Hip Replacement Surgery

by Timothy Lane, M.D.

Whether you have just begun exploring treatment options for hip arthritis or have decided to take the surgical route, this article will assist you in understanding the benefits and limitations of total hip replacement surgery.

A total hip replacement surgery is performed on patients who continue to have severe hip arthritis after all conservative treatment options including anti-inflammatory medication, physical therapy, activity modification, walking aids and injections have been exhausted. Hip replacement surgery can decrease the pain and disability associated with arthritis and is usually performed when arthritis inhibits the patient’s functional activities and in turn affects their quality of life. The majority of people who undergo this procedure experience both a significant reduction in their pain and notice improvement in their function. Hip replacement surgery relieves pain from an arthritic or painful hip joint, but it does not relieve pain caused by other problems such as arthritis of the back or tendon pain. The decision to have total hip replacement surgery is difficult and requires collaboration between the patient, family and the orthopaedic surgeon.

The patient is admitted to the hospital on the day of surgery. After the patient is admitted, the anesthesia team evaluates the patient and will often use general anesthesia for the surgery, meaning the patient is unconscious during the procedure. The operation typically takes 1.5 to 3 hours to complete. During the operation, an incision is made beside the hip in order to expose the hip joint. About 2 inches of the upper femur is removed and the socket is reshaped to accommodate the new socket. The new head of the femur and socket (the artificial hip prosthesis) are made of titanium plus a bearing material, which commonly involves stainless steel against high-density polyethylene. After the surgery, the patient is moved to the recovery room for several hours to monitor the patient’s recovery from the anesthesia.

Post-surgery, the patient remains in the hospital for two to three days. During the hospital stay, the patient begins a physical therapy program, regaining the ability to walk and the ability to perform daily activities such as getting in and out of bed and in and out of the bathroom. The patient is released to go home once medically stable and functioning fairly well. Only 2 to 5 percent of patients recovering from total hip replacement surgery continue their physical therapy at a rehabilitation facility. Otherwise, physical therapy is continued at home with a home therapist for two to four weeks. When the patient is mobile and no longer required to be at home, they will begin a period of outpatient physical therapy, however this is not usually needed.

The initial period of physical therapy after the surgery concentrates on regaining hip function. Typically, a person with a recent total hip replacement surgery is allowed full weight bearing but does benefit from use of a walker or cane for three to six weeks. This allows time for healing to occur between the bone and the prosthesis and allows the ligaments and muscle to heal. The physical therapist will teach the patient specific exercises to perform and which activities to avoid. The therapist will also demonstrate and teach daily living activities such as getting up from a chair and picking up items off of the floor. During the first three months after surgery, it is important to avoid certain positions in order to adequately allow healing of the soft tissues around the hip. The therapist will go over these positions with the patient and show how to avoid them both in the hospital and home settings. After three months, positioning limitations are eliminated however, some permanent limitations still exist. Patients with a total hip replacement should not participate in running sports or sports that involve impact loading such as jumping from a height and landing on the legs. Additionally, squatting with heavy weight should be avoided for the first year. This allows time for the bond between the artificial hip and the bone to fully strengthen.

As with any medical procedure, there are certain risks involved. The first set of risks involved with total hip replacement surgery occurs at or around the time of surgery. These uncommon risks include infection, blood clots, bleeding and complications from surgery such as serious problems with the bowels or lungs. Heart attack, stroke and death are also potential risks of surgery, but rarely occur. Antibiotics are given intravenously and special surgical gear is worn by the surgical team to minimize the risks of infections during the surgery.

The second set of risks associated with total hip replacement surgery involves blood clots in the leg veins or pelvis, and are the most common complication. Blood thinning medications are given the day after surgery and continued for 14 days. These medications help prevent blood clots, making them a rare occurrence. While blood thinners decrease the risk of blood clots, there is still the risk of bleeding or having an adverse reaction to these medications. It is important to carefully follow your orthopaedic surgeon’s instructions in order to minimize such risks during the first few weeks of recovery.

Patient education and following your orthopaedic surgeon’s instructions are important to ensure the longevity of the replaced hip. 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, causing the hip replacement to loosen and become painful. Therefore, most orthopaedic surgeons advise against high-impact activities such as running, jogging, jumping, and other high-impact sports. In 95 percent of patients, the new hip lasts at least 15 years with normal use and activity. Should the prosthesis wear out, procedures to replace the prosthesis can be performed, but are usually more complicated than the initial procedure.

Total hip replacement surgery usually provides dramatic improvement in function and significantly decreases the level of pain a patient experiences. This surgery is one of the most successful joint replacement surgeries performed today and the long-term results continue to improve remarkably with the addition of new devices and techniques.