Hip Replacement

Definition

A total hip replacement is a surgery to replace a diseased or injured hip joint. An artificial ball-and-socket joint is inserted to make a new hip.

A minimally invasive total hip replacement is also a surgery to replace a diseased or injured hip joint. This surgery only requires one or two tiny incisions and special instruments. People eligible for this surgery are typically:

Younger than 50
Of normal weight
Healthier than those who have the traditional total hip replacement surgery

Left Total Hip Replacement

Reasons for Procedure

This surgery is done when pain and stiffness limit your normal activities. This pain and stiffness is usually due to osteoarthritis. Surgery is done when other treatments have been tried and are no longer working. These other treatments include rest, medicine, and physical therapy.

Other reasons for surgery may include a broken hip, rheumatoid arthritis, bone tumors, and loss of blood supply to the bones of the hip.

Possible Complications

If you are planning to have a hip replacement, your doctor will review a list of possible complications, which may include:

Hip dislocation , which is the most common complication—occurs when the ball portion of the prosthesis dislocates from its normal position in the hip
Infection
Blood clots
Swelling or bleeding
Injury to nearby nerves or blood vessels
Anesthesia-related problems, like pneumonia
Noisy or squeaky hip after surgery

Factors that may increase the risk of complications include:

Pre-existing medical condition, such as heart or lung problems
Obesity
Infection, such as urinary tract infection or gum disease—Having an infection increases the risk of bacteria entering the bloodstream and infecting the joint.
Previous problems with blood clots
Smoking

Be sure to discuss these risks with your doctor before the surgery.

What to Expect

Prior to Procedure

Your doctor may do the following:

In the time leading up to the procedure:

Try to lose weight if you are overweight. This will decrease the amount of stress on your new joint. Pool exercise may be a good option.
To enhance safety and recovery, make home modifications:
- Install safety bars, a raised toilet seat, a shower bench, and a hose. Install handrails on stairways and steps.
- Remove throw rugs. Check to make sure extension cords are in a safe place.
- Purchase a stable, firm-backed arm chair. When seated, your knees should remain lower than your hips.
- Buy items to make daily activities easier, such as reachers and dressing aids.
- Place items so that they are easy to reach. This way, you will be able to avoid bending.
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs
- Blood thinners
Your doctor may suggest donating your own blood for the surgery. You will most likely lose some blood and fluid during this surgery. If you need a blood transfusion, the doctor can use your own blood.
If you become sick or have a fever just before the surgery, tell your doctor right away.
Arrange for a ride to and from the hospital. Also, arrange for help at home.
If you smoke, try to smoke less or stop smoking.
Eat a light meal the night before the surgery. Do not eat or drink anything after midnight. If you have diabetes, ask your doctor if you will need to adjust your medicine.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

Description of the Procedure

Total Hip Replacement

An incision will be made along your joint. The muscles will be moved aside. The damaged bone and cartilage of the hip joint will be removed. The remaining bone will be prepared for the prosthesis. The new artificial joint will be placed in position. Depending on the type of prosthesis, the doctor may use bone cement to hold one or both parts of the artificial hip firmly to your bone. Lastly, the incision will be closed with stitches or staples.

Minimally Invasive Total Hip Replacement

This surgery may be done with one or two small incisions. Special tools are used that fit into these small incisions. In some cases, x-rays will be used to help guide the doctor.

For the one-incision surgery, an incision will be made over the outside of your hip. The muscles and tendons will be moved out of the way. Next, the damaged bone and cartilage of the hip joint will be removed. The remaining bone will be prepared for the prosthesis. The new artificial joint will then be placed in position. Depending on the type of prosthesis, bone cement may be used to hold the artificial hip in place. Lastly, the incision will be closed with staples or stitches.

In a two-incision surgery, an incision will be made over the groin and another over the buttock. The above process will then be followed.

Placement of Prosthesis

Placement of Prosthesis

How Long Will It Take?

Total hip replacement: 1-1½ hours
Minimally invasive total hip replacement: 1 or more hours

How Much Will It Hurt?

You will have pain after the surgery. Pain medicine will be given to help with discomfort.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is:

4-6 days for a total hip replacement
1-2 days for minimally invasive total hip replacement

Your doctor may choose to keep you longer, if complications occur. In some cases, you may need to stay in a rehabilitation unit. The focus will be on regaining function.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may need to:

Walk with help, using a walker, on the day after surgery.
Be careful. A fall can damage or dislocate the new joint. Do not try to walk without help.
Take medicine to prevent blood clots.
Wear compression boots or stockings.
Begin physical therapy to regain mobility and strength.
Breathe deeply and cough 10-20 times every hour—This will decrease the risk of fluid build-up in the lungs. The fluid can cause pneumonia.

At Home

When you return home, do the following to help ensure a smooth recovery:

Keep the incision area clean and dry.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
When seated, place a V-shaped pillow between your legs. This will help you to maintain correct positioning of your hip.
Work with the physical therapist. You will learn how to move your hip and maintain proper alignment. You should also talk to your doctor and physical therapist about ways to prevent dislocations. Depending on your surgery, you may need to avoid crossing your legs, flexing your hips more than 90 degrees, and turning your feet very far inward or outward.
Only take medicines recommended by your doctor. Do not take over-the-counter remedies without your doctor's approval.
Inform your dentist of your surgery. You may need antibiotics for some dental procedures. This will decrease the risk of bacteria entering the bloodstream and traveling to the prosthesis.
Maintain a healthy weight. Obesity can increase wear on your new joint.
Avoid jogging and other high-impact sports. This can also increase wear on the joint, cause it to loosen, and cause pain.
Be sure to follow your doctor’s instructions.

Within six weeks, you should be able to resume normal, light activities. A replacement hip typically lasts 10-15 years.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occur:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge around incision site
Pain and/or swelling in the feet, calves, or legs
Cough, shortness of breath, chest pain
Severe nausea or vomiting
Hip pain that you cannot control with the medicines you have been given or that becomes worse
Numbness, tingling, or loss of feeling in your leg, knee, or foot

In case of an emergency, call for medical help right away.

RESOURCES

American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

CANADIAN RESOURCES

The Arthritis Society http://www.arthritis.ca

Canadian Orthopaedic Association http://www.coa-aco.org

References

Activities after hip replacement. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00356. Updated April 2009. Accessed May 6, 2013.

Al Muderis M, Bohling U, Grittner U, Gerdesmeyer L, Scholz J. Cementless total hip arthroplasty using the Spongiosa-I fully coated cancellous metal surface: a minimum twenty-year follow-up. J Bone Joint Surg Am. 2011 Jun 1;93(11):1039-1044.

Antibiotic prophylaxis for patients after total joint replacement. American Academy of Orthopaedic Surgeons website. Available at: http://orthodoc.aaos.org/davidgrimmmd/Antibiotic%20Prophylaxis%20for%20Patients%20after%20Total%20Joint%20Replacement.pdf. Published February 2009. Accessed May 6, 2013.

Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl 3):338S-400S.

Hip fracture. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated April 24, 2013. Accessed May 6, 2013.

Lindström D, Azodi, Sadr O, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. AnnSurg. 2008;248:739-745.

Minimally invasive total hip replacement surgery. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00404. Updated August 2007. Accessed May 6, 2013.

Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. Surgical technique. J Bone Joint Surg Am. 2009 Mar 1;91 Suppl 2 Pt 1:50-73.

Questions and answers about hip replacement. National Institute of Arthritis, Musculoskeletal, and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Hip%5FReplacement/default.asp. Updated April 2012. Accessed May 6, 2013.

Skerker RS, Mulford GJ. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Hanley and Belfus; 2002 (chap 56).

Who needs a hip replacement? NIH SeniorHealth website. Available at: http://nihseniorhealth.gov/hipreplacement/whoneeds/01.html. Accessed May 6, 2013.

Revision Information

Reviewer: Lawrence Frisch, MD, MPH; Michael Woods, MD
Review Date: 05/2013 -
Update Date: 05/06/2013 -

Cartersville Medical Center