Overview
Total hip replacement (THR) is an excellent treatment option for people with late-stage degenerative hip disease. THR is one of the most successful and common surgical procedures in orthopedic surgery. In addition to marked reduction in pain and improvement in sleep, most people regain range of motion, physical ability, and quality of life.
- The hip joint is composed of a ball and socket, with the surface of each covered by cartilage.
- A number of conditions and diseases can cause the cartilage surfaces to degenerate, which in turn leads to pain, stiffness, and disability.
- Doctors replace both the ball (femoral head) and socket (acetabulum) during total hip replacement surgery.
A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a "cup-shaped" bone of the pelvis called the acetabulum.
The ball is the head of the thigh bone (femur). Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal ball and stem inserted into the femur bone and an artificial plastic cup socket.
When to Seek Medical Care ?
Call your doctor immediately if any of the following occur:
- You become short of breath or have difficulty breathing.
- You have pain or a crushing sensation in your chest.
- You feel your heart is racing or beating irregularly.
- You develop a fever.
- You show signs of an infection—increasing redness and warmth along the incision site or drainage of fluid from the incision.
- Your calf, thigh, or hip becomes unusually swollen, warm, red, or painful.
Who is a candidate for total hip replacement?
Total hip replacements are performed most commonly because of progressively severe arthritis in the hip joint. The most common type of arthritis leading to total hip replacement is degenerative arthritis (osteoarthritis) of the hip joint. This type of arthritis is generally seen with aging, congenital abnormality of the hip joint, or prior trauma to the hip joint.
Other conditions leading to total hip replacement include bony fractures of the hip joint, rheumatoid arthritis, and death (aseptic necrosis) of the hip bone. Hip bone necrosis can be caused by fracture of the hip, drugs (such as alcohol or prednisone and prednisolone), diseases (such as systemic lupus erythematosus), and conditions (such as kidney transplantation).
Total Hip Replacement Preparation
- Talk to someone who has undergone hip replacement surgery to become familiar with the procedure and the recovery period.
- Your doctor will evaluate your overall health to ensure that you are well enough to safely withstand the surgery. Any unstable medical conditions or infections must be treated before surgery.
- Allow time to rest after the operation and find people to help with your care and daily activities for the first few weeks.
- Because you may need blood transfusions during the operation or recovery period, you may want to donate some of your own blood before the procedure to be given back to you.
- Do not eat or drink anything after midnight on the day of your surgery. Follow any other instructions your doctor gives you.
During the Procedure
- You will arrive at the hospital usually on the day of surgery.
- An anesthesiologist will meet with you to discuss various options for anesthesia.
- You may have a general anesthesia, in which you will be completely unconscious.
- You may have regional anesthesia that will numb you from the waist down and keep you moderately sedated.
- The surgeon will expose your hip joint and dislocate the ball from the socket.
- The doctor removes the head from the femur (thigh bone) and reams away the surface of the socket.
- The doctor secures in place a prosthetic cup (socket) made of polyethylene.
- The surgeon then secures a metal head (ball) and stem into the femur either by a press fit or with bone cement.
- The doctor places the ball into the cup and takes your new hip through a range of motion to ensure proper stability and mobility.
- The surgeon closes your incision, and you are brought to the recovery room.
After the Procedure
You will stay in the hospital for 4-7 days
- The first night you will be confined to bed with a wedge-shaped pillow between your legs to keep the new hip joint in place.
- A tube placed in the new hip joint during surgery to drain any fluid or blood likely will be removed the next day.
- If you are having trouble urinating, another tube likely will be placed in your bladder.
- Normally you will begin physical therapy the day after surgery, and within days you can walk with a walker, cane, or crutches.
Risks
Infection: A small number of people can develop an infection with a total hip replacement. You may require further surgery to remove the prosthetic components and clean out the joint along with a course of antibiotics lasting 6-8 weeks.
Deep venous thrombosis (DVT): A blood clot (thrombosis) may form in veins of your pelvis, thigh, or leg. After surgery, you will receive blood-thinning medication, usually aspirin or warfarin (Coumadin), to prevent clots from forming.
Pulmonary embolism (PE): An embolism occurs when a clot breaks free and travels to your lungs. An embolism potentially can cause serious respiratory difficulty. The risk of having one is less than 1%.
Bleeding: As with any surgery, you will experience bleeding both during and after the procedure. You often will need a blood transfusion.
Nerve injury: You have a small risk of injuring the nerves that allow sensation and movement of your leg. Often this problem, if it occurs, will go away over time.
Anesthesia: Any type of anesthesia has risks associated with it. Discuss these with your doctor.
Fracture: Other bones may be broken during surgery. These breaks may affect your rehabilitation and require a longer hospital stay.
Dislocation: Your new hip will not move as well as a normal joint and thus can be dislocated more easily. You must be cautious not to sit too low or to cross your legs.
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