Total Hip Replacement Surgery

When a hip has been severely damaged or worn down by arthritis or a serious hip injury, hip replacement surgery can allow many people whose movement is disabled become more active. Total hip replacement surgery, also called total hip arthroplasty, is a surgical procedure during which damaged bone and joint tissue are removed and then replaced with new, artificial parts. The goal is to improve mobility by relieving pain and improving function of the hip joint.

What causes the hip joint to become damaged?
The most common cause of chronic hip pain and disability is arthritis.

  • Osteoarthritis occurs when the cartilage cushioning the bones of the hip wears away and the bones rub directly against each other, causing pain and stiffness.
  • Rheumatoid arthritis is a chronic inflammatory disease that causes joint pain, stiffness, and swelling.
  • Post-traumatic arthritis follows a serious hip injury or fracture when the bone and cartilage do not heal properly. The irregularities lead to more wear on the joint surfaces.

Breakdown of the hip joint can also occur when bones become damaged by an injury, tumors or insufficient blood supply.

Who is a candidate for hip replacement surgery?
The decision to have total hip replacement surgery is a joint one made by the patient, the patient’s primary care doctor, the patient’s family and an orthopaedic surgeon. Recommendations for surgery are based on the extent the patient’s pain, disability and total health status.

Patients may benefit from hip replacement surgery if

  • their pain limits everyday activities, such as walking, bending, getting out of a chair, going up stairs, getting off the toilet or getting up from the floor.
  • they are unable to sleep at night because of the pain.
  • they receive little relief from non-surgical treatments, such as physical therapy, exercise programs or anti-inflammatory drugs.
  • they suffer side effects from pain medications.

In the past, hip replacement surgery generally was reserved for people between the ages of 60 to 80 because they were less active and put less strain on an artificial hip. In recent years, however, the surgery is being used on younger people because new technology has improved the artificial parts, and the parts last longer and withstand more stress and strain.

What are the benefits of total hip replacement surgery?
Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and significant improvement in their ability to perform common activities. However, it’s important to know that the surgery will not enable someone to do more than he or she could before the hip problem developed.

How does hip replacement surgery work?
A joint is formed by the ends of two or more bones that are connected by thick bands of tissue called ligaments. The hip joint is located where the ball (femoral head) at the upper end of the femur (the long thigh bone) meets the rounded socket (acetabulum) in the pelvis. During the surgical procedure, the orthopaedic surgeon removes damaged cartilage and bone and replaces the ball of the femur and the pelvis socket with new, artificial joints. The surgical procedure generally takes 1 1/2 – 2 hours.

There are a variety of materials currently used in artificial hip joints. All of them consist of two main components: the ball component, which is made of highly polished metal, and the socket component, which is a durable plastic cup that may have an outer metal shell.

The surgeon uses one of three alternatives to secure the artificial hip joints:

  • In a cemented procedure, surgical cement is used to fill the gap between the prosthesis and the remaining natural bone to secure the artificial joint. Cemented procedures are more often used on older, less active people and on people with weakened bones, such as those who have osteoporosis.
  • In a non-cemented procedure, the artificial parts are made of porous material that allows the patient’s own bone to grow into the pores and hold the new parts in place. This form of surgery is often used on younger, more active people because it may last longer. The primary disadvantage of a non-cemented prosthesis is the longer recovery time and thigh pain that occurs as the natural bone grows and attaches to the prosthesis.
  • Sometimes a doctor may use a combination, or hybrid replacement in which a cemented ball and a non-cemented socket are used.

Soon after the surgery, sometimes even the day of the surgery, physical therapists teach a patient exercises to improve recovery. Usually within a day or two, patients are able to sit on the side of the bed and even walk with assistance. Full recovery from the surgery takes three to six months, depending on the type of surgery, the overall health of the patient, and the success of the rehabilitation.

In some cases, doctors are able to use special tools for a minimally invasive surgery when replacing the hip. Generally, recovery time is less and pain is lower when using this type of surgery.