About Total Hip Replacement
If hip pain limits your ability to walk, work or perform simple activities and less invasive procedures (such as medication, physical therapy and injections) have failed, then total hip replacement might be right for you. Hip replacement surgery removes the parts of the hip that are causing you pain and replaces them with artificial parts. This procedure aims to make it less painful to move the hip, improve its function and improve your quality of life.
Hip Replacement Surgery
(Total Hip Arthroplasty, Hip Arthroplasty, Total Hip Replacement, Hip Replacement)
What is a hip replacement surgery?
Hip replacement, also called total hip arthroplasty, is a surgical procedure to replace a worn out or damaged hip with a prosthesis (an artificial joint). This surgery may be considered following a hip fracture (breaking of the bone) or for someone who has severe pain due to arthritis.
Various types of arthritis may affect the hip joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the hips. Rheumatoid arthritis, which causes inflammation of the synovial lining of the joint and results in excessive synovial fluid, may lead to severe pain and stiffness. Traumatic arthritis, arthritis due to injury, may also cause damage to the articular cartilage of the hip.
The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged and to relieve hip pain that cannot be controlled by other treatments.
A traditional hip replacement involves an incision several inches long over the hip joint. A newer approach that uses 1 or 2 smaller incisions to perform the procedure is called minimally invasive hip replacement. However, the minimally invasive procedure is not suited for all candidates for hip replacement. The doctor will determine the best procedure for a person, based on that individual's situation.
Anatomy of the hip
Joints are formed where bones meet. Most joints are mobile, allowing the bones to move without friction or discomfort. The hip joint is a ball-and-socket joint, which allows backward, forward, sideways, and rotating movements. The ball part of the hip joint is the head of the femur (thigh bone), and the acetabulum is the socket, a cup-like structure in the pelvis. The hip joint has significantly more bony contact and stability compared with other joints, such as the shoulder.
A hip joint consists of the following:
Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.
Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.
Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
Bursa. A fluid-filled sac located between bones, ligaments, or other adjacent structures that helps cushion joints.
Femur. Thighbone or upper leg bone.
Acetabulum. A socket or cuplike structure that holds the femur head.
Reasons for the procedure
Hip replacement surgery is a treatment for pain and disability in the hip. The most common condition that results in the need for hip replacement surgery is osteoarthritis.
Osteoarthritis is characterized by the loss of joint cartilage in the hip. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain due to degenerative joint disease may be unable to do normal activities that involve bending at the hip, such as walking or sitting, because they are painful.
Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a hip injury, can also lead to degeneration of the hip joint.
Hip replacement may also be used as a method of treating certain hip fractures. A fracture is a traumatic event that may result from a fall. Pain from a fracture is severe and walking or even moving the leg is difficult.
If medical treatments are not satisfactory at controlling pain due to arthritis, hip replacement surgery may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited to, the following:
Glucosamine and chondroitin sulfate
Limiting painful activities
Assistive devices for walking (such as a cane)
There may be other reasons for your doctor to recommend a hip replacement surgery.
Risks of the procedure
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
Blood clots in the legs or lungs
Changes in leg length or gait
Need for revision or additional hip surgery
Nerve injury resulting in weakness or numbness
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Before the procedure
Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You may 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 medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
You will be asked to fast for eight hours before the procedure, generally after midnight.
You may receive a sedative prior to the procedure to help you relax.
You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
Stop smoking, as smoking can delay wound healing and slow down the recovery period.
Lose weight if needed.
Perform conditioning exercises as prescribed to strengthen muscles.
Arrange for someone to help around the house for a week or 2 after you are discharged from the hospital.
Based on your medical condition, your doctor may request other specific tests or examinations.
During the procedure
Hip replacement requires a stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Hip replacement surgery is performed while you are asleep under general anesthesia or sedated under spinal anesthesia. Your anesthesiologist will discuss this with you in advance.
Generally, hip replacement surgery follows this process:
You will be asked to remove clothing and will be given a gown to wear.
An intravenous (IV) line may be started in your arm or hand.
You will be positioned on the operating table.
A urinary catheter may be inserted (after you are asleep).
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
The doctor will make an incision in the hip area.
The doctor 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 femur (thighbone), the ball (head joint) 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 2 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 onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2 types is used to replace a hip.
The incision will be closed with stitches or surgical staples.
A drain may be placed in the incision site to remove fluid.
A sterile bandage or dressing will be applied.
After the procedure
In the hospital
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Hip replacement surgery usually requires an in-hospital stay of several days.
It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.
You will be discharged home or to a rehabilitation center. In either case, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.
Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Notify your doctor to report any of the following:
Redness, swelling, bleeding, or other drainage from the incision site
Increased pain around the incision site
Numbness and/or tingling in the affected leg
You may resume your normal diet unless your health care provider advises you differently.
You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.
It is important that you avoid falls after your hip replacement surgery because a fall can result in damage to the new joint. Your therapist may recommend an assistive device (cane or walker) to help you walk until your strength and balance improve.
Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following:
Proper handrails along all stairs
Safety handrails in the shower or bath
Shower bench or chair
Raised toilet seat
Stable chair with firm seat cushion and firm back with two arms, which will allow your knees to be positioned lower than your hips
Long-handled sponge and shower hose
Long-handled shoe horn
Reaching stick to grab objects
Firm pillows to raise the hips above the knees when sitting
Removing loose carpets and electrical cords that may cause you to trip
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your health care provider. Please consult your doctor with any questions or concerns you may have regarding your condition.
This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.
Frequently Asked Questions
- What is a joint replacement made of?
- Who needs a total joint replacement?
- How do I know if I need surgery?
- Why have a total joint replacement?
- What does the surgery involve?
- Will I need a blood transfusion?
- How long will I be in the hospital?
- What therapy will I have to do?
- What are the major risks to the surgery?
- What if I get an infection?
- What are total hip precautions, and how long do I have to follow them?
- What happens when I leave the hospital?
- What do I do at home while recovering?
- How long do I take narcotics?
- When can I drive?
- When do I see my surgeon after surgery?
- Who do I call if I'm having problems after surgery?
- How long do total joints last? Will I need another surgery?
- What lifelong activities can I do or not do?
- Why do I have to have x-rays every two years?
- Why do total joints wear out?
- Why should I take prophylactic antibiotics for the rest of my life?
A replacement joint is a manufactured prosthesis made of titanium, chrome cobalt and polyethylene to replace an arthritic hip, knee and sometimes the ankle, shoulder, elbow or wrist.
Someone who has moderate to severe arthritis, significant limits on normal daily activity, and severe pain they can no longer live with.
As a patient you may want to choose surgery if you have pain that is not managed by anti-inflammatories (NSAIDS) and your daily activities are limited by this pain to the extent that you cannot do what you would like to do; for example, you cannot go grocery shopping without severe pain in the involved joint.
A total joint replacement will allow you to return to more normal activities and relieve your pain (95% success rate).
For total hip arthroplasty, the femoral head is removed, the canal in the middle of the femur is shaped to accept the stem and the acetabulum (socket in the pelvis) is shaped to accept the cup. A liner is inserted into the cup and a head onto the stem.
You may; though, we no longer need you to donate your own blood in advance.
In general, for an uncomplicated total knee or hip, the hospital stay is about one to three days after surgery.
Starting the afternoon after surgery you will have physical therapy and after that twice a day, which includes exercises, learning to sit, stand and walk with your new total joint. Patients usually take a few steps the first day, then walk around their room and so on. After you leave the hospital, you will have a list of the exercises you have learned to continue yourself at home. Many patients will receive physical therapy at home.
The major risks include the following:
Blood clot: We do reduce risk of this by using blood thinners (Enoxaparin, Aspirin or Coumadin), T.E.D. hose (compressive stockings) and compression boots on your feet to increase circulation.
Infection: You are given IV antibiotics before and after surgery.
Nerve, blood vessel damage: Because specialists performing this replacement work close to important vessels and nerves, they take great care not to injure these structures.
Total hip arthroplasty (THA) dislocation: As a patient you can avoid this by following total hip precautions. Complications with existing or new medical problems.
Infection is very rare, but a diffcult complication. Read more about joint infection after replacement.
Avoid internal and external rotation of the operated hip. Keep knees and toes straight ahead. Avoid flexing hip past 90% (for six weeks), though it’s best to follow precautions for life. Please no excessive stretching/yoga. Your THA could dislocate anytime even 10–20 years after surgery.
You will usually need 24-hour help for a week. If you don't have adequate help at home, you should consider a rehab facility or extended care facility. You can check with your insurance to see who is approved, but the final plans will be made with our case management team while you are in the hospital.
Recovery will involve the following:
First four to six weeks: Do your physical therapy exercises; keep the wound clean: no ointments or lotion on the wound; wear your T.E.D. hose for those four weeks; take blood thinners (Coumadin managed by the anti-coagulation service); walk as tolerated with crutches/walker; transition to a single crutch/cane as tolerated.
After six weeks: Continue exercises and walk or ride a stationary bicycle; use a crutch/cane until walking without a limp; return to work part time or full time as tolerated (as early as four to six weeks from surgery). You may return to full activity when ready except for running/jumping activities; kneeling on a TKA may be difficult but won’t damage it.
The best lifelong activities at this point are walking, swimming and biking.
Only as long as you need them, but usually about 5–14 days from the day of surgery; then Tylenol will usually handle the pain.
Usually three to four weeks after surgery (make sure you have control of your leg, you have no spasms, you are off pain medication and use caution.)
Two weeks after your surgery, your surgeon will remove your staples. You will also be seen six weeks after surgery, six months, one year and two years for the rest of your life. X-rays will be obtained at six weeks and yearly. (Even if you live out of town, we like to see copies.)
Please call the nurse/MA who works with your surgeon, and your post-operative instructions will give you a phone number to use. If you feel like it is an emergency, please call the clinic immediately or the University Hospital operator to have the orthopedic resident on call paged at the following number:
If it is after 5 p.m., go to your nearest emergency department.
Today, total joints last 15–20 years depending on the amount of activity (demand) and your general health. You may need another surgery depending on how old you are and how much wear and tear you put on your total joint.
We advise patients to resume just about everything, especially walking, swimming and bicycle riding. We discourage repetitive jumping and running, yoga or excessive stretching.
When a total joint starts to wear out, we can often see changes on the x-ray before you feel symptoms. If we x-ray your joint every two years, we can better determine the need and time for another operation.
The metal components of total joints can loosen over time, but often the cause of wear is from the bearing surface. Your immune system attacks the particles from the bearing surface but also melts bone away. Now we are using a metal liner (metal-on-metal), ceramic-on-ceramic and cross-linked polyethylene liners that wear less than what we had years ago.
You should take prophylactic antibiotics because total joints are made of metal and are at risk for infection when bacteria circulate through your bloodstream. If your joint becomes infected, it requires more than two additional surgeries. Therefore, take antibiotics with any bacterial infection as prescribed by your family practitioner. We strongly recommend that you take antibiotics for all dental and invasive procedures for the rest of your life.
Adult Reconstruction, Femoroacetabular Impingement, Hip Arthroscopy, Hip Preservation, Hip Replacement, Joint Replacement, Knee Replacement, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Periacetabular Osteotomy, Physician Assistant, Surgical Dislocation
|University Orthopaedic Center||(801) 587-7028|
Adult Reconstruction, Direct Anterior Hip Replacement, Femoroacetabular Impingement, Hip Arthroscopy, Hip Dysplasia, Hip Instability, Hip Preservation, Hip Replacement, Hip Revision, Joint Infection, Joint Replacement, Knee Preservation, Knee Replacement, Knee Revision, Labral Tear, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Oxford Partial Knee Replacement, Patello-Femoral Arthroplasty (PFA), Periacetabular Osteotomy, Surgical Dislocation, Uni-Compartmental Knee Arthroplasty, Unicompartmental Knee Replacement
|University Orthopaedic Center||(801) 587-7109|
Adult Reconstruction, Femoroacetabular Impingement, Hip Dysplasia, Hip Preservation, Hip Replacement, Hip Revision, Joint Replacement, Knee Replacement, Labral Tear, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Periacetabular Osteotomy, Surgical Dislocation, Uni-Compartmental Knee Arthroplasty
|University Orthopaedic Center||(801) 587-7109|
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