Total Hip Replacement Information

What is the basic anatomy of the hip?
The hip, one of the main weight-bearing joints in the body, consists of two core parts:
  • A ball (femoral head) at the top of your thighbone (femur).
  • A rounded socket (acetabulum) in your pelvis.
Bands of tissue called ligaments connect the ball to the rounded socket. Cartilage, which cushions the bones and lets them move easily, covers the surfaces of the ball and socket. In a healthy hip, ligaments and cartilage serve as protection so that the bones do not rub against each other.
What is a total hip replacement?
Total hip replacement surgery is a procedure that involves replacing the ball at the top of your thighbone (femoral head) with a metal ball and resurfacing the hip socket with a metal shell and plastic liner. When joint replacement is performed correctly, the prosthesis enables the artificial joint to move as a normal, healthy joint. It is a good idea to watch a joint replacement video to complete understand the procedure.
Who is a candidate for total hip replacement?
Total joint replacement is usually reserved for those suffering with severe arthritic conditions.   You should consult a doctor about total joint replacement if you have:
  • Difficulty with daily work and recreational activities.
  • Long-term pain that cannot be relieved with medication or physical therapy.
  • Significant joint stiffness and loss of mobility.
  • X-rays that show advanced arthritis or other degenerative problems.
What are the reasons for total hip replacement?
The most common reason for hip replacement surgery is pain that cannot be relieved by traditional medications or physical therapy. The restricted flexibility or motion of the hip joint makes daily actions such as sitting, climbing stairs or even putting on socks a challenge.
Are hip replacements a common procedure?
According to the Centers for Disease Control and Prevention, about 332,000 total hip replacements are performed in the United States each year.
What conditions contribute to hip deterioration?
The most common conditions of hip deterioration include:
  • Osteoarthritis, which occurs when the articular cartilage cushion on top of the bone of the ball and socket joint wears down over time, causing the bones to rub against each other. The friction produces pain, swelling, stiffness, restricted motion and limited function. People over 50 years old and those with a family history of arthritis are more susceptible to the disease.
  • Rheumatoid arthritis, an autoimmune disease in which the synovial membrane becomes inflamed, produces too much synovial fluid, and damages the articular cartilage, leading to pain and stiffness. The synovial membrane is the soft tissue found between the joint capsule and the joint cavity.
  • Traumatic arthritis, which can follow a serious hip injury or fracture. In this situation the articular cartilage becomes damaged and, over time, causes hip pain and stiffness.
How will I be evaluated prior to surgery?
Your orthopaedic surgeon will review your medical history and ask general questions about your hip pain and mobility. He will perform a physical exam to assess hip motion, stability, strength and overall leg alignment. X-rays will be taken to determine the extent of damage. Occasionally, blood tests, MRI (magnetic resonance imaging), or bone scanning may be needed to determine the condition of the bone and soft tissues of your hip.
How long is the hip surgery?
The procedure generally takes a few hours to remove the damaged cartilage and bone and install the hip prosthesis. You should, however, expect to stay in the hospital for one to two  days (including the day of surgery) while your pain level is monitored and treated, and you reach your discharge goals, which you will learn about in your pre-operative total joint education class.
What activity is expected post-surgery?
Walking and light activity are important to your recovery and will begin the day of or one day following surgery. Most patients begin standing and walking with a cane/walker the day after surgery.
What complications can occur from a hip replacement surgery?
The most common complication is blood clots forming in the leg veins or pelvis. However, you can prevent blot clots by wearing support hose and taking blood thinners. Notify your doctor immediately if you experience leg pain or swelling unrelated to your incision, tenderness or redness of your calf, shortness of breath and/or chest pain.
What other precautions should be taken to ensure a full recovery?
To assure proper recovery and prevent dislocation of the prosthesis, you must take special precautions:
  • Do not use stairs without doctor consent.
  • Do not cross your legs.
  • Do not bend your hips more than a right angle (90°).
  • Do not turn your feet excessively inward or outward.
  • Use a pillow between your legs while sleeping until otherwise advised by your doctor.
What activities can I participate in with a total hip replacement?
Low-impact exercise such as walking, swimming, cycling and aerobic conditioning such as doubles tennis is generally acceptable. It is strongly suggested to avoid running or other high-impact activities as they can cause wear and tear of the implant and lead to failure.
How should someone select a joint replacement physician?
It’s important to choose a physician that  specializes in and performs only hip and knee joint replacement surgeries. Doctors that perform many different orthopaedic procedures do not usually have the level of experience needed to ensure success. If a doctor performs 350 hip and knee replacement surgeries per year, and another performs 35, success is far more likely with the surgeon who has more experience.
Patients that have joint replacement surgery will experience bone loss, which makes a second surgery even more difficult and increases chances of further complications. Dr. Brett R. Smith and Dr. G. Daxton Steele, specialize in and perform only hip and knee joint replacement surgery and have a success rate of greater than 99 percent. Outcomes are more predictable and the complications are far less if performed correctly the first time by a specialist.
What is minimally invasive total hip replacement?
Minimally invasive total hip replacement involves inserting the implants through smaller incisions rather than a slightly longer incision. This gained traction a few years ago as it was believed by some clinicians to provide quicker, less painful recovery and more rapid return to normal activity. However, experts at the Andrews Institute Total Joint Center believe the benefits of a hip replacement done through a reasonable incision have improved outcomes. Risks with minimally invasive joint surgery include the skin being stretched so much that it does not always return to normal and can increase the risk of infection, and the surgeon may not always be able to angle surgical instrumentation or the joint replacement at optimal levels. Imagine a mechanic lifting the hood of your car only eight inches, rather than opening completely to fix your motor.
What preventive measures can patients take to avoid hip replacement?
High-impact activities such as running and jumping lead to a load at the hip that may exceed seven times the a person’s body weight. The extra load on the joints can cause degeneration of the cartilage and joints, leading to arthritis. The less impact one inflicts on their body, the longer it will perform at a healthy level.
How long does a hip replacement last?
Most hip replacements will last a lifetime. However, as successful as most replacement surgeries are, the artificial joint can become loose or wear out, requiring a revision (repeat) surgery. The rate at which this happens depends on a person’s age, weight, quality of bone health, activity level and compliance with physician orders. Your physician can provide you a better estimate of what to expect after evaluating your specific condition.