Total Hip Replacement-Arthroplasty

Total Hip Replacement (Arthroplasty)

More than 300,000 total hip replacements are performed in the U.S. each year. That number is expected to increase to 500,000 by the year 2030. The hip and knee replacement specialists at Orthopaedics at Rogers Park Surgery perform more of these procedures than any other group in the Chicago area.

Total hip replacement (arthroplasty) is performed when the hip is causing significant pain, a compromised lifestyle and has deteriorated past the point where more conservative procedures might be effective.

During the procedure, the surgeon removes the damaged cartilage along with some bone and replaces this with an artificial hip joint (prosthesis). The prosthesis consists of two parts; a round ball (femoral head – secured into the center of the upper femur with a stem), which rests in the cup-like acetabular component (socket) placed in the pelvis.

Total Hip Replacement Overview (video length 1:49 min)

Common Causes of Hip Pain

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.

  • Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
  • Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed “inflammatory arthritis.”
  • Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
  • Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis (also commonly referred to as “osteonecrosis”). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.
  • Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
WHO IS A CANDIDATE?

Ninety percent of the hip replacement patients have osteoarthritis. This occurs when the cartilage that lines the hip’s ball-and-socket joint deteriorates, often due to progressive wear-and-tear. As healthy cartilage deteriorates, the bone rubs against bone, which causes pain.

The remaining ten percent of patients require hip replacements due to other types of arthritis, bone tumors, trauma and other conditions, such as osteonecrosis.

Children are not candidates for hip replacements because their bones are still growing. While doctors recommend children wait until age 18, occasionally younger individuals may require hip replacement.

WHAT ARE THE DIFFERENT WAYS TO PERFORM A TOTAL HIP REPLACEMENT?

As part of a hip replacement surgery, a surgeon will need to access the hip joint to replace the ball and socket. There have been many different surgical approaches described for accessing the hip joint and surgeons use different surgical approaches based on their own experience and preferences.

Basically, there are two ways of performing hip replacements – via the posterior and anterior approach. The posterior approach involves entering the hip socket from the back (posterior) of the hip area. During the anterior approach to surgery, the doctor enters through the front of the hip area.

There are advantages and disadvantages to both approaches. However, the most important aspect of a surgical approach to the hip is that it allows the surgeon to safely insert the hip components so that a hip replacement will function well for a long time.

Anterior Approach to the Hip
While popular recently, the anterior approach to hip replacement has been used by qualified surgeons for many years. The main advantage to the anterior approach to hip replacement is that it results in a smaller incision scar and carries a lower risk of dislocation (the hip popping out of the socket). The main disadvantages are a higher risk of damaging the muscles that stabilize the hip joint, which can lead to a limp, and the possibility of a patch of numbness on the thigh. When performed by a skilled surgeon, this approach is compatible with a rapid recovery.

Posterior Approaches to the Hip
The posterior approach is the one used most commonly by surgeons in North America. The main advantages are its simplicity and a lower risk of damaging the muscles that stabilize the hip joint. Its main disadvantage is that it carries a higher risk of dislocation. When performed by a skilled surgeon, this approach is compatible with a rapid recovery

Much of this material may be confusing and it can be controversial among surgeons. All of the Orthopaedics surgeons at Rogers Park Surgery Center have the experience and skill to allow for a rapid and safe recovery with as little pain as possible. They have performed thousands of hip replacements, have trained hundreds of other joint replacement surgeons from across the country and are experts in these procedures.

To determine which approach is best, patients should discuss this issue with their doctor.

Deciding to Have Hip Replacement Surgery

Talk With Your Doctor at Rogers Park Surgery Center. Call us today at 773-761-0500 or contact us online to schedule your appointment.

Your orthopaedic 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.

In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.

Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.

Realistic Expectations

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.

With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.

Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.

With appropriate activity modification, hip replacements can last for many years.

Preparing for Surgery
Medical Evaluation

If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.

Tests

Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.

Social Planning

Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.

If you live alone, your orthopaedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.

Home Planning

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

  • Securely fastened safety bars or handrails in your shower or bath
  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
  • Removal of all loose carpets and electrical cords from the areas where you walk in your home
Your Surgery

You will most likely be admitted to Rogers Park Surgery Center early in the morning on the day of your surgery.

Anesthesia

After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

Implant Components

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 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).

The prosthetic components may be “press fit” into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on a number of factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.

Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.

Procedure

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

X-rays before and after total hip replacement. In this case, non-cemented components were used.
X-rays before and after total hip replacement. In this case, non-cemented components were used.
Recovery

The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon’s instructions regarding home care during the first few weeks after surgery.

Wound Care

You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.

Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.

Diet

Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.

Activity

physical therapy for total hip replacement

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.

Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside
  • Resuming other normal household activities, such as sitting, standing, and climbing stairs
  • Specific exercises several times a day to restore movement and strengthen your hip. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery
Possible Complications of Surgery

The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.

Infection

Infection may occur superficially in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later.

Minor infections of the wound are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

Blood Clots

Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program which may include blood thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early mobilization.

Deep vein thrombosis

Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.

Leg-length Inequality

Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopaedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.

Dislocation

Hip implant dislocation

Hip implant dislocation.

This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.

Loosening and Implant Wear

Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a second surgery called a revision may be necessary.

Other Complications

Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. In a small number of patients, some pain can continue or new pain can occur after surgery.

Avoiding Problems After Surgery
Recognizing the Signs of a Blood Clot

Follow your orthopaedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

Warning signs of blood clots. The warning signs of possible blood clot in your leg include:

  • Pain in your calf and leg that is unrelated to your incision
  • Tenderness or redness of your calf
  • New or increasing swelling of your thigh, calf, ankle, or foot

Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing
Preventing Infection

A common cause of infection following hip replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections.

Following surgery, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter your bloodstream. Your orthopaedic surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.

Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible hip replacement infection:

  • Persistent fever (higher than 100°F orally)
  • Shaking chills
  • Increasing redness, tenderness, or swelling of the hip wound
  • Drainage from the hip wound
  • Increasing hip pain with both activity and rest
Avoiding Falls

A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.

Your orthopaedic surgeon and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

Other Precautions

To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement.

Prior to discharge from the hospital, your surgeon and physical therapist will provide you with any specific precautions you should follow.

Outcomes
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 with 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 orthopaedic surgeon for a card confirming that you have an artificial hip.

Protecting Your Hip Replacement

There are many things you can do to protect your hip replacement and extend the life of your hip implant.

  • Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
  • Make sure your dentist knows that you have a hip replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
  • See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.
Best Home Exercises after Total Hip Replacement: Critical Exercises

 

 

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.