What is hip replacement surgery?

Hip replacement (total hip arthroplasty) is surgery to replace a worn out or damaged hip joint. The surgeon replaces the old joint with an artificial joint (prosthesis). This surgery may be a choice after a hip fracture or for severe pain because of arthritis.

Normal hip joint.

Hip joint with arthritis.

Various types of arthritis may affect the hip joint:

• Osteoarthritis. This is a degenerative joint disease that affects mostly middle-aged and older adults. It may cause the breakdown of joint cartilage and adjacent bone in the hips.

• Rheumatoid arthritis. This type of arthritis causes inflammation of the synovial lining of the joint. It causes extra synovial fluid and joint destruction. It may lead to severe pain and stiffness.

• Traumatic arthritis. This arthritis is caused by an injury. It may also damage the hip cartilage.

The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged. It also helps relieve hip pain that can’t be controlled by other treatments.

A traditional hip replacement involves an incision several inches long over the hip joint. A newer approach uses 1 or 2 smaller incisions to do the surgery. This is called minimally invasive hip replacement. But the minimally invasive procedure is not suited for all people who need hip replacement. An orthopedic surgeon will figure out the best procedure for you. This is a surgeon who specializes in treating bone, muscle, joint, and tendon problems.

Why might I need hip replacement surgery?

Hip replacement surgery is a treatment for pain and disability in the hip. Osteoarthritis is the most common reason for hip replacement surgery.

Osteoarthritis causes loss of joint cartilage in the hip. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain from degenerative joint disease may not be able to do normal activities that involve bending at the hip. These activities include walking and sitting.

Other forms of arthritis, such as rheumatoid arthritis and arthritis, that results from a hip injury can also damage the hip joint. So can avascular necrosis. This is loss of blood supply to the head of the femur. Childhood hip diseases that can cause arthritis as an adult can also damage the hip.

Hip replacement may also be used to treat certain hip fractures. A fracture is an injury often from a fall. Pain from a fracture is severe. Walking or even moving the leg causes pain.

If other medical treatments don't control your arthritis pain, your healthcare provider may advise a hip replacement. Some medical treatments for degenerative joint disease may include:

• Anti-inflammatory medicines

• Glucosamine and chondroitin sulfate

• Injections of steroid medicines

• Pain medicines

• Limiting activities that are painful

• Assistive devices for walking, such as a cane

• Physical therapy

Your surgeon may have other reasons to advise a hip replacement surgery.

What are the risks of hip replacement surgery?

Any surgery can have complications. Some possible complications may include:

• Bleeding

• Infection

• Blood clots in the legs or lungs

• Dislocation

• Difference in leg length

• Need for revision or additional hip surgery

• Nerve injury that causes weakness, numbness, or both

You may have other risks depending on your specific health condition. Discuss any concerns with your surgeon before the surgery.

How do I get ready for hip replacement surgery?

• Your surgeon will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• In addition to a complete health history, your healthcare provider will do a physical exam to make sure that you are in good health before having the surgery. You may have blood tests or other diagnostic tests.

• Tell your surgeon if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia (both local and general).

• Tell your surgeon about all medicines you are taking. This includes prescription and over-the-counter medicines, vitamins, and herbal supplements.

• Tell your surgeon if you have a history of bleeding disorders or if you are taking any blood-thinners (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the surgery.

• Tell your surgeon if you are pregnant or think you may be pregnant.

• Follow any directions you are given for not eating or drinking before the surgery.

• You may get medicine (sedative) before the surgery to help you relax.

• You may meet with a physical therapist before your surgery to talk about rehabilitation (rehab).

• If you smoke, stop before your surgery. Smoking can delay wound healing and slow down the recovery period.

• Lose weight if you need to.

• Do conditioning exercises as prescribed to strengthen muscles.

• Arrange for someone to help around the house for a week or two after you are discharged from the hospital.

• Based on your health condition, you may need other tests or exams.

What happens during hip replacement surgery?

Hip replacement often needs a short stay in a hospital. Procedures may vary depending on your condition and your surgeon's practices.

Hip replacement surgery is done while you are asleep under general anesthesia or sedated under spinal anesthesia. Your anesthesiologist will discuss this with you before the surgery.

Generally, hip replacement surgery follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.

2. An IV (intravenous) line may be started in your arm or hand.

3. You will be given anesthesia. You may be under general anesthesia. This is medicine that puts you to sleep and keeps you from feeling pain during the surgery. The anesthesiologist may also give you a nerve block, or spinal or epidural anesthesia. These numb the lower half of your body so you don’t feel pain.

4. You will be positioned on the operating table.

5. A urinary catheter may be inserted after you are asleep.

6. The anesthesiologist or nurse anesthetist will watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

7. The skin over the surgical site will be cleaned with an antiseptic solution.

8. The surgeon will make an incision in the hip area.

9. The surgeon will remove the damaged parts of the hip joint and replace them with the prosthesis. The hip prosthesis is made up of a stem that goes into the thighbone (femur), the head joint (ball) that fits into the stem, and a cup that is inserted into the socket of the hip joint. The stem and cup are made of metal. The ball may be made of metal or ceramic. The cup has a liner that may be made of plastic or ceramic. The two most common types of artificial hip prostheses used are cemented prostheses and uncemented prostheses. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface. The bone grows onto this surface to attach to the prosthesis. Sometimes a combination of the two types is used to replace a hip.

10. The incision will be closed with stitches or surgical staples.

11. A drain may be placed in the incision site to remove fluid.

12. A sterile bandage or dressing will be put on the site.

What happens after hip replacement surgery?

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure