Hip Replacement
If your hip has been damaged by arthritis, a fracture, or other conditions, you can have severe pain with simple activities such as walking or getting in and out of a chair. Your hip may be stiff causing difficulty putting on your shoes and socks. You may even have pain while sitting or sleeping.
We have many conservative measures to relieve pain from arthritis such as injections, medications, PRP, and physical therapy. But if these are not adequate to relieve your pain, hip replacement may be the best option.
Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
We can even perform hip replacements as an outpatient if you meet the qualifications.
Hip replacement surgery is one of the most successful operations in all of medicine. It can return you to the life you want to live!
Anatomy
The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
The bone of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily. Arthritis occurs when this cartilage is damaged and wears away, leaving bare bone instead.
A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.
Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.
[HIP ANATOMY IMAGE]
Hip replacement surgery
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
The damaged femoral head is removed. The central canal of the bone is opened and a metal stem is placed into the hollow center of the femur. The femoral stem may be either cemented or friction press fit into the bone.
A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
The cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. A plastic or ceramic spacer is inserted into the metal socket, which gives the ball a smooth surface to glide on.
[IMAGE OF HIP REPLACEMENT COMPONENTS]
Do you have to stay in the hospital after surgery?
Modern advances in surgical techniques mean shorter hospital stays than ever. If you are healthy and have good support at home, you may be a candidate to go home the same day as your surgery. But even if you stay overnight, most people are able to go home the next day.
For more information, you can read our article about Outpatient Joint Replacement HERE.
When is it time to get a hip replacement?
The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. It is important to consider your level of pain, diagnosis, other medical conditions, and effectiveness of conservative treatment options.
When is hip replacement recommended?
The people who benefit the most from hip replacement include those who have:
- Hip pain that limits everyday activities, such as walking or bending
- Hip pain that continues while resting, either day or night
- Stiffness in a hip that severely limits the ability to move or lift the leg
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
Who is a candidate for hip replacement surgery?
Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually.
Total hip replacements have been performed successfully at all ages, from the but the younger you are, the more likely you are to need to wear out the replacement and need revision surgery.
Poorly controlled diabetes puts you at high risk for infection after surgery. And an infected joint replacement can put your life at risk or could require removal of the prosthetic joint. So we require that your blood sugar be under good control before performing a hip replacement.
High BMI can also put you at significant risk for complications after surgery, so we evaluate these cases on an individual basis.
What are the risks of hip replacement?
The risks of joint replacement have been greatly reduced over the years. Improvements in the materials mean that modern replacements wear out much more slowly than before.
This has also allowed for changes to the implants that decreases the chance of dislocation, though you will still have to take precautions during the early phases of healing to help prevent the joint from dislocating.
Improvements in surgical technique as well as the use of tranexamic acid (TXA) during surgery have greatly reduced bleeding and the possibility of transfusion after surgery.
Blood clots are always a risk after joint replacement, and you will need to be on blood thinners for 2-4 weeks after joint replacement surgery.
Other risks will be discussed by your surgeon before you make the decision to go forward with your joint replacement.
Realistic Expectations
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
If you only have pain with athletics, but are able to perform the rest of your daily activities without pain, you probably won’t experience much improvement from a joint replacement. We would recommend you alter your athletic activities instead and delay a hip replacement until the arthritis inhibits daily life instead.
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 and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jumping, or other high-impact sports. If you have particular activities that you are looking forward to you should discuss them with your surgeon.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, hip replacements can last for many years.
Surgeons Performing Hip Replacement
Dr. Thomas Courtney
Dr. Richard Patterson
Dr. Steven Pancio
Surgeons Performing Anterior Approach Hip Replacement
Dr. Steven Pancio
