Total hip replacement is a surgical operation where the hip joint is replaced with a prosthesis, or artificial implant. This surgery has been performed by orthopedic surgeons for over fifty years and continual advancements make this an effective option for those suffering from a damaged hip joint.
The hip joint is one of the largest weight-bearing joints in the body. It is a “ball and socket” construct in which the round head of the femur (thigh-bone) connects with the acetabulum of the pelvis. The ends of the bones are covered with a smooth, soft tissue called cartilage that allows effortless motion through the hip. The joint is surrounded by soft tissue, muscles, and a capsule that provide stability and leg movement.
The most common cause of a damaged hip joint is arthritis. Patients will present with progressive groin pain and stiffness. Movements at the hip become more painful and difficult. This occurs when the cartilage begins to wear away over time, causing the “ball and socket” to rub together leading to joint damage.
- Osteoarthritis: cartilage wear and tear as we age. Risk factors include age (greater than 50 years old) and family history of arthritis. As cartilage deteriorates, the bone becomes rough and will grind in the joint.
- Inflammatory Arthritis: A chronic disease, most common is rheumatoid arthritis, where the surrounding joint tissue becomes inflamed and can progress to cartilage injury and painful joint.
- Fracture: A break in the bone can occur from a bad fall or serious injury to the hip. If the bone does not heal properly or the cartilage becomes damaged, the joint may wear down.
- Necrosis: An injury to the hip, such as a fracture or dislocation, can disrupt the blood supply to the bone. This can lead to bone decay and collapse, resulting in arthritis. Other causes of necrosis include long-term use of alcohol or steroids, certain chronic diseases, and chemotherapy. Sometimes, the cause is unknown.
Your physician will discuss your history and symptoms and evaluate your hip joint. X-rays of the hip will be ordered to assess for any joint damage and arthritis. Sometimes, MRIs are ordered to look for other causes of your hip symptoms.
For patients with mild complaints such as occasional hip pain, those who are still performing daily activities without much difficulty, and patients who are not ready for surgery, nonsurgical treatment may be discussed. Some patients will benefit from anti-inflammatory medication, physical therapy, and activity modification. Younger individuals may benefit from delaying surgery, as the hip implants can wear out and may require additional surgery years later to replace the worn artificial material.
Your surgeon will discuss if a total hip replacement is an option for you and review outcomes, risks, and potential complications of surgery. During a total hip replacement surgery, an incision is made around the hip joint along the side or in front of the hip. The damaged ball is removed and the socket (acetabulum) is prepared. A metal stem is then inserted into the hollow thigh bone and a ball is attached to this prosthesis. A metal cup is inserted into the socket. The prosthesis may or may not be cemented in. Finally, the new ball and socket are joined and the surrounding tissue is closed around the hip joint. The incision is closed with staples or stitches and a bandage will be applied. After surgery, you will go to the recovery area. Most patients will stay in the hospital for a few days after surgery. A foam wedge or pillows may be placed between your legs to keep your hip in position for healing. Physical therapy often begins the same day as surgery or the next day to begin walking and learn proper strengthening exercises and range of motion precautions.
Total hip replacement risks and complications include: blood clots, infection, dislocation of the joint, blood vessel or nerve injury, and implant wear and loosening.
After the surgery, activity precautions to protect your new hip will be reviewed to allow proper healing. Total hip replacement surgery is a successful surgery to remove all or most hip pain due to arthritis. It is important to discuss the risks of the surgery and expectations after the procedure with your doctor.