the back (posterior). Some muscles and other soft tissues, such as ligaments, are cut or moved so the doctor can get to the hip joint.

Another type of surgery is done through an incision in the front (anterior) of the hip. Anterior hip surgery causes less damage to muscles and other soft tissues than getting to the hip joint from the side or the back.

When hip replacement is done with smaller incisions (sometimes called minimally invasive surgery), it may cause less blood loss and leave a smaller scar. But it can also mean a longer time in surgery, because the surgery is harder to do. And if the new hip can't be fitted properly through the smaller incision, the doctor may have to make a larger cut.

Your doctor can explain your options and help you understand the risks and benefits of each type of surgery.

The surgery may take 1 to 3 hours.

Surgery usually works well. You will probably have much less pain and be able to do most of your daily activities more easily. But recovery does take time and patience.

Most hip replacements (about 90 out of 100) last at least 15 years. And more than half last for 25 years or more. It depends on your age, how much stress you put on the joint, and how well your new joint and bones mend. Your weight can make a difference. Every extra pound of body weight adds 3 pounds of stress to your new hip joint. Controlling your weight will help your new hip joint last longer.

The risks of hip replacement surgery can be divided into two groups.

Risks of the surgery and recovery period

These risks include:

• Blood clots. These can be dangerous if they block blood flow from the leg back to the heart, or if they move to the lungs.
• Infection. Infection in the wound is usually treated with antibiotics. Infection deep in the joint may need more surgery. In some cases, the hip implant has to be replaced with another one.
• Nerve injury. This is rare. It can cause tingling, numbness, or difficulty moving a muscle.
• Problems with wound healing.
• Problems with anesthesia.
• Hip dislocation after surgery.
• Difference in leg length. Any difference is usually very small and can be corrected by using a shoe insert.

Long-term risks

These risks may happen months to years after the surgery. They include:

• Loosening of the hip implant in the bone.
• Infection in the joint.
• A reaction to the metal in the new hip joint. As metal ball and socket parts rub against each other, tiny bits of the surface of the parts wear off. Some people are sensitive to the types of metal that may be used for joint replacement.

During total hip replacement surgery, your doctor replaces the worn parts of your hip joint with artificial parts made of metal, ceramic, or plastic.

You may want this surgery if you have hip pain and trouble moving that you can't treat in other ways. Osteoarthritis or rheumatoid arthritis can cause these types of problems. Another cause is bone loss due to a poor blood supply.

Hip replacement is sometimes done after a hip fracture.

On the day of surgery, you'll learn how to get in and out of bed. You'll also learn how to walk with a walker, crutches, or a cane. By the time you leave the hospital, you'll be able to safely sit down and stand up, dress yourself, use the toilet, and bathe.

As soon as possible, you'll start physical therapy. You'll learn exercises to help you get stronger. You'll also be taught how to move your body without dislocating your hip.

During the first week or so after surgery, you'll need less and less pain medicine. For a few weeks after surgery, you'll probably take medicine to prevent blood clots.

It usually takes a few months to get back to full activity. After you recover from surgery, you may have much less pain than before and a better quality of life.

Sometimes hip replacements have to be done again. It depends on your age, how much stress you put on the joint, and how well your new joint and bones mend. Your weight can make a difference. Every extra pound of body weight adds 3 pounds of stress to your new hip joint. Controlling your weight can help your new hip joint last longer. It should also last longer if you avoid hard physical work and sports that stress the joint.

In the future, make sure to let all health professionals know about your artificial hip so they will know how to care for you.

Precautions

If you have surgery through the side or back or your hip, you'll need to follow "hip precautions" until your hip is fully healed. Most often, this means that you:

• Keep your toes pointing forward or slightly out. Don't rotate your leg too far to the inside.
• Do not bend your hip more than 90 degrees. This means no bending forward while sitting down and no bending over to tie your shoes.
• Do not let your affected leg cross the center of your body toward the other leg. Your therapist may suggest that you:
  • Do not cross your legs or feet.
  • Be very careful as you get in or out of bed or a car. Make sure your leg does not cross the imaginary line down the middle of your body.
  • Keep a pillow between your knees when you are lying down.

There are different precautions after anterior surgery. Your physical therapist will teach you how to move safely. For example, while you're healing, the therapist may suggest that you:

• Do not cross your legs or feet.
• Do not step backward or bend backward.
• Do not turn your leg too far out to the side. Keep your toes pointing forward or slightly in.

Exercise and activity

After traditional surgery, you'll slowly return to most of your activities.

• You'll need to use a walker, crutches, or a cane for the first few weeks after surgery. Your doctor will tell you when you can walk on your own.
• Your doctor will tell you when you can drive again.
• You may be able to go back to work in 4 weeks to 4 months. It depends on your job.
• Your doctor will tell you when you can do activities like swim, dance, golf, or ride a bike.
• You may need to avoid some strenuous activities. These may include running, horseback riding, tennis, and any type of skiing.
• For most people it is safe to have sex about 4 to 6 weeks after the surgery.

Hip replacement surgery is done through one or two cuts (incisions). The cuts may be toward the front (anterior) of your hip, or they may be on the side or toward the back (posterior). You and your doctor can discuss which surgery is best for you.

You may have anesthesia to block pain and medicine to make you drowsy. Or you may get medicine to make you sleep. After making the incision, your doctor will:

• Remove worn bone tissue and cartilage from the hip joint.
• Replace the ball at the upper end of your thighbone (femur).
• Replace your hip socket with a shell and liner.
• Fit the ball into the shell and liner to make a new hip joint.

There are two kinds of replacement joints.

• Cemented joints. The cement fits between the new joint and the bone.
• Uncemented joints. These have a metal coating with many small openings. The bone is shaped to fit the new joint almost perfectly. At first, there will be some small spaces between the bone and the new joint. Over time, the bone grows to fill these small openings.

Sometimes a doctor uses a cemented ball and an uncemented socket.

Your doctor can tell you which type of new hip joint is best for you.

Total hip replacement surgery is usually done when hip pain and loss of function caused by osteoarthritis become severe and when treatment no longer relieves pain. Hip replacement is sometimes done after a hip fracture.