In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage are removed and replaced with prosthetic components. Arthritis damage is the most common reason to need a hip replacement.
The damaged femoral head and socket is removed and replaced with a metal or ceramic ball and metal socket.
This artificial joint (prosthesis) helps reduce pain and improve function.
Why THR is Done?
Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:
- Osteoarthritis
- Rheumatoid arthritis
- Osteonecrosis (AVN or Avascular necrosis of hip).
You might consider hip replacement if you have hip pain that:
- Persists, despite pain medication
- Worsens with walking, even with a cane or walker
- Interferes with your sleep
- Makes it difficult to get dressed
- Affects your ability to go up or downstairs
- Makes it difficult to rise from a seated position
Realistic Expectations
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, hip replacements can last for many years.
Risks Involved
Risks associated with hip replacement surgery can include:
- Blood clots
- Infection. Infections can occur at the site of your incision and in the deeper tissue near your new hip. Most infections are treated with antibiotics, but a major infection near your prosthesis might require surgery to remove and replace the prosthesis.
- Fracture
- Dislocation. Certain positions can cause the ball of your new joint to come out of the socket, particularly in the first few months after surgery.
- Change in leg length.
- Nerve damage. Rarely, nerves in the area where the implant is placed can be injured.
How You Prepare
Before surgery, you’ll meet with your orthopedic surgeon for an exam. The surgeon will:
- Ask about your medical history and current medications
- Examine your hip, paying attention to the range of motion in your joint and the strength of the surrounding muscles
- Order blood tests, and an X-ray. An MRI is rarely needed
During this preoperative evaluation is a good time for you to ask questions about the procedure. Be sure to find out which medications you should avoid or continue to take in the week before surgery.
During The Procedure
The surgical procedure takes a few hours. Techniques for hip replacement are constantly evolving. Surgeons continue to develop less invasive surgical techniques, which might reduce recovery time and pain.
After The Procedure
After surgery, you’ll be moved to a recovery area for a few hours while your anesthesia wears off. Medical staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.
Blood Clot Prevention
After your surgery, you’ll be at an increased risk of blood clots in your legs. Possible measures to prevent this complication include:
- Moving early.
- Applying pressure
- Blood-thinning medication. Your surgeon might prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are, and your overall risk of blood clots, you might need blood thinners for several weeks after surgery.
Physical Therapy
Your rehabilitation will begin within 24 hours after surgery. Most hip replacement patients progress to walking with a cane, walker, or crutches within a day or two after surgery. As the days progress, you will increase the distance and frequency of walking.
- Your recovery will begin directly following surgery in the Post-Anesthesia Care Unit (PACU), where your medical team will manage your pain and monitor your vital signs.
- Once the anesthesiologist is satisfied with your condition, you will be moved to an inpatient recovery room to monitor your progress.
- You will most likely have a dressing and tube on your hip for drainage, which should be removed the day after surgery.
- The pain management team will assess your medication and use a multifaceted approach to ensure comfort and mobility during the rehabilitation process.
- You will begin rehabilitation with a physical therapist within 24 hours. Your therapist will help you sit up, get in and out of bed, and practice walking and climbing stairs using a walker, cane or sometimes crutches.
- You will then continue physical therapy outside the hospital for 6 to 8 weeks. After that period, most patients are able to do everyday activities and return to playing sports.
Results
Expect your new hip joint to reduce the pain you felt before your surgery and increase the range of motion in your joint. But don’t expect to do everything you could do before the hip became painful.
High-impact activities — such as running or playing basketball — might be too stressful on your artificial joint. But in time, you might be able to swim, play golf, hike or ride a bike comfortably.
Questions Related to Hip Replacement
How do you know if you need a hip replacement?
If you have these arthritis symptoms, you should consider a hip replacement:
- severe hip pain that is not relieved by medication and that interferes with your work, sleep or everyday activity
- hip stiffness that restricts motion and makes it difficult to walk
Healthy Hip Versus Arthritic Hip
The hip is a ball-and-socket joint. The ball, at the top of your femur (thighbone), is called the femoral head. The socket, called the acetabulum, is a part of your pelvis. The ball moves in the socket, allowing your leg to rotate and move forward, backward, and sideways.
In a healthy hip, soft tissue called cartilage covers the ball and the socket to help them glide together smoothly. If this cartilage wears down or gets damaged, the bones scrape together and become rough. This condition, known as osteoarthritis, causes pain and restricts motion. An arthritic hip can make it painful for you to walk or even to get in or out of a chair. If you have been diagnosed with hip arthritis, you may not need surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or physical therapy may provide relief. But, if these efforts do not relieve symptoms, you should consult an orthopedic surgeon. X-ray of a total hip replacement showing the ball, socket and stem implants.
How Long Do Hip Implants Last?
Generally speaking, a hip replacement prosthesis should remain effective for between 10 and 20 years, and some can last even longer.
Results vary according to the type of implant and the age of the patient. When a hip implant does need to be replaced because it has loosened or worn out over time, this requires what is called hip revision surgery.
Frequently Asked Questions About Hip Replacement Surgery
What Are Hip Implants Made Of?
There are three separate implants: the stem, the ball, and the socket.
- The stem, made out of metal (usually titanium or cobalt-chrome) is inserted into your natural thighbone.
- The ball is usually made out of polished metal or ceramic and fits on top of the stem.
- The socket is usually a combination of a plastic liner and a cobalt-chrome or titanium backing.
Dr. Prateek Goyal at SDMH has one of the lowest rates of infection for hip replacement surgery, as well as a significantly lower rate of readmission compared to the national average. SDMH also performs more hip and knee replacements than many other hospitals in Rajasthan and is ranked the No. 1 hospital for orthopedics in the Rajasthan.
The success rate for hip replacement surgery at SDMH is very high.