The hip is what is commonly referred to as a "ball-and-socket" joint, and it connects the trunk of the body to the legs through the pelvis.  The hip, a major weight bearing joint, is surrounded and held together by muscles, ligaments and other soft tissues.  The bones of the hip joint are covered by a layer of smooth, shiny cartilage that cushions and protects the bones while allowing easy motion. Surrounding the hip joint is the synovial lining, which produces a moisturizing lubricant. The cartilage is the material that "cushions" the ball and socket and allows the joint to move in a smooth and free manner.

 

 

 

When pain and stiffness in your hip keep you from your daily activities, you may need total hip replacement. The development of total hip replacement began over 40 years ago. Today, more than 180,000 people in the United States annually undergo hip replacement surgery to diminish pain and stiffness and restore mobility.

 

The most frequent source of debilitating hip pain is arthritis. It is estimated that 40 million people in the United States have some form of arthritis. That's one in every seven people, one in every three families. Of the more than 100 types of arthritis, the following three are the most common causes of joint damage.

 

Osteoarthritis is a disease which involves the breakdown of tissues that allow joints to move smoothly. The layers of cartilage and synovium become damaged and wear away, leaving the underlying bones unprotected from wearing against each other. Osteoarthritis occurs primarily in people over 60.

 

Rheumatoid arthritis is a systemic disease because it may attack any or all joints in the body. It affects women more often than men and can strike young and old alike. With rheumatoid arthritis, the body's immune system produces a chemical that attacks and destroys the synovial lining covering the joint capsule, the protective cartilage and the joint surface, causing pain, swelling, joint damage, and loss of mobility.

 

Trauma-related arthritis, which results when the joint is injured, is the third most common form of arthritis. It also causes joint damage, pain and loss of mobility.

 

When conservative methods of treatment fail to provide adequate relief, total hip replacement is considered. If your X-rays show destruction of the joint, you and your surgeon will decide if the degree of pain, deterioration and loss of movement is severe enough that you should undergo the operation.

 

Today, your orthopedic surgeon can replace your problem hip thanks to the development of total hip implants, which have been shown to provide long-term relief. Total joint replacement is a remarkably successful operation that has transformed the lives of many people by enabling them to be active and pain-free.

 

 

 

Total hip replacement or "arthroplasty" is the replacement of the ball and socket of the hip joint with artificial parts called prostheses. The surgical procedure involves removing the diseased portions of the joint and replacing them with new parts. There are two main components used in total hip replacement. The femoral component is made of metal and replaces the ball. The acetabular component replaces the socket and may be made entirely of a very hard medical-grade plastic called polyethylene. It may also be made of a metal and polyethylene combination in which the polyethylene cup is placed inside a metal shell. The acetabular component is then secured inside the natural pelvic socket

 

The natural ball portion of the femur (thigh bone) is removed during surgery and the inside of the femur (the canal) is drilled and enlarged to fit the femoral component of the hip prosthesis. The socket portion of the pelvis is also enlarged with a special surgical instrument to make room for the new artificial socket component. The femoral component is inserted down the enlarged shaft of the thigh bone. The acetabular component is inserted into the enlarged socket. The ball and socket are then fitted together and stabilized with the surrounding ligaments and muscles, just as your original hip had been. Since the painful diseased cartilage has been removed, there is generally a very quick relief of pain, an outstanding feature of this procedure.

 

X-rays are taken of your knee joint. You should bring any X-rays that may have been taken of your knee in the past. These X-rays will help your surgeon plan the surgery and evaluate the fit of your new knee prosthesis.

 

The surgical procedure for total hip arthroplasty usually takes about two hours or less, and the new joint is often immediately solid. However, to strengthen the weakened muscles and soft tissue surrounding and supporting the joint requires a longer-term program of exercise and physical therapy. Although many patients see and feel immediate benefits, they must continue to rehabilitate themselves for several months to get the total benefit.

 

 

 

Your hip evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary. It helps the surgeon understand your pain, limitations in activity and the progression of your hip problem.

 

After your history is taken, a physical exam is performed. The range of motion of your hips and knees are measured and your muscle strength is evaluated. The surgeon will observe how you walk, sit, bend and move.

 

X-rays are taken of your hip joint. You should bring any X-rays that may have been taken of your hip in the past. These X-rays will help your surgeon plan the surgery and evaluate the fit of your new hip prosthesis.

 

A small amount of fluid may be taken from your hip joint to check for infection.

 

After your initial orthopedic evaluation, the surgeon will discuss possible alternatives to surgery. If the X-rays show severe joint damage and no other means of treatment has provided relief, total hip replacement may be recommended.

 

 

 

You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop two weeks prior to surgery. If you are taking aspirin or certain arthritis medications, inform your surgeon; you may need to stop taking these two weeks before surgery. If you are taking estrogen (i.e. Premarin), your surgeon will probably advise you that it will be necessary to stop taking it one month prior to surgery. Your doctor may want you to donate your own blood ahead of time for a possible transfusion during surgery.

 

Most patients are admitted to the hospital the day before or the day of the surgery. In many facilities, much of the pre-admission paperwork has already been done, and all the patient generally needs to do is sign the release forms. The nursing staff will advise you of simple exercises they will do after surgery: turning, coughing and deep breathing. These are important exercises for clearing the lungs of anesthesia and fluids that may collect. Prior to surgery, patients may receive a shave prep and an antiseptic scrub to the surgical area around the hip. The anesthesiologist will speak to you before surgery, and discuss the type of anesthetic to be used.

 

 

 

You cannot eat or drink anything after midnight the day of surgery. The day of your surgery, you will be taken to the operating room about a half hour early. The surgical procedure takes a few hours. In order to receive medications and blood transfusions during surgery, an intravenous (IV) line will be started. When the anesthesia you are given has taken affect, an incision is made in the hip. The surgeon removes part of the thighbone and then reshapes the thighbone and hip socket so the new joint will fit properly. The new "socket" is positioned into the pelvis bone, and the implant's long stem is placed firmly into the top of the thighbone.

 

Once both parts of the implant are in place, they are joined together and tested for proper fit. Finally the incision is closed with stitched or surgical staples.

 

 

 

You will awaken after your surgery in the Post-Anesthesia Recovery Room. You will remain there until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You may feel as though you only left your room for a few minutes. If you experience pain, medication will be available.

 

 

 

You may have a tube or drain coming through the surgical dressing that is attached to a drainage apparatus. This system provides gentle, continuous suction to remove any blood that may accumulate in the surgical area. The drain will probably be removed several days after surgery. Your dressing will be changed and a smaller one applied.

 

You may move the leg that was not operated on as soon as you awaken. As you lie on your back, flexing the unoperated hip will reduce aching in your lower back. The nurse will help you find comfortable positions. You may turn with a pillow between your legs. The nurse will encourage you to do ankle pumping exercises every hour to protect against blood clots.

 

An IV may remain in your arm for several days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon.

 

To prevent problems in your lungs, you may receive an incentive spirometer after surgery to encourage you to cough and breathe deeply. This is used every hour while you are awake.

 

It is normal to feel discomfort after surgery. Inform the nurse of your pain, and medication will be ordered.

 

 

 

Your hip rehabilitation program begins right after surgery and is ordered by your surgeon. Isometric exercises (tightening muscles without moving the joint) will begin while you are still in bed. You will be instructed to do these exercises a number of times per day while awake. You will be encouraged by the physical therapist to move your ankle and other joints so that you will remain strong.

 

These exercises will help you regain strength and mobility. The physical therapist will teach you the safest methods for getting in and out of bed or a chair, and on and off the toilet. You will be taught the do's and don'ts of joint replacement recovery.

 

It is pertinent for you to adhere to your surgeon's directions and follow proper positioning techniques throughout your rehabilitation. Since you will no longer be in the hospital, arrangements will be made for someone to remove the sutures or skin clips about 10 days after surgery. It is not uncommon to still experience some pain. The full recovery period normally lasts three to six months.

 

The day after surgery, you will probably begin walking and performing exercises that move your hip joint. Initially, the physical therapist will assist you in getting out of bed and standing at the bedside with a walker. For your entire hospital stay, you will probably walk, with a walker or crutches, two times per day under the supervision of the therapist. Your walking distance will gradually increase.

 

Look for any changes around your incision. Contact your surgeon if you develop any of the following:

• Drainage and/or foul odor coming from the incision.
• Fever (temperature about 101 degrees F or 38 degrees C) for two days.
• Increased swelling, tenderness, redness and/or pain.

The physical therapist will check your progress daily and will keep your surgeon informed. Pain medication may be taken prior to your physical therapy if you request it.

 

 

 

The usual hospital stay for hip joint replacement is three to five days. You will quickly gain independence after your surgery. To protect your hip, you will not be permitted to sit past a 90-degree angle. To accommodate sitting, there will be an elevated chair and an elevated toilet available for your use. This will allow your hip to be higher than or equal to your knee while sitting. An elevated toilet seat will be ordered for you to take home.

 

You usually may begin driving once you are able to bear full weight on your knee. Be sure you are comfortable with your strength. Be sure to practice driving in a safe area. Once you are comfortable with your mobility, you generally may drive anywhere.

 

At home, you will need a firm chair with arms.

 

We encourage you to be active in order to control your weight and muscle tone. It is generally three to four months before you can resume low-impact aerobic activity such as walking, golfing, bowling and swimming. Jogging, high-impact aerobics and contact sports are never allowed. Your new knee is artificial and although it is made of very durable materials, it is subject to wear and tear.

 

The therapist will teach you how to dress, get out of bed without help and use a walker or crutches. You will continue to work to strengthen yourself in preparation for your return home.

 

It is important for you to adhere to your doctor's directions and follow proper positioning techniques throughout your rehabilitation. By the time you leave the hospital, you normally will be progressing well in regaining mobility and stability. If sutures or clips are not ready to be removed before discharge, you will be advised about who will remove them and where this will be done. It is not uncommon to still experience some pain. The full recovery period normally lasts three to six months.

 

 

 

Just prior to your discharge, you will receive instructions for your at-home recovery. Until you see the surgeon for your follow-up visit, you must take certain activity precautions.

 

As soon as you are home from the hospital, make an appointment to see the doctor.

 

Look for any changes around your incision. Contact your surgeon if you develop any of the following:

• Drainage and/or foul odor coming from the incision.
• Fever (temperature about 101 degrees F or 38 degrees C) for two days.
• Increased swelling, tenderness, redness and/or pain.

Take time to adjust to your home environment. It is normal to feel frustrated, but these frustrations will soon pass. It is okay to take it easy.

 

 

 

Depending upon the physical demands of your job, you normally can resume work when authorized by your surgeon.

 

You usually may begin driving once you are able to bear full weight on your hip. Be sure you are comfortable with your strength. Be sure to practice driving in a safe area. Once you are comfortable with your mobility, you generally may drive anywhere.

 

Sexual intercourse may be resumed at any time as long as all hip precautions are kept in mind.

 

We encourage you to be active in order to control your weight and muscle tone. It is generally three to four months before you can resume low-impact aerobic activities such as walking, bicycling and swimming. Jogging, high-impact aerobics and certain sports should be avoided. Your new hip is artificial, and although made of extremely durable materials, it is subject to wear and tear.

 

Since your rehabilitation is an individual one, please seek advice on future activities from your surgeon.

 

 

 

It is normal for you to have some discomfort. You will probably receive a prescription for pain medication before you go home. If a refill is needed, please call your surgeon's nurse a few days before you run out of pills. Contact your surgeon if your discomfort or pain increases.

 

 

 

You may be seen six weeks, five months and twelve months after your surgery. It may be requested that you see your surgeon once a year after the first year, even if you are not having any problems, to check out the condition of your new hip joint.

 

Any infection must be promptly treated with proper antibiotics because infection can spread from one area to another through the blood stream.