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Hip

Hip Replacement

If your hip has been damaged by arthritis, a fracture or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.

If medications, changes in your everyday activities, and the use of walking aids such as a cane are not helpful, you may want to consider hip replacement surgery. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.

First performed in 1960, hip replacement surgery is one of the most important surgical advances of the last century. Today, more than 193,000 total hip replacements are performed each year in the United States.

How the Normal Hip Works
The hip is one of your body’s largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint. Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.

The hip is one of your body’s largest weight-bearing joints. It consists of two main parts: a ball at the top of your thighbone that fits into a rounded socket in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint. Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.

Common Causes of Hip Pain and Loss of Hip Mobility
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

The most common cause of chronic hip pain and disability is arthritis. are the most common forms of this disease.

Is Hip Replacement Surgery For You?
The decision whether to have hip replacement surgery should be a cooperative one between you, your family, your primary care doctor, and your orthopedic surgeon. Although many patients who undergo hip replacement surgery are age 60 to 80, orthopedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability and general health status, not solely on age.

You may benefit from hip replacement surgery if:

  • Hip pain limits your everyday activities such as walking or bending.
  • Hip pain continues while resting, either day or night.
  • Stiffness in a hip limits your ability to move or lift your leg.
  • You have little pain relief from anti-inflammatory drugs or glucosamine sulfate.
  • You have harmful or unpleasant side effects from your hip medications.

Other treatments such as physical therapy or the use of a gait aid such as a cane don’t relieve hip pain.
Orthopedic Evaluation

  • A medical history, in which your orthopedic surgeon gathers information about your general health and asks questions about the extent of your hip pain and how it affects your ability to perform every day activities.
  • A physical examination to assess your hip’s mobility, strength and alignment.
  • X-rays to determine the extent of damage or deformity in your hip.
  • Occasionally, blood tests or other tests such as a Magnetic Resonance Imaging (MRI) or a bone scan may be needed to determine the condition of the bone and soft tissues of your hip.

Your orthopedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options such as medications, physical therapy or other types of surgery also may be considered.

What to Expect From Hip Replacement Surgery
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.

Following surgery, you will be advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life. You may be asked to avoid specific positions of the joint that could lead to dislocation.

Even with normal use and activities, an artificial joint (prosthesis) develops some wear over time. If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.

Surgical Procedure
The surgical procedure takes a few hours. Your orthopedic surgeon will remove the damaged cartilage and bone, then position new metal, plastic or ceramic joint surfaces to restore the alignment and function of your hip.

Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic or metal, which may have an outer metal shell).

Special surgical cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint.

A non-cemented prosthesis has also been developed which is used most often in younger, more active patients with strong bone. The prosthesis may be coated with textured metal or a special bone-like substance, which allows bone to grow into the prosthesis.

 

Your Stay in the Hospital
You will usually stay in the hospital for a few days. After surgery, you will feel pain in your hip. Pain medication will be given to make you as comfortable as possible.

To protect your hip during early recovery, a positioning splint, such as a V-shaped pillow placed between your legs, may be used.

Walking and light activity are important to your recovery and will begin the day of or the day after your surgery. Most hip replacement patients begin standing and walking with the help of a walking support and a physical therapist the day after surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.

Possible Complications After Surgery
The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2 percent of patients. Major medical complications, such as heart attack or stroke, occur even less frequently.

Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. Your orthopedic surgeon may prescribe one or more measures to prevent blood clots from forming in your leg veins or becoming symptomatic.

How Your New Hip is Different
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time and most patients find these are minor compared to the pain and limited function they experienced prior to surgery.

Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated. You may ask your orthopedic surgeon for a card confirming that you have an artificial hip.

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