FAQ Hip Replacement
- Foot & Ankle
- Joint Replacement & Reconstruction
- Physical Medicine & Rehabilitation
- Musculoskeletal Oncology
- Pain Management
- Rehabilitation Services
- Shoulder & Upper Extremity
- Sports Medicine
Who should have hip replacement surgery?
The most common reasons people have hip replacement surgery are pain, limited mobility and decreased ability to do daily activities. Pain results from the wearing down of the hip joint that is caused by osteoarthritis. Other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness and swelling), avascular necrosis (loss of bone caused by insufficient blood supply), injury and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
Before suggesting hip replacement surgery, the doctor is likely to try walking aids such as a cane, or nonsurgical therapies such as medication and physical therapy. These therapies do not always help relieve pain and improve the function of the hip joint. Hip replacement surgery may be an option if persistent pain and disability interfere with daily activities. Before a doctor recommends hip replacement surgery, joint damage should be seen on X-rays.
In the past, hip replacement surgery was an option primarily for people over 60 years of age. Typically, older people are less active and put less strain on the artificial hip than do younger, more active people. In recent years, however, doctors have found that hip replacement surgery can be very successful in younger and more active people. New technology has improved the artificial parts, allowing them to withstand more stress and strain. A more important factor than age in determining the success of hip replacement is the overall health and activity level of the patient.
What are alternatives to total hip replacement?
Before considering a total hip replacement, the doctor may try other methods of treatment, such as an exercise program, weight loss and medications. An exercise program can strengthen the muscles in the hip joint and help relieve pain.
The doctor may also treat inflammation in the hip with nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen.
In a small number of cases, the doctor may prescribe corticosteroids, such as prednisone or cortisone. Cortisone can be injected into the joint or taken in pill form (i.e., prednisone). Cortisone injections can greatly reduce pain in the joint but, only for a limited time.
Another treatment option is visco supplementation. In this treatment, a lubricant is injected into the joint to try and improve function and reduce pain. This usually requires a series of three to five injections (Synvisc or Hyalgan). This is a temporary treatment.
If physical therapy and medication do not relieve pain and improve joint function, the doctor may suggest corrective surgery that is less complex than a hip replacement, such as an osteotomy. Osteotomy is surgical repositioning of the joint. The surgeon cuts away damaged bone and tissue and restores the joint to its proper position. The goal of this surgery is to restore the joint to its correct position, which helps to distribute weight evenly in the joint. For some people, an osteotomy relieves pain. Recovery from an osteotomy can take six months to a year. After an osteotomy, the hip joint may continue to worsen and the patient may need additional treatment. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure.
What does hip replacement surgery involve?
The hip joint is located where the upper end of the femur meets the acetabulum. The femur, or thigh bone, looks like a long stem with a ball on the end. The acetabulum is a socket or cup-like structure in the pelvis, or hip bone. This "ball and socket" arrangement allows a wide range of motion, including sitting, standing, walking and other daily activities.
During hip replacement, the surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural, gliding motion of the joint. Hip replacement surgery usually lasts one to two hours.
Sometimes the surgeon will use a special cement to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a "cemented" procedure. In an uncemented procedure, the artificial parts are made of porous material that allows the patient's own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a "hybrid" replacement, which consists of a cemented femur part and an uncemented acetabular part.
Is a cemented or uncemented prosthesis better?
Research has proven the effectiveness of cemented and uncemented prostheses to reduce pain and increase joint mobility. These results are usually noticeable right after surgery. Cemented replacements are more frequently used than cementless ones for older (70+ years), less active people and people with weak bones, such as those who have osteoporosis.
Cemented prostheses were developed 40 years ago and work quite well. Because each person's condition is unique, the doctor will weigh the pros and cons to decide which type of prosthesis is best for that patient.
What can be expected immediately after surgery?
Patients are allowed only limited movement immediately after hip replacement surgery. When the patient is in bed, the hip usually is braced with pillows or a special device that holds the hip in the correct position. The patient may receive fluids through an IV tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid, and a tube (catheter) may be used to drain urine until the patient is able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.
How long are recovery and rehabilitation?
Within a day of surgery, therapists will teach the patient exercises that will improve recovery. A respiratory therapist may ask the patient to breathe deeply, cough or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.
A physical therapist may teach the patient exercises, such as contracting and relaxing certain muscles, that can strengthen the hip. Because the new, artificial hip has a more limited range of movement than a healthy hip, the physical therapist may teach the patient proper techniques for simple daily activities, such as bending and sitting, to prevent injury to the new hip. As early as one to two days after surgery, a patient may be able to sit on the edge of the bed, stand and even walk with help.
Usually, people spend about three to four days in the hospital after hip replacement surgery. Full recovery from the surgery takes about three to six months, depending on the type of surgery, the overall health of the patient and the success of rehabilitation.
What are possible complications of hip replacement surgery?
According to the American Academy of Orthopaedic Surgeons, about 200,000 total hip replacement operations are performed each year in the United States and less than 10 percent require further surgery. New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.
The most common problem that may happen soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest.
The most common long-term complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the body. The inflammation may trigger the action of special cells that remove some of the bone, and may eventually cause the implant to loosen. To treat this, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Scientists are experimenting with new materials that last longer and cause less inflammation.
Acute complications of hip replacement surgery include infection, blood clots and blood loss during surgery.
When is revision surgery necessary?
Hip replacement is one of the most successful orthopedic surgeries performed. More than 90 percent of people who have hip replacement surgery have lasting pain relief and will never need revision surgery. However, because more younger people are having hip replacement surgery, and wearing away of the joint surface becomes a problem after 15 to 20 years, revision surgery is becoming more common. Revision surgery is harder than first-time hip replacement surgery, and the outcome is generally not as good, so it is important to explore all options before having additional surgery.
Doctors consider revision surgery for two reasons: If medication and lifestyle changes do not relieve pain and disability, or if X-rays of the hip show that damage has occurred to the artificial hip that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces or joint loosening shows up on an X-ray. Other possible reasons for revision surgery include fracture, dislocation of the artificial parts and infection.
What types of exercise are best for someone with a total hip replacement?
Proper exercise can reduce joint pain and stiffness, and increase flexibility and muscle strength. People who have an artificial hip should talk to their doctor or physical therapist about developing an appropriate exercise program. Most exercise programs begin with safe range-of-motion activities and muscle-strengthening exercises. The doctor or therapist will decide when the patient can move on to more demanding activities. Most doctors recommend avoiding high-impact activities, such as basketball, jogging and tennis. These activities can damage the new hip or cause it to become loose. Some recommended exercises are cross-country skiing, swimming, walking and stationary bicycling. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.
What hip replacement research is being done?
To help avoid problems, researchers are studying the types of patients most likely to benefit from a hip replacement. Researchers are also developing new surgical techniques, materials, and prostheses designs, and studying ways to reduce the inflammatory response of the body to the prosthesis. Other areas of research include recovery and rehabilitation programs, such as home health and outpatient programs.