Total hip replacement is an operation to replace the hip joint with an artificial hip, or
implant. The operation helps people who have hip pain that limits their
ability to function normally and who cannot get relief from other
treatments, such as medication or physical therapy. Hip pain may be the
result of arthritis, rheumatism, a hip deformity or a hip fracture.
Before surgery
Shortly before the
surgery, you'll be asked to shower or bathe. Your doctor may recommend an antibacterial soap.
You'll be given anesthesia to put you to sleep during the
surgery, and the surgeon will position you so that he or she can best
reach your hip.
During surgery
The surgeon makes an incision to expose your hip joint and
separates the muscles covering the bones. The thighbone (femur) and
hip bone (pelvis) are separated from each other, and any deformed or damaged bone and tissue are removed.
Once this is done, the surgeon is ready to begin putting the
artificial hip in place. Artificial hips are designed to resemble the
natural joint as much as possible. To mimic the original
ball-and-socket joint, implants have three parts: a stem, or long rod,
which is anchored inside the thighbone; a ball at the top of the stem;
and a cup (which is placed inside the socket in the hip bone) in which
the ball fits.
Some designs combine the stem and ball into a single piece, and
others leave them separate to allow for a more customized fit. The
components are made of a combination of metals, plastics or ceramics.
During surgery, the cup is placed in the hip socket first. The
surgeon then hollows out the center of the thighbone to make room for
the stem. The stem is secured into the thigh bone, and the ball is
secured into the cup in the pelvis. Once the hip is set, muscles and
tendons that were moved or cut are repaired or put back in place. The
surgeon then stitches the incision closed. The surgery lasts one to two hours.
Components may be placed with or without cement, or a combination may be used. If the components are "press fit" without cement, their surface is designed to encourage the bone to grow on to the implant.
Cemented and cementless implants each have benefits and risks. Your
doctor can help you understand which type of implant is best for you.
After surgery
When you wake up after surgery, you may or may not feel pain. If
you're uncomfortable, your doctor may give you pain-relief medicine.
Your new joint will be unstable for a time after your operation, and you may have to stay in the hospital for a day or two, until you can get in and out of bed by yourself, do some walking, use the bathroom, and practice exercises you will have to do at home.
Getting up and moving early reduces the risk of blood clots, which, according to the American Academy of Orthopaedic Surgeons,
are one of the most common complications of hip replacement surgery. Other
things your doctor may recommend to reduce the risk of blood clots
include wearing support hose or leg coverings and taking blood-thinning
medications.
Once you're able to get out of bed, you may have to use tools such
as a cane, crutches or a walker until your hip becomes strong and
mobile and your balance and strength improve. Your healthcare team
will help you decide what tools you need, show you how to use them and
let you know when you can quit using them.
Other precautions
When you get a hip replaced, it's important not to cross your legs
or bend your hips more than 90 degrees. You should also avoid turning
your feet too far inward or outward. Your doctor may suggest sleeping
with a pillow between your legs for a time to lessen your risk of
moving in a way that will dislodge your hip during sleep.
You must also take steps to prevent infections. Bacteria that enter
your bloodstream during teeth cleanings or other dental procedures pose
a special danger if they lodge near your hip. Therefore, your doctor
may recommend that you start taking antibiotics before dental
appointments.
Finally, realize that your new hip may activate metal detectors, such as those in airports.
Tell a security officer about your artificial hip if an alarm
activates. You may want to ask your doctor for a card confirming you
have an artificial hip and carry the card with you at all times.
Reviewed 10/12/2023