During hip replacement, a surgeon removes the damaged sections of your hip joint and replaces them with parts usually constructed of metal and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.
Also called total hip arthroplasty, hip replacement surgery may be an option for you if your hip pain interferes with daily activities and more-conservative treatments haven’t helped. Arthritis damage is the most common reason to need hip replacement.
Why it’s done
Conditions that can damage the hip joint, sometimes necessitating hip replacement surgery, include:
- Osteoarthritis. Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.
- Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode bone and cartilage and deform joints.
- Osteonecrosis. If there is inadequate blood supply to the ball portion of the hip joint, the bone may collapse and deform.
The hip replacement operation is one of the most reliable operations in orthopaedic surgery and consistently reduces or eliminates the pain of the arthritis in most patients. Some of the important benefits of a Total Hip replacement surgery are, marked reduction in pain and improvement in sleep, most people regain range of motion, physical ability, and quality of life.
Risks associated with hip replacement surgery may include:
- Blood clots. Clots can form in your leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to your lung, heart or rarely your brain. Your doctor may prescribe blood-thinning medications to reduce this risk.
- Infection. Infections can occur at the site of your incision and in the deeper tissue near your new hip. Most infections are treated with antibiotics, but a major infection near your prosthesis may require surgery to remove and replace the prosthesis.
- Fracture. During surgery, healthy portions of your hip joint may fracture. Sometimes the fractures are so small that they heal on their own, but larger fractures may need to be corrected with wires, pins and possibly bone grafts.
- Dislocation. Certain positions can cause the ball of your new joint to become dislodged. To avoid this, it is often recommended that after surgery you don’t bend more than 90 degrees at the hip and don’t let your leg cross the midline of your body. If the hip dislocates, your doctor may fit you with a brace to keep the hip in the correct position. If your hip keeps dislocating, surgery is often required to stabilize it.
- Change in leg length. Your surgeon takes steps to avoid the problem, but occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by weakness in the muscles surrounding the hip. In this case, progressively strengthening and stretching those muscles may help.
- Loosening. Although this complication is rare with newer implants, your new joint may not become solidly fixed to your bone or may loosen over time, causing pain in your hip. Surgery might be needed to fix the problem.
The diagnosis of a hip pain starts with medical history taking by your doctor. Here the doctor tries understanding the cause for pain as well as reviewing any other underlying complaints. Observation of the hip at rest and while standing or walking, palpation (or feeling) of the hip and surrounding structures, testing for range of motion and strength, and checking for sensation and pulses all may be done. Few blood tests may also be ordered.
The most common imaging technique used in the diagnosis of a hip pain is X-ray. Other imaging like CT scan or a MRI scan may also be used.
During the procedure
To perform a hip replacement, your surgeon:
- Makes an incision over the front or side of your hip, through the layers of tissue
- Removes diseased and damaged bone and cartilage, leaving healthy bone intact
- Implants the prosthetic socket into your pelvic bone, to replace the damaged socket
- Replaces the round top of your femur with the prosthetic ball, which is attached to a stem that fits into your thighbone
Techniques for hip replacement are evolving. As surgeons continue to develop less invasive surgical techniques, the hope is that these techniques might reduce recovery time and pain compared with standard hip replacements. However, studies comparing the outcomes of standard hip replacement with those of minimally invasive hip replacement have had mixed results.
After the procedure
After surgery, you’ll be moved to a recovery area for a few hours while your anesthesia wears off. Medical staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.
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