Hip replacement involves the removal of a damaged or diseased hip joint and replacing it with an artificial implant. This type of surgery is most often to help decrease pain and improve mobility in patients living with hip osteoarthritis symptoms that have not resolved within a conservative treatment. The most common type of surgery in this regard is a total hip replacement, in which both acetabulum (the hip socket) and the head of the femur (the ball of the hip joint) are replaced.
Hip replacement surgery is considered a highly successful one with reliable outcomes. The new hip functions similar to a normal hip and significantly improves a patient’s quality of life.
With a total hip replacement, a portion of the pelvis and the head of the thighbone are completely removed. They are replaced with lookalike implants; a cup to serve as the socket, and a ball to serve as the femoral head. A metal rod is inserted into the femur to allow the new head to be secured. When only the femoral head is replaced with a prosthesis, the surgery is called a partial hip replacement.
Generally, a hip replacement is done by an orthopedic surgeon. Therefore, while traditionally an inpatient procedure is done in a hospital, some patients may qualify to have the surgery on an outpatient basis.
There are a few approaches in terms of how a surgeon may perform a hip replacement, such as the following:
- Posterior approach – This is the most common approach used. You are operated on while lying on your side; an incision is made on the outside of the hip, close to your buttocks. Muscles are then cut to access the hip joint.
- Lateral approach – This is essentially the same as the posterior approach, except that the incision is made on the outside of the hip, closer to the front of the body (instead of the buttocks).
- Direct anterior approach – You are positioned on your back and the incision is made on the front of the thigh. This is sometimes called muscle-sparing hip replacement, as the surgeon works around muscles to access the hip joint.
Risks & Complications
Some possible risks and complications can occur through hip replacement surgery associated with anesthesia, including respiratory or cardiac malfunction. Other complications regarding hip replacement surgery include:
- Blood clots – Clots can form in your leg veins right after surgery. This can be dangerous because a piece of a clot can break off and travel to your lung, heart, or, in rare cases, your brain. Fortunately, your doctor may prescribe blood-thinning medications to help reduce this risk.
- Fracture – During surgery, healthy portions of your hip joint may fracture. Sometimes, the fractures are small enough to heal on their own, however, larger fractures might need to be stabilized with wires, screws, and possibly a metal plate.
- Dislocation – Certain positions can cause the ball of your new joint to come out of the socket, particularly in the first few months after surgery. If the hip dislocates, your doctor might fit you with a brace to keep the hip in the proper position. If your hip continues to dislocate, surgery is required to stabilize the affected area.
- Change in leg length – Your surgeon takes steps to avoid the issue, however, occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contractor of muscles around the hip. In this case, progressively strengthening and stretching those muscles can help.
- Infection – Infections can occur at the site of your incision and in the deeper tissue near your new hip. Most infections are treated with antibiotics, but a major infection near your prosthesis might require surgery to remove and replace the prosthesis.
- Nerve damage – In rare cases, nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness, and pain.
- Loosening – Although this complication is rare with newer implants, your new joint might not become solidly fixed to your bone or might loosen over time, causing pain in your hip. Surgery might be needed to fix the problem.
Who Gets a Hip Replacement?
Patients at increased risk for complications are those living with severe rheumatoid arthritis or systemic lupus. Additionally, patients with Type 1 diabetes, hemophilia, or those who have had previous prosthetic joint infections, are at a higher risk of needing a hip replacement.
For other risk factors on who are required to have a hip replacement, here are a few signs when a patient will need to undergo this type of surgery:
Chronic and significant pain
Damage to your hip joint can cause chronic and significant pain, not just in your hip, but anywhere between your hip and knee. Severe pain is one of the main reasons patients seek a hip replacement, but it isn’t the only symptom that could indicate your need for this surgical procedure.
A sudden difficulty when completing tasks
The most important factor that may lead to undergoing a hip replacement is how much your injured hip is affecting your life. Even if you can manage the pain, significant disability of the hip joint can make even the most routine tasks difficult or near impossible, such as putting on your shoes or socks, walking normal distances, and standing on one leg even with assistance for added support.
Stiffness is another indication that your hip may be severely injured and in need of hip replacement surgery.
Hip joint pain is causing emotional and mental complications
The physical ramifications of hip joint pain are obvious, as it affects your ability to move and perform actions. However, chronic joint pain can also take a toll on a patient’s emotional and mental well-being. Even if you can tolerate your level of hip pain, after dealing with this symptom over the course of months or even years, you may find yourself exhibiting the signs of a mental health condition. In fact, chronic pain has been linked to both depression and anxiety.
Side effects from hip pain medications
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) and other types of pain medication your doctor prescribes are relatively safe when used for a short amount of time. However, side effects can develop with prolonged use including stomach irritation, ulcers, and an increased risk of stroke, blood clots, and heart attack.
How Does It Affect You? How Serious Is It?
Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include the following:
- Osteoarthritis – Commonly known as ‘wear-and-tear’ arthritis; osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.
- Rheumatoid arthritis – Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.
- Osteonecrosis – If there isn’t enough blood supply to the ball portion of the hip joint, such as a result of a dislocation or fracture, the bone might collapse and deform.
You might consider hip replacement if you have hip pain that:
- Persists, despite pain medication.
- Interferes with your sleeping routine.
- Worsens with walking, despite the support of a cane or walker.
- Affects your ability to go up or down the stairs.
- Having difficulty rising from a seated position.
Recommended Treatment & Rehabilitation
Preparation for a hip replacement begins weeks before your procedure and involves both getting your body ready for the surgery and recovery from it, as well as tending to practical matters. Here are some of the suggestions a doctor may give you before proceeding with the surgical procedure of a hip replacement:
- Stay active and perform any exercises suggested by your doctor to build strength.
- Try to lose weight and quit smoking to reduce your risk of complications.
- Set up household chores such as grocery runs and meal making.
- Secure recommended mobility aids, like a cane or crutches.
Generally, a hip replacement typically takes about one to two hours to complete. Despite the different surgical approaches that can be used, the steps of a hip replacement are the same.
Regional or general anesthesia is heavily required before proceeding with this kind of operation. The surgeon makes their incision using the pre-determined surgical approach and then uses precise instruments to remove the bone and cartilage from the ball-and-socket hip joint. They create surfaces that can accommodate the implants perfectly. In a total hip replacement, the cup that will serve as the new hip socket is placed first (although this is skipped in a partial hip replacement). Next, the surgeon hollows the end of the femur to place a metal rod that the artificial femoral head is then attached to. The ball is finally placed in the cup.
After any incisions are closed and surgery is complete, you are moved to recovery. Measures will be taken to control pain, minimize swelling, and get you moving safely. You will stay at the hospital for at least one night (unless you are undergoing an ambulatory procedure, in which case you will be discharged that day).
Overall, patients recovering from hip replacement urgent are advised to do hip-strengthening exercises each day. Exercise will help increase muscle flexibility and strength, which helps protect joints, and will also promote healing by increasing blood flow.
At about 6 weeks after surgery, most patients are able to scale back and perform exercises 3-4 times a week.
Below are hip-strengthening exercises that doctors and physiotherapists commonly recommended to hip replacement patients. Patients may be advised to do 10 or 15 repetitions of each exercise a few times a day. Therefore, here are some exercise examples for anyone to try:
Lie on your back with your legs extended, then contract the quadriceps muscles at the front of the thigh. During the contraction, the leg should be kept straight, so that it may seem the back of the knee is pressing down. Finally, hold this position for 5 seconds and release before repeating 2-3 times a day.
Lie on your back with your legs extended, then squeeze your buttocks, contracting the gluteus muscles. Lastly, hold for 5 seconds and release before repeating 2-3 times a day.
Lie on your back with the legs extended. Flex the new hip and its knee, bringing the knee off the bed and sliding the foot along the bed. Keep the other leg straight, then hold for 10 seconds. Heel slides work both the quadriceps and hamstring muscles and will help improve the patient’s range of motion.
Raise the foot and extend the knee until the leg is straight. Hold for 5 seconds before slowly lowering the foot until it rests on the floor again.
Straight leg raises
You must lie on your back while bending the un-operated leg so that the knee is up, and the bottom of the foot is resting on the floor. Straighten the operated leg so that it is flat against the bed. Afterwards, lift the straightened leg, raising the toes toward the ceiling. The heel should be 3-6 inches off the bed. Finally, gently lower the leg to the bed, then repeat 2-3 times a day.
Alternative & Homeopathic Treatment
Patients who have had a hip replacement must take precautions to protect their new hip(s). Below are tips and safeguard measures that can help increase comfort and decrease the risk of dislocation and other injuries:
Using a walker or cane
A walker or cane helps ensure that a person does not fall and dislocate or damage the new hip. Walkers and canes also signal to strangers to be more cautious. Strangers in public areas are generally less likely to bump, jostle, or startle a person using a cane or walker. Most patients are able to decrease dependence on their canes and walkers over time.
Treating hip pain
It is important to note that hip replacement patients get adequate pain relief. Uncontrolled pain can make it difficult to participate in rehabilitation exercises and can even lead to chronic pain. Some patients do not want to take pain medications because they worry about potential side effects or fear addiction.
In the early weeks following hip replacement surgery, many people are tired and prone to falls. People can maximize rest time and reduce the chance of falls by planning ahead. For example, put essential items like the TV remote control, phone, and tissues where they can be easily accessed. Some people attach small bags or baskets to the front of their walkers to ensure light necessities are always with them.