Total Hip Replacement
What is a hip replacement (hip arthroplasty)?
This surgery is where your hip (or parts of it) is replaced with a manmade implant (prosthesis). It’s usually performed on adults after other treatments like using a cane or walker, weight loss, medicines and physical therapy have failed to help. You may need a hip replacement because of:
- Osteoarthritis.
- Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis).
- Femoroacetabular impingement syndrome.
- Injuries, like a hip fracture or dislocation from a fall.
- Developmental hip dysplasia.
- An injury that didn’t heal right.
- Osteonecrosis (avascular necrosis).
- Neoplasms.
- Childhood hip disorders, like Legg-Calvé-Perthes disease and slipped capital femoral epiphysis.
Because all surgery has risks, and prostheses can fail as time goes by, your healthcare provider may recommend delaying a hip replacement until severe symptoms are present.
What is the hip?
Your hip is a joint — a ball-and-socket joint — that connects the thigh bone (femur) of your leg to your pelvis. Your femur has a “head” at its top that’s shaped like a ball, and it fits into the acetabulum (the socket). It’s kept in place by ligaments, tendons and muscles around the joint. Your hip is the most flexible and free-moving joint in your body and can move backwards and forwards, to the side and can perform twisting motions.
What are the types of hip replacements?
There are two major types of hip replacements:
- Total hip replacement (the most common type): A total hip replacement switches both the femoral head and the acetabulum with a prosthesis.
- Partial hip replacement: A partial replacement substitutes the femoral head only. This is typically done for patients with certain types of hip fractures.
What kind of healthcare provider performs hip replacements?
If a hip replacement is the best treatment for you, your healthcare provider may send you to an orthopaedic surgeon for evaluation. Your orthopaedic surgeon will evaluate your hip joint with a full physical exam and X-rays and develop a treatment plan for how surgery can best benefit you.
What symptoms may indicate that I need a hip replacement?
Some of the following symptoms may be related to conditions that hip replacements address. They include:
- Pain in the anterior hip or groin.
- Pain in the buttock and trochanteric region.
- Pain with activity and at rest.
- Pain that gets worse when you put weight on the leg.
- Stiffness/tightness of the hip.
- Loss of motion.
- Difficulty sleeping.
- Difficulty walking.
- Difficulty putting on shoes and socks.
Who shouldn’t go through a hip replacement?
Hip replacement surgery isn’t for everyone. Even if someone is in pain and can’t move their hip as well as expected, they aren’t automatically considered for a hip replacement. You might be ineligible if you have:
- Severe medical problems such as heart failure, anemia, recent myocardial infarction (heart attack), unstable angina and more. Talk to your healthcare provider about issues that may disqualify you.
- An active infection.
- An immature skeleton.
- Irreversible or permanent muscle weakness.
- Paraplegia, quadriplegia.
- A neuropathic (Charcot) joint.
- Severe morbid obesity.
How do I prepare for surgery? What happens before a hip replacement?
In order to prepare for surgery, you’ll schedule a series of appointments to receive testing and clearance. During these appointments, studies including lab testing, urine analysis, an EKG and X-rays may be performed. Based on the results of these tests and your health history, clearance is or is not initiated for the surgery.
Before surgery, your medical risk will be assessed. Your healthcare providers need to make sure that the risks of a hip replacement don’t outweigh the benefits. They will check for:
- How anxious/stressed you are about your surgery.
- How well you’ll handle blood loss.
- How well you might tolerate anesthesia.
- How you might manage the rehabilitation process.
- How your other medical problems may affect your healing.
- How active you are.
- How appropriate your weight is.
Your lower extremities will be evaluated before surgery. Your healthcare providers will do the following:
- Muscle testing: Strength of the hip flexors, extensors, abductors and adductors. Also the strength of the limb below the hip.
- Nerve and vascular status testing: Sciatic and perineal nerve function testing, sensory examination and an assessment of the arterial pulses. Checking if there’s any severe vascular disease.
- Palpation testing: Palpation helps rule out other causes of hip pain which are not from the joint
- General inspection: Examining your gait (walk), any previous incisions, abnormal swelling, cuts, discolorations and infections.
- Range of motion testing: Hip flexion/extension, abduction/adduction and internal/external rotation.
- Trendelenburg sign: Tests the strength and function of the hip abductor muscles.
- Measure your leg length.
- Straight leg rise: Testing groin pain, radiating pain (pain that starts in one place and travels to another), back pain, posterior hip pain and lower leg pain.
You will have radiographs (X-rays) of the hip and pelvis to assess the status and structure of the hip joint. Occasionally advanced imaging (MRI or CT scan) may be needed to assist in the diagnosis or treatment planning.
Your healthcare provider will likely require some tests before surgery. Tests may include:
- Complete blood count (CBC).
- Prothrombin time (PT).
- International normalized ratio (INR).
- Activated partial thromboplastin time (aPTT).
- Blood type/screen.
- Basic chemistries.
- Urinalysis.
- Other tests, as needed.
- Electrocardiogram (ECG).
You can also take some steps to help ensure an easier and safer recovery after surgery. Make a few simple changes around the house, and arrange for someone to help you following surgery. If you smoke, quit or cut down to improve your surgery risk and recovery rate. It’s also helpful to lose weight if needed, have an obstructive sleep apnea screening, and try to resolve other conditions you have. Don’t eat or drink anything after midnight the night before surgery.
You can try these tips at home prior to surgery:
- Remove any loose rugs, as they can be hazardous when you’re walking in the house. Make sure you tape down all electrical cords.
- Store additional canned and frozen foods, and make sure all supplies are between waist and shoulder level.
- Prepare a sleeping room on the main floor, or make sure that you only have to climb the stairs once a day.
Special equipment can help ensure an easier recovery following surgery. Your physical and occupational therapists will recommend equipment for you and will help you and your family get this equipment following surgery. Some of this equipment may include:
- Elevated toilet seats.
- Shower seats.
- Handrails and grab bars.
- Grasping device for putting on socks and shoes.
Infectious arthritis is an infection in a joint. It may also be referred to as septic arthritis. It occurs when an infection caused by a bacteria or virus spreads to a joint or the fluid surrounding the joint. This fluid is called the synovial fluid. This infection usually begins in another area of the body and spreads through the bloodstream to the joint tissue. The infection may also enter the body through surgery, open wounds, or injections.
Infectious arthritis usually only occurs in one joint. The condition typically affects a large joint such as the knee, hip, or shoulder. It occurs more often in children, older adults, and people who use illegal drugs.