Total Hip Replacement Overview

Total Hip Replacement Demand Grows Along With Number of Arthritis Patients

Orthopaedic surgeon and nurse with replacement hip stem
Getty Images/Monty Rakusen

The first total hip replacement was devised in 1962 by Sir John Charnley of England. The first FDA-approved total hip replacement was implanted in 1969. Joint replacement was one of the most important orthopedic surgical advances of the 20th century. Every year in the United States alone, more than 285,000 hip replacements are performed, and the number is expected to double to about 573,000 by the year 2030, according to the March 6, 2008 issue of Time.

The traditional total hip replacement prosthesis, which replaces your damaged hip joint, consists of three parts:

  • A plastic cup that replaces your acetabulum (hip socket)
  • A metal ball that replaces the femoral head
  • A metal stem that is attached to the shaft of the femur

There are also ceramic hip replacements and other alternatives to the total hip replacement -- for example, the Birmingham Hip Resurfacing System.

Who Needs a Hip Replacement?

Normal hip function is needed for mobility and to perform almost all of your usual daily activities. If your hip has been injured or if it is painful due to arthritis, you may find it difficult to perform daily activities without mobility aids. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the three most common types of arthritis that cause hip pain.

The decision to have hip replacement surgery should be made with your family, primary care physician, an orthopedic surgeon. Consider the following. Do you have:

  • Hip pain that interferes with usual activities involving walking and bending?
  • Hip pain that persists when resting during the day or night?
  • Joint stiffness in the hip that affects moving or lifting your leg?
  • Unsatisfactory relief from NSAIDs (nonsteroidal anti-inflammatory drugs)?
  • Unsatisfactory relief from pain medications?
  • Inadequate improvement after having tried physical therapy, the use of assistive devices and mobility aids?

If you answered yes to most or all of the questions, you may be a candidate for total hip replacement surgery.

How Is an Individual Patient Evaluated for Hip Replacement?

While many patients who undergo total hip replacement surgery are between 60 and 80 years old, there are patients younger and older that have successful outcomes. Age is not the sole criteria when patients are evaluated for hip replacement surgery; the level of pain and disability, and general health are also considerations.

An evaluation for hip replacement surgery includes:

  • Your medical history
  • A physical examination to assess the hip range of motion, hip alignment, and hip stability and strength
  • X-rays to determine joint damage

Other imaging studies or bone scans are sometimes used to assess the condition of the bone and soft tissues of the hip.

Are Your Expectations About Hip Replacement Realistic?

Patients who are planning for hip replacement surgery must fully understand what to expect before, during, and after surgery. Initially and throughout recovery, the patient should be focused on the primary goals of surgery -- pain relief and improved function of the hip (regaining strength and better range of motion).

During the 3 months of recuperation, there will be some restrictions to prevent dislocation of the new prosthesis. You will be taught how to move and how you should not move. You may need assistive devices such as a raised toilet seat, long-handled reachers, dressing stick, sock aid, and firm cushions. Some restrictions will be temporary and others permanent.

Certain activities, such as jogging, running, jumping sports, contact sports, and high-impact aerobics will be off-limits after surgery and for the rest of your life. But even with normal use, over time the hip prosthesis develops wear and can loosen. If that happens, you would need another surgery, called revision hip replacement.

Are You Prepared for Surgery?

Your orthopedic surgeon and his staff will guide you through their normal routine for hip replacement surgery. They will assign you a surgery date and give you a schedule for what should be done prior to surgery, from checking medical insurance to pre-op testing to autologous blood donation if needed.

Once everything is in order for pre-surgical matters, you will be given information about what to expect during surgery. You will learn about your options for anesthesia, how long the surgery will take, how long you can expect to be in the hospital, and discharge planning. After surgery or post-op, you will be given rehabilitation instructions or home-going instructions.

What Are Possible Complications of Hip Replacement?

According to the American Academy of Orthopaedic Surgeons, the complication rate for total hip replacement surgery is low. Fewer than 2% of patients serious complications, such as joint infection. Following hip replacement surgery, blood clots in the leg veins or pelvis are the most common complication. There are treatments your doctor can prescribe to prevent blood clots or deal with them if they do form.

Some patients experience leg-length inequality after hip surgery. Shoe inserts may be required to even out the leg length. Other complications can include:

  • Dislocation
  • Nerve or blood vessel injury
  • Bleeding
  • Fracture
  • Some stiffness or residual pain

Points to Remember About Hip Replacement

After having a total hip replacement, be conscious of certain important aspects of your recovery:

  • Do your post-op exercises as instructed by your physical therapist.
  • Balance rest and activity, especially until some restrictions are lifted by your doctor.
  • Follow instructions to prevent blood clots. If you are told to wear support hose, wear the support hose.
  • Know and recognize the signs of infection.
  • Get rid of throw rugs or extension cords that may provoke a fall.
  • No cheating; follow doctor's orders. If you are told to do something, there is a sound reason for it.
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