What is a hip replacement?
The hip joint is like a "ball-and-socket." The head of the femur (upper leg bone) is the ball, which fits into the socket formed by one of the pelvic bones. This ball-and-socket structure allows us to sit, stand and walk, among other activities.
Hip replacement (arthroplasty) is a surgical procedure to remove diseased parts of the hip joint and replace them with prosthesis (artificial hip). The surgery may be recommended to relieve pain, increase mobility and improve the function of the hip joint.
What conditions are treated with hip replacement surgery?
The most common reason for hip replacement surgery is to treat the "wear and tear" of the hip joint that results from osteoarthritis. Other conditions that might bring about a need for a hip replacement include rheumatoid arthritis, hip injury or bone tumors.
Who should have hip replacement surgery?
Your doctor may recommend a hip replacement if:
- significant hip joint damage is seen on your x-rays
- you have persistent pain
- a joint disability prevents you from doing routine activities
In the past, hip replacement surgery was recommended mostly for people older than 60. That has changed, though, doctors have found that hip replacement surgery can be very successful in younger people (and more active older people), too. Technology advances enable the latest artificial parts to withstand more stress and strain. The success of a hip replacement depends more on a person's overall health and activity level, than his or her age. The average lifespan of a replacement is only 15 to 20 years, though; if the surgery is done at age 50, another hip replacement might be needed later.
Are there people who should not have hip replacement surgery?
Hip replacement may not be the best option for people who suffer from Parkinson's disease or severe muscle weakness because they are more likely than others to damage or dislocate an artificial hip. Someone who is at high risk of infection or in poor health is also less likely to recover successfully from the surgery.
Are there alternatives to having a hip replacement?
Before suggesting hip replacement surgery, your doctor may tell you to try medication, physical therapy, or walking aids such as a cane. If these therapies are not helpful, your doctor might also suggest an osteotomy to relieve pain.
An osteotomy is a corrective surgery that is less extensive than a hip replacement. The procedure can restore the joint to its correct position, which helps distribute weight evenly in the joint. Recovery typically takes six to 12 months. After an osteotomy, however, the hip joint may continue to degenerate and more treatment could be needed.
What does hip replacement surgery involve?
A surgeon will remove the diseased bone and cartilage from your hip joint, while the healthy parts are left intact. Then the surgeon replaces the head of the femur (the ball) and the bony socket with a new, artificial joint. The new hip will move almost like a natural joint.
The surgery generally lasts two to three hours. Sometimes a special glue, or cement, is used to bond the new parts of the hip joint to the existing bone. This is called a "cemented prosthesis." When an uncemented prosthesis is used, the artificial parts are made of porous materials which allow your own bone to grow into it and hold the new parts in place.
A third method the surgeon might use is a "hybrid" joint replacement. In this approach, both cemented and uncemented parts are used.
Is a cemented or uncemented prosthesis better?
An uncemented prosthesis may last longer than a cemented one in some cases. If you ever need another hip replacement, the second operation may be easier, too. The main disadvantage of the uncemented prosthesis is that recovery takes longer. With an uncemented hip replacement, you'll need to limit your activities for up to three months after surgery.
If you have a cemented prosthesis, you may have reduced pain and increased joint mobility right after surgery. This approach is used more often with older, less active people, and for those with osteoporosis.
Talk to your doctor about the advantages and disadvantages of these approaches for your unique situation.
What should you expect after the surgery?
You will not be allowed to move much right after surgery. The doctor prescribes medicine for pain or discomfort. Your hip will probably be braced with pillows or a special device that holds the hip in the correct position while you are in bed. You may be given fluids through an intravenous tube to replace fluids lost during surgery.
A tube may be placed near your incision for draining fluid. You may also be given a catheter (tube) to enable you to urinate until you are able to use the bathroom.
Most people spend three to five days in the hospital after hip replacement surgery. Full recovery may takes from three to six months. Recovery time will depend on the type of surgical procedure performed, your overall health and your progress in physical rehabilitation.
What is recovery and rehabilitation like after a hip replacement?
On the day after surgery or sometimes the same day, therapists will show you exercises that will enhance recovery.
A respiratory therapist may ask you to breathe deeply or cough. These exercises reduce the amount of fluid that may collect in the lungs after surgery. You may also be asked to blow into a device to measure your lung capacity.
A physical therapist may teach you exercises to strengthen the hip, such as contracting and relaxing certain muscles. Because the artificial hip has a more limited range of movement than a healthy hip, the therapist also will show you proper techniques for bending and sitting in ways to prevent injury to the new hip. As soon as one to two days after surgery, you may be able to sit on the edge of your bed, stand and walk with assistance.
What can you do to prepare for hip replacement surgery?
- Find out what to expect before, during and after surgery. Ask your doctor for information, recommended websites and available brochures.
- Ask someone to help you around the house for a week or two when you return from the hospital.
- Arrange for someone to take you to and from the hospital.
- Set up your home and bedside before the surgery. Place everything you need within easy reach. This might include the television remote control, radio, telephone, medicine, tissues, wastebasket, and a pitcher and glass.
- Buy or prepare food ahead of time that can be reheated and served without effort, such as frozen meals or soups.
What can you do to speed your recovery after a hip replacement?
- Follow your doctor's recommendations.
- Work with a physical therapist or other health care professional on a rehabilitation program.
- Your hands and arms will be needed for balance or to use crutches. So, wear an apron or clothes with pockets to help you carry things around the house.
- Get a long-handled "reacher" to turn on lights or grab things that are beyond arm's reach. A physical therapist can tell you where to obtain one.
What complications could occur after hip replacement surgery?
About 120,000 hip replacement surgeries are performed each year in the United States. Fewer than 10 percent of patients require further surgery. Hip replacements are far less risky today with new technology and advances in surgical techniques.
The most common complication after surgery is a hip dislocation. Because the artificial ball and socket are smaller than normal ones, the ball can become dislodged from the socket if the hip is moved in certain positions. Pulling the knees up to the chest could cause this. Less common problems after the operation include infection, blood clots and bone growth beyond normal edges.
Later on, you could have an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. This inflammation could trigger the action of cells that eat away some of the bone; this causes the implant to loosen. To treat this complication, your doctor may prescribe anti-inflammatory medications or recommend revision surgery.
What types of exercise are best if you've had a total hip replacement?
Exercise can help to relieve joint pain and stiffness, and increase flexibility and muscle strength. If you have an artificial hip or are about to get one, talk to your doctor about an appropriate exercise program. Your doctor may also refer you to a physical therapist for this advice.
Most exercise programs begin with easy activities to improve your range of motion and strengthen your muscles. Your doctor or physical therapist will tell you when you can attempt more demanding activities.
You may be told to avoid high-impact activities, such as basketball, jogging and tennis. These activities could damage your new hip or cause parts of it to loosen.
Instead, exercises such as cross-country skiing, swimming, walking and stationary bicycling are recommended as safer. These exercises can help improve muscle strength and cardiovascular fitness without injuring your new hip.
When is revision surgery necessary?
More than 90 percent of people who have hip replacement surgery will not need a second hip surgery. After 15 to 20 years, though, the joint surface can wear away. Because more people at younger ages are having hip replacements, revision surgery is more common today. The second surgery is harder than the first hip replacement, however, and the outcome is usually not as good.
Revision surgery might be advised:
- if medication and lifestyle changes do not relieve pain and disability
- if x-rays of the hip show that damage has occurred to the artificial hip that must be corrected
- if there is a fracture, infection or dislocation of the artificial parts
This article was reviewed and updated June 2007.
|
)
