Comprehensive Guide to Hip Replacement Surgery 2024

Hip replacement

Comprehensive Guide to Hip Replacement Surgery

What is Hip Replacement?

Hip replacement is a surgical procedure to treat hip pain. The surgery replaces parts of the hip joint with an artificial joint. The hip joint consists of a ball (at the top of the thigh bone, also known as the femur) and a socket (in the pelvis, also known as the hip bone).

Hip replacement surgery involves replacing one or both of these parts. The goal of the procedure is to allow you to resume daily activities and exercise with less pain.

Surgeons perform more than 90% of hip replacement surgeries on adults over the age of 50. Your healthcare provider may recommend hip replacement if pain and other symptoms in your hip joint affect your ability to stand, walk, and move.

Types of Hip Replacement

The surgeon will perform either a total hip replacement or a partial hip replacement:

Total Hip Replacement: The surgeon will replace the entire hip joint with an artificial joint. They will replace the top part (femoral head) of the thigh bone (femur) and the socket that fits it. Nearly all hip replacement surgeries are total hip replacements.

Partial Hip Replacement: Partial hip replacement is very rare. The surgeon will replace only part of the hip. This is usually done only to fix certain types of broken hips (hip fractures) or to remove certain types of tumors.

Who Can Benefit from Hip Replacement

Your doctor may recommend hip replacement if you have severe pain, inflammation, and damage to the hip joint due to conditions such as:

  • Osteoarthritis (most common)
  • Rheumatoid arthritis
  • Osteonecrosis (avascular necrosis)
  • Injury such as a hip fracture
  • Tumor in the hip joint
  • Minimally Invasive Hip Replacement

Minimally invasive hip replacement aims to minimize the impact of surgery on healthy tissues, such as muscles and blood vessels.

Nowadays, orthopedic surgeons use minimally invasive techniques with all surgical approaches to access the hip. The surgeon will discuss which method is best for the patient.

When the surgery is minimally invasive, the surgeon accesses the hip joint through one or two small incisions by moving the muscles aside. This method may have several advantages, such as:

  • Reduced risk of muscle damage
  • Less pain
  • Faster and easier recovery
  • Less limping
  • Shorter hospital stay
  • Lower chance of hip dislocation

Minimally invasive hip replacement is not suitable for all patients. Your age, weight, fitness level, and other factors will help the surgeon determine if you are a good candidate.

Traditional Hip Replacement Surgery

Traditional hip replacement surgery involves a large incision that helps the surgeon access the hip, usually through the side or from the back.

Recovery from traditional hip replacement may take time because the surgeon needs to cut or separate some muscles and tendons to access the joint.

(Muscles and tendons are repaired once the artificial joint is in place.) You may be at risk of dislocation until all the supporting structures of the new hip heal.

Components of the Artificial Hip Joint

The hip joint, also called the hip prosthesis, consists of two parts:

  • A ceramic ball attached to a metal stem inserted into the thigh bone for stability.
  • A metal cup (usually made of titanium) with a plastic inner layer, attached to the socket part of the hip joint (acetabulum) to allow the artificial joint to rotate smoothly.

Procedures for Hip Replacement Surgery

Before the Surgery

The surgeon will conduct a physical examination and some tests before hip replacement surgery. They will ask you about your symptoms and check your current range of motion (how far you can move your hip).

Tell the surgeon about any medications and supplements you are taking.

The surgeon will compare the hip you will be replacing with your other hip. They will make you move your hip in different directions. These movements will help them examine the muscles supporting the hip and leg.

You may need several tests before hip replacement, including:

  • Hip X-rays.
  • Blood tests such as the basic metabolic panel (BMP).
  • Urinalysis (urine test).
  • You may need other imaging tests in addition to X-rays. Your surgeon may order:
  • MRI (magnetic resonance imaging).
  • CT scan (computed tomography).
  • EKG (electrocardiogram).

Hip replacement

During the Surgery

Hip replacement is performed in a hospital or surgery center. It is often considered an outpatient procedure, although you may need to stay a night or two for monitoring or to resolve complications.

A typical, uncomplicated hip replacement surgery involves the following steps:

  • Once you enter the operating room, you will receive an IV line (intravenous) in your hand or arm. A urinary catheter may also be inserted.
  • You will receive anesthesia, either general (whole body) or above the waist (epidural), based on the recommendation of the anesthesiologist and orthopedic surgeon.
  • The surgeon will position you appropriately to access the hip joint and make an incision. The location of the incision depends on the approach (anterior, posterior, or lateral) used by the surgeon.
  • The surgeon will remove the head of the femur (the ball part of the joint) and make an opening in the top of the thigh bone. They will then insert the stem of the artificial ball, with or without cement. The ceramic replacement head will then be attached to the top of the femoral implant.
  • The surgeon will then remove damaged cartilage from the acetabulum (the socket part of the joint) and attach the new cup.
  • The surgeon will bend and move your leg to ensure it works properly.
  • Tissue layers will be closed with dissolvable stitches. The outer layer of skin will be closed with surgical glue. No stitches will need to be removed after surgery.
  • You will be taken to the recovery room for a few hours and then moved to your hospital room. The surgeon will tell you when it is safe to return home, which may be the same day, depending on your condition.

After the Surgery

Hip replacement recovery begins immediately. You will be encouraged to get up and move as soon as possible after surgery. Patients with no other health conditions can return home once they demonstrate their ability to walk, climb stairs, and get in and out of a car.

Some patients may spend some time in an inpatient rehabilitation unit to prepare for independent living at home. Whether you return home or to a rehabilitation unit after surgery, you will need physical therapy for several weeks to regain muscle strength and a good range of motion.

Your surgeon, physical therapist, or occupational therapist will advise you when you are ready to walk with or without assistance and how to manage your pain.

The provider will discuss your rehabilitation needs, what to expect in the coming days and weeks, and how to make the most of your recovery. Your motivation and cooperation in completing physical therapy are crucial for an effective recovery and overall success of the surgery.

During recovery, be sure to:

  • Keep the surgical area clean and dry. Your doctor will give you specific instructions for bathing.
  • Take all medications as directed.
  • Keep all follow-up appointments with the surgeon.
  • Attend physical therapy and complete home exercises.
  • Resume your normal diet unless otherwise instructed.
  • Elevate the leg and use ice to control swelling.
  • Do not drive until your doctor says it is safe to do so.

Some fluid may leak from the wound site. This is normal during the first few days after surgery. Let the doctor know immediately if you experience increased redness, swelling, or discharge from the incision, severe fever, chills, or severe pain.

Advantages of Hip Replacement

Hip replacement surgeries are usually very successful. Most people who have hip replacement experience significant reductions in their symptoms—especially pain and stiffness.

Once you fully recover, you should have increased movement and range of motion (how far you can move your hip). Hip replacement usually makes it easier to walk, climb stairs, and engage in other physical activities.

Complications of Hip Replacement

Complications of hip replacement are rare, but they can occur. The most common complications include:

  • Infection
  • Blood clots in your legs (deep vein thrombosis) or lungs (pulmonary embolism).
  • Problems with the prosthesis, including loosening or dislocation.
  • Bone fractures (bone breaks) around the prosthesis.
  • Stiffness in your joint.

How long does it take to recover from hip replacement?

Everyone’s body responds differently to hip replacement surgery. It usually takes several months to recover after hip replacement. You will need physical therapy for a few months.

Your surgeon or physical therapist will give you stretching and strengthening exercises to start as soon as 24 hours after surgery. You will work on regaining strength and flexibility in your leg and hip and your ability to stand and sit.

You will need to do exercises that strengthen and stretch the muscles around the hip joint. You will also slowly resume climbing stairs, bending, and walking.

You will gradually regain your range of motion and strength over time. It may take six to 12 weeks before you can move your hip without restrictions.

How long does an artificial hip joint last?

An artificial hip joint usually lasts a long time. Many people who have hip replacement surgery have their joint last a lifetime.

It is rare, but some people may need additional surgeries on their hips in the future. Your surgeon will tell you what to expect.

Hip Replacement for People Over 70 Years Old

Everyone’s healing time from hip replacement surgery is different. Even your age does not guarantee that your recovery will be faster or take longer than someone else’s.

People over 70 years old may take longer to recover than people under 70, but there is no specific rule that guarantees how long your body will take to heal.

The most important part of your recovery is how you feel. As you progress through physical therapy and your body heals, you should notice that it is easier to move and use your hip than it was before surgery.

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