Definition & Overview

Total hip replacement surgery, also known as arthroplasty, is a medical procedure that involves the removal of a diseased hip joint and replacing it with an artificial prosthetic joint or implant, often made of hard plastic and metal components. The new prosthetic joint restores hip function and helps reduce pain caused by conditions such as arthritis.

Hip replacement surgery is considered as one of the breakthrough procedures in orthopedic surgery. It can be successfully performed across all ages, from young teenagers with juvenile arthritis to elderly patients with degenerative arthritis.

Who Should Undergo and Expected Results

Total hip replacement is often recommended to treat progressively worsening cases of severe forms of arthritis involving the hip joint. Most cases are performed for degenerative arthritis (osteoarthritis), a condition linked to aging, trauma and congenital abnormality. Patients with rheumatoid arthritis, osteonecrosis (inadequate blood supply) of the hip bone, systemic diseases (including lupus erythematosus) and bone fractures that affect the hip can also undergo the procedure.

Patients who are recommended for total hip replacement are usually those who experience progressively severe chronic pain that leads to the impairment of normal body functioning. It is an elective procedure and can be considered for those who experience pain that:

  • Persists even with pain and anti-inflammatory medications
  • Interferes with regular sleep
  • Worsens when walking and climbing the stairs, even with the use of a walker or cane
  • Makes sitting and rising from seated position very difficult

As for the expected results, patients will be able to slowly restore movements mentioned above once they fully recover from the surgery. They can also expect long-lasting pain relief. However, even after complete healing, sports and certain strenuous activities have to be avoided, as hip replacement surgery is only sought to restore day-to-day activity.

Among realistic activities that can be performed after hip surgery include walking, driving, swimming, playing golf, biking, dancing, and low-impact sports.

How is the Procedure Performed?

Prior to performing total hip replacement surgery, your orthopedic surgeon will perform a general physical examination, blood tests, X-ray and even an MRI to ensure that you are healthy to undergo the procedure and to check whether the joints and surrounding muscles are fit for hip replacement.

The surgery can be performed using traditional surgical techniques or minimally invasive method, the difference of which lies in the size of the incision made. The procedure takes a few to several hours.

In a traditional hip replacement surgery, a general anesthesia is required. The surgeon makes an 8-10 inch cut along the side of the affected hip and moves the underlying muscles to expose the hip joint. The ball-like part of the thighbone and other damaged structures are removed, and an artificial joint is attached using a special adhesive that allows the new structure to fuse with the rest of the thighbone.

The same procedure is performed when using minimally invasive method, but a shorter incision (usually 2-5 inches long) is made. This allows for less blood loss, reduced pain and scarring, shorter hospital stay, and faster healing process.

Possible Risks and Complications

After surgery, patients are closely monitored to ensure that complications will not arise. Significantly reduced mobility can be expected right after the procedure and physical therapy will commence within a few days and will continue for weeks or months to help restore normal hip function.

Risks associated with hip replacement surgery include the following:

  • Blood clotting - Clots can form in the leg veins following the procedure. To prevent this complication, blood-thinning medications are usually prescribed.
  • Infection - The risk of infection is present as with any type of surgery, specifically on the incision site and the tissues underneath. Should this occur, antibiotics are prescribed for minor cases, while major infection would usually require another surgical procedure to replace the prosthesis.
  • Bleeding - There is some degree of bleeding in hip replacement surgery, so preparation for a blood transfusion is always recommended prior to the procedure.
  • Fracture - Fractures can occur in healthy parts of the hip joint. While most fractures heal over time, some cases are treated using metal structures or bone grafts.
  • Dislocation - This complication occurs when the prosthetic ball comes out of the socket. Depending on the severity, dislocation may be easily repaired without the need for another surgery.
  • Change in length of leg - There are cases when the newly installed hip prosthesis would make one leg shorter or longer than the other to maximize stability and hip biomechanics. Should this happen, progressive stretching and strengthening can help restore normal leg proportion.

Although effective in treating chronic hip conditions, the newly installed prosthetic hip joint can eventually wear out and loosen after several years. This is due to everyday activities and physiological thinning of the bone (osteolysis). When this occurs, a second hip replacement or revision surgery can be recommended.

References:

  • Goldman L, et al. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com.

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

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