Who Should Have Hip Replacement Surgery?
Hip replacements are most commonly done for osteoarthritis (wear and tear) and rheumatoid arthritis. It may also be done for avascular necrosis (loss of bone due to inadequate blood supply).
Hip replacement may be an option if persistent pain and disability interfere with daily activities. Before a doctor recommends hip replacement, joint damage should be detectable on x rays.
In the past, hip replacement surgery was an option primarily for people over 60 years of age. Older people are less active and put less strain on the artificial hip ,however, doctors have found that hip replacement surgery can be very successful in younger people as well. New techniques and technology have improved the artificial parts, allowing them to withstand more stress and strain.
What Does Hip Replacement Surgery Involve?
The hip joint is located where the upper end of the thigh bone meets the pelvis. 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. 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 1 to 1.5 hours.
Sometimes the surgeon will use 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?
Cemented prostheses were developed 30 years ago. Uncemented prostheses were developed about 15 years ago to try to avoid the possibility of loosening parts and the breaking off of cement particles, which sometimes happen in the cemented replacement. Because each person's condition is unique, the doctor and patient must weigh the advantages and disadvantages to decide which type of prosthesis is better.
The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, people with uncemented replacements must limit activities for up to 3 months to protect the hip joint. The process of natural bone growth also can cause thigh pain for several months after the surgery.
Research has proven the effectiveness of cemented prostheses to reduce pain and increase joint mobility. These results usually are noticeable immediately after surgery. Cemented replacements are more frequently used than cementless ones for older, less active people and people with weak bones, such as those who have osteoporosis and in patients with rheumatoid arthritis.
What Can Be Expected Immediately After Surgery?
Patients are allowed to get up the day after surgery with the help of a frame or crutches. Generally they will be able to put as much weight through the operated leg as they are comfortable with. The patient may receive fluids through an intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid for about 48 hours Most patients will be provided with patient controlled analgesia where they can press a button on a machine which delivers a set amount of painkiller into their body effectively relieving pain.
How Long Are Recovery and Rehabilitation?
On the day after surgery or sometimes on the 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 an undiseased hip, the physical therapist also will teach the patient proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to the new hip. As early as 1 to 2 days after surgery, a patient may be able to sit on the edge of the bed, stand, and even walk with assistance.
Usually, people do not spend more than 6-7 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 6-12 weeks depending on the type of surgery, the overall health of the patient, and the success of rehabilitation.
How to Prepare for Surgery and Recovery
People can do many things before and after they have surgery to make everyday tasks easier and help speed their recovery.
- Learn what to expect before, during, and after surgery. Request information written for patients from the doctor or contact one of the organizations listed near the end of this fact sheet.
- Arrange for someone to help you around the house for a week or two after coming home from the hospital.
- Arrange for transportation to and from the hospital.
- Set up a "recovery station" at home. Place the television remote control, radio, telephone, medicine, tissues, waste basket, and pitcher and glass next to the spot where you will spend the most time while you recover.
- Place items you use every day at arm level to avoid reaching up or bending down.
- Stock up on kitchen staples and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily.
- Follow the doctor's instructions.
- Work with a physical therapist to rehabilitate your hip.
- Use a long-handled "reacher" to turn on lights or grab things that are beyond arm's length. Hospital personnel may provide one of these or suggest where to buy one.
What Are Possible Complications of Hip Replacement Surgery?
Approximately 80,000 hip replacement operations are performed each year in the United Kingdom 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. Generally the incidence of hip dislocation is no more than 1 % .
Infection can happen in less than 0.5% cases and in sever cases may require further surgery to eradicate the infection. In most severe infections the artificial hip may need to be taken out and a further replacement can only be done after the infection has settled completely.
Clot formation in the calf veins can happen in a small percentage of patients and in rare cases, these clots may travel up to the lungs and cause a heart attack. Special stockings and blood thinning medicines are provided to reduce this complication.
The most common later 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 surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. This problem generally does not arise before 8-10 years.
What Types of Exercise Are Most Suitable for Someone With a Total Hip Replacement?
Proper exercise can reduce joint pain and stiffness and increase flexibility and muscle strength. 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. It is safer to avoid high-impact activities, such as basketball, jogging, and tennis. These activities can damage the new hip or cause loosening of its parts. Some recommended exercises are swimming, walking, and stationary bicycling. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.