Total Hip Replacement
You may not notice how critical proper hip function is to your daily life until you no longer have it. When damage occurs to the hip — due to arthritis, injury or another medical condition — even basic activities like standing up or walking can be both painful and challenging. Hip pain can also permeate into your sleep hours, preventing you from getting a good night’s rest.
Some individuals suffering from hip damage will find sufficient relief by taking medications, using walking aids, like canes, or changing how they perform daily tasks. If these efforts do not provide the desired result, total hip replacement surgery may be the next logical treatment step. This procedure replaces the diseased hip joint with a prosthesis, providing relief from pain and allowing you to resume the everyday activities you once enjoyed.
What Is Total Hip Replacement?
Total hip replacement, also called total hip arthroplasty, is a type of orthopaedic surgery. It involves removing the ball and socket of the hip and replacing it with an implant known as a hip prosthesis. The prosthesis consists of four parts: a titanium stem, ceramic or metal head and plastic liner, and titanium shell. Total hip replacement surgery is one of the most commonly performed medical procedures for patients over the age of 65, but is frequently performed in younger individuals.
Degenerative diseases of the hip joint are the most common reasons for needing total hip replacement surgery. These diseases are characterized by gradual “wear and tear” of the hip cartilage that normally cushions the hip joint. As a result of this degenerative process, the bones start to rub against each other and cause pain.
The great majority of hip problems occur in people over 50 years of age, who are usually candidates for this surgery. However, other conditions that affect health and functioning can also lead to patients needing hip replacement surgery.
Hip replacement is a major surgery usually performed under spinal anesthesia and on an inpatient basis. However, with advancements in surgical techniques and pain management, we have made it possible to have hip replacement as an outpatient procedure at the Orthopaedic Institute of Ohio.
Overview of the Hip
The hip is a ball-and-socket joint that allows for some of the major motions of the lower body like bending, squatting, climbing and walking. The socket portion of the hip is known as the acetabulum, which is a component of the pelvis or hip bone. The ball portion consists of the femoral head that is located at the top of the femur (thighbone). Cartilage covers both the components to cushion them during motion, and a capsule surrounds the joint to lubricate it and prevent friction. When any of these parts stop working correctly, it can lead to persistent pain, limited range of motion and the inability to participate in many activities. Many patients have difficulty putting on socks and shoes. In many of these cases, total hip replacement is the only way to provide relief and regain function.
How Is Total Hip Replacement Done?
A total hip replacement surgery is usually performed under general or spinal anesthesia.
During a hip replacement procedure, the surgeon makes an incision on the front or side of your hip, between 4-10 inches long. They then remove the head and neck of your thigh bone to gain access to the acetabulum (socket) connected to your pelvis. The damaged cartilage is removed and replaced with a titanium shell which is pressed fit into place, sometimes with screws.
Your surgeon then adds a spacer made of plastic into the metal socket to allow smooth gliding of the new joint. After that, your surgeon hollows out your femur bone to insert the implant stem, which is tightly fitted into place. Bone will heal onto the stem and shell over time. The stem has a metal or ceramic type ball that will replace the ball of your hip joint.
The ball and socket are then merged together, forming your new hip bone. Your incisions are closed with stitches, and you are moved to the recovery room, where nurses monitor your recovery from anesthesia. After you wake up, you are either taken to a hospital room or discharged. The whole procedure takes around two hours to complete.
Who Needs a Hip Replacement?
If you have chronic and debilitating hip pain that is preventing you from doing everyday tasks, such as sleeping at night, working, vacationing, visiting your family or friends, or is otherwise preventing you from doing whatever is important in your life, you may consider hip replacement surgery. Many people have difficulty donning and doffing socks and shoes. Different conditions can lead to chronic hip pain and the potential need for total hip arthroplasty:
Osteoarthritis
The most common reason for hip pain is osteoarthritis. It occurs when the joint wears out or becomes damaged over time. Cartilage protecting the joint thins, and the bones of the joint begin to rub against each other and form osteophytes. This condition usually is not seen until the 60s or 70s.
Rheumatoid Arthritis
This autoimmune disorder can lead to chronic inflammation of the hip and a breakdown of the cartilage. These issues can lead to significant pain and reduced mobility, necessitating treatment to stop the damage. While hip replacements do not “cure” systemic rheumatoid arthritis, they can dramatically improve a patient’s quality of life over the long term by reducing symptoms and increasing the function of the replaced hip.
Post-Traumatic Arthritis
This type of arthritis is a long-term result of a previous injury like a fracture or dislocation. The damage that occurs can lead to the deterioration of cartilage, which can cause pain and other symptoms over time.
Avascular Necrosis
This condition is also caused by an injury to the hip but is attributed to the diminished blood supply to the head of the femur as a result of the damage. Lack of blood can lead to sometimes rapid deterioration of the bone over time, which may result in chronic pain and stiffness in the joint.
Childhood Hip Conditions
Children are sometimes born with structural defects in the hip. Even if they are successfully treated at an early age, these problems can affect how the hip develops and increase the incidence of arthritis later in life as well. Children sometimes develop a different condition called juvenile idiopathic arthritis (JIA), which can cause permanent damage to the hip joint that will require hip replacement surgery later in life.
Benefits of Total Hip Replacement
The number one advantage of total hip replacement is relief from pain. Patients with osteoarthritis of the hip often experience excruciating pain that prevents them from doing simple tasks like putting on socks or walking.
However, there are many other advantages to getting this surgery:
Improved mobility. With the pain now gone, patients are able to move freely following hip replacement surgery. Walking, climbing stairs, bending and other motions are effortless again.
Improved well-being. Chronic pain from hip problems can lead to sleep problems, depression and severely limited life. Patients who undergo this surgery can resume their normal activities and see their well-being improve greatly.
Long-lasting results. Total hip replacement has a high success rate and offers long-lasting results. The majority of treated patients do not need Revision Hip Replacement even 20 or 30 years after their procedure.
Is Total Hip Replacement Right for You?
Hip replacement surgery has been performed for nearly six decades, and the techniques and prosthetics have continued to improve over that time. Today, more than 300,000 hip replacements are done in the United States each year, according to the Agency for Healthcare Research and Quality. How do you know if you should be one of the people undergoing this procedure? There are some specific circumstances when surgery might be recommended:
- Your hip pain interferes with daily activities like walking, bending, and other routine activities of daily life
- Pain and stiffness in the hip that limits your range of motion
- Hip pain that interferes with your ability to sleep at night
- Hip pain that impairs your ability to work or do anything else that is important to you in your life
- Insufficient relief from medications, walking assistance or therapy exercises
Our team at the Orthopaedic Institute of Ohio will provide a comprehensive assessment of your condition, symptoms and concerns to help you determine whether surgery might be the best option for you.
Implant Options
Hip implants consist of two primary components designed to work together as the natural hip joint. The first component is the ball component, which replaces the damaged femoral head. The ball features a long stem that is set into the femur after space is created inside the bone. The ball is usually constructed of metal or a stable ceramic material. The stem is made of titanium. The second component is the synthetic socket that fits into the pelvic bone. This component is crafted of titanium with a polyethylene or “plastic” liner. Your surgeon will determine the best device and method based on the severity of damage to your joint and other factors.
Before Your Hip Replacement Procedure
A couple of weeks before your operation, you will need to undergo a series of medical tests to see if you are a candidate for this procedure and to help your surgeon determine the best approach for your case. These tests usually include:
Reviewing medical history. Your surgeon will ask questions about your general health, the extent of your hip pain and your level of functioning.
Physical exam. Your surgeon may also need to perform a physical exam to look for muscle wasting and abnormalities in alignment and movement to help with establishing a treatment plan.
X-rays and MRI scans. Imaging tests help surgeons see the type and extent of damage to the hip joint and the condition of the surrounding bone and tissue. This helps determine which procedure will give you the best possible outcomes.
Blood and urine tests. To see if you are healthy enough to undergo surgery, we may also ask for blood work and urinalysis.
At your consultation, our team will provide guidance on how to prepare for your surgery. Most patients are asked to cease taking blood thinners, quit smoking and start losing weight if overweight. Patients are also given instructions to help with their recovery, such as to arrange for walking aids and for someone to help them during recovery.
Hip Replacement Surgery Overview
Your surgeon will perform your hip replacement under general or spinal anesthesia, ensuring you will be comfortable during the operation. An incision will be made along the hip to allow for access to the damaged joint, so the prosthetic may be placed. Some patients may qualify for a less invasive technique depending on body habitus and hip abnormality. Your surgeon will determine whether this method might be an option for you.
The procedure will take a couple of hours as the surgeon removes the damaged areas of bone, so the prosthetic can adhere securely to the joint. You may also spend one or two days in the hospital after your surgery to receive the attentive care necessary during the early days of your recovery process. Some patients may qualify for outpatient hip surgery and may go home the same day. Once you are ready to leave the hospital, you will most likely be discharged to your home. However, occasionally, patients may need to go to a rehab or nursing facility to recover.
Total Hip Replacement Recovery
You are strongly encouraged to begin walking soon after your hip replacement surgery since this can reduce your risk for blood clots and speed the healing process. You may also be required to take blood-thinning for a few weeks after your procedure to further reduce your clot risk. You will also have supervised physical therapy and exercises to perform at home to strengthen your new hip and restore your range of motion. The better you adhere to your exercise program, the quicker and more comfortable your recovery is likely to be. Most hip replacement patients are back to their usual routine activities within four to six weeks, and almost all non-strenuous activities within 8 to 12 weeks.
How Long Does a Hip Replacement Last?
A systematic review and meta-analysis of case series and national registry reports found that 60 percent of all patients can expect their hip replacements to last 25 years, if not more.
Ultimately, how long your hip implant will last depends on your general health, weight, activity levels and type of implant.
Hip implants can wear down over time, just like any other medical device. Young people and athletic types are more likely to put strain on their implants than older adults engaging in moderate activity. If you have uncontrolled diabetes, you have a higher risk of developing complications related to your total hip replacement.
Modern implants are produced with better materials and technologies and are more durable than implants produced several decades ago. Studies show that these may last a lifetime with moderate physical activity and good health depending on the age of implantation.
Relief from Pain, Restoration of Activity
Hip replacement offers significant relief from pain and stiffness for most patients, which can be very long-lasting. This procedure has a high patient satisfaction rate when it is performed well, which is why choosing an experienced surgeon is so critical to the process. Our surgeons have considerable experience and expertise in a variety of hip replacement techniques including the latest technologies available, allowing us to tailor surgery to the unique needs of each of our patients. Contact the Orthopaedic Institute of Ohio today at 419-222-6622 to schedule a consultation and find out if hip replacement is right for you.
