• Hip Replacement

    (Hip Arthroplasty; Arthroplasty, Hip; Total Hip Replacement; Minimally Invasive Total Hip Replacement; Mini-incision Hip Replacement)

    Definition

    A total hip replacement is a surgery to replace a diseased or injured hip joint. An artificial ball-and-socket joint is inserted to make a new hip. The artificial joint is called a prosthesis.
    A minimally invasive total hip replacement is also a surgery to replace a diseased or injured hip joint. This surgery only requires one or two tiny incisions and special instruments. People eligible for this surgery are typically:
    • Younger than 50
    • Normal weight
    • Healthier than those who undergo the traditional total hip replacement surgery
    Left Total Hip Replacement
    Hip Replacement
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    This surgery is done when pain and stiffness limit your normal activities. This pain and stiffness is usually due to osteoarthritis. Surgery is done when other treatments have been tried and are no longer working. These other treatments include rest, medicines, and physical therapy.
    Other reasons for sugery may include a broken hip, rheumatoid arthritis, bone tumors, and loss of blood supply to the bones of the hip.

    Possible Complications

    If you are planning to have a hip replacement, your doctor will review a list of possible complications, which may include:
    • Hip dislocation (most common complication)—occurs when the ball portion of the prosthesis dislocates from its normal position in the hip
    • Infection
    • Blood clots
    • Swelling or bleeding
    • Injury to nearby nerves or blood vessels
    • Anesthesia-related problems, like pneumonia
    • Noisy or “squeaky” hip after surgery
    Factors that may increase the risk of complications include:
    • Pre-existing medical condition (such as heart or lung problems)
    • Obesity
    • Infection (such as urinary tract infection, gum disease)—Having an infection increases the risk of bacteria entering the bloodstream and infecting the joint.
    • Previous problems with blood clots
    • Smoking
    Be sure to discuss these risks with your doctor before the surgery.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • X-rays—a test that uses radiation to take a picture of structures inside the body
    • Blood tests
    • MRI scan—a test that uses a magnetic field to make pictures of structures inside the body
    • CT Scan—a special type of x-ray that uses a computer to make pictures of structures inside the body
    In the time leading up to the procedure:
    • Try to lose weight if you are overweight. This will decrease the amount of stress on your new joint. Pool exercise may be a good option.
    • To enhance safety and recovery, make home modifications:
      • Install safety bars, a raised toilet seat, a shower bench, and hose. Install handrails on stairways and steps.
      • Remove throw rugs. Check to make sure extension cords are in a safe place.
      • Purchase a stable, firm-backed arm chair. When seated, your knees should remain lower than your hips.
      • Buy items to make daily activities easier (such as reachers, dressing aids).
      • Place items so that they are easy to reach. This way, you will be able to avoid bending.
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (such as aspirin)
      • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
    • Your doctor may suggest donating your own blood for the surgery. You will most likely lose some blood and fluid during this surgery. If you need a blood transfusion, the doctor can use your own blood.
    • If you become sick or have a fever just before the surgery, tell your doctor right away.
    • Arrange for a ride to and from the hospital. Also, arrange for help at home.
    • If you smoke, try to smoke less or stop smoking.
    • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight. If you have diabetes, ask your doctor if you will need to adjust your medicine.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

    Description of the Procedure

    Total Hip Replacement
    The doctor will make an incision along your joint. The muscles will be moved aside. The damaged bone and cartilage of the hip joint will be removed. The doctor will then prepare the remaining bone for the prosthesis. The new artificial joint will be placed in position. Depending on the type of prosthesis, the doctor may use bone cement to hold one or both parts of the artificial hip firmly to your bone. Lastly, the incision will be closed with stitches or staples.
    Minimally Invasive Total Hip Replacement
    This surgery may be done with one or two incisions.
    For both types, special tools are used that fit into these small incisions. In some cases, x-rays will be used to help guide the doctor.
    For the one-incision surgery, the doctor will make an incision over the outside of your hip. The doctor will move the muscles and tendons out of the way. Next, the damaged bone and cartilage of the hip joint will be removed. The doctor will prepare the remaining bone for the prosthesis. The new artificial joint will then be placed in position. Depending on the type of prosthesis, bone cement may be used to hold the artificial hip in place. Lastly, the incision will be closed with staples or stitches.
    In a two-incision surgery, the doctor will make an incision over the groin and another over the buttock. The above process will then be followed.
    Placement of Prosthesis
    hip replacement hardware
    Copyright © Nucleus Medical Media, Inc.
    Placement of Prosthesis
    hip replacement hardware
    Copyright © Nucleus Medical Media, Inc.

    How Long Will It Take?

    • Total hip replacement: 1-1½ hours
    • Minimally invasive total hip replacements: 1 or more hours

    How Much Will It Hurt?

    You will have pain after the surgery. Pain medicine will be given to help with pain.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is:
    • 4-6 days for a total hip replacement
    • 1-2 days for minimally invasive total hip replacement
    Your doctor may choose to keep you longer, if complications arise. In some cases, you may need to stay in a rehab unit. The focus will be on regaining function.

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital, you may need to:
    • Walk with help, using a walker, on the day after surgery.
    • Be careful. A fall can damage or dislocate the new joint. Do not try to walk without help.
    • Take medicine to prevent blood clots.
    • Wear compression boots or stockings.
    • Begin physical therapy to regain mobility and strength.
    • Breathe deeply and cough 10-20 times every hour—This will decrease the risk of fluid build-up in the lungs. The fluid can cause pneumonia.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Keep the incision area clean and dry.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • When seated, place a V-shaped pillow between your legs. This will help you to maintain correct positioning of your hip.
    • Work with the physical therapist. You will learn how to move your hip and maintain proper alignment. You should also talk to your doctor and physical therapist about ways to prevent dislocations. Depending on your surgery, you may need to avoid crossing your legs, flexing your hips more than 90 degrees, and turning your feet very far inward or outward.
    • Only take medicines recommended by your doctor. Do not take over-the-counter remedies without your doctor's approval.
    • Inform your dentist of your surgery. You may need antibiotics for some dental procedures. This will decrease the risk of bacteria entering the bloodstream and traveling to the prosthesis.
    • Maintain a healthy weight. Obesity can increase wear on your new joint.
    • Avoid jogging and other high-impact sports. This can also increase wear on the joint, cause it to loosen, and cause pain.
    • Be sure to follow your doctor’s instructions.
    Within six weeks, you should be able to resume normal light activities. A replacement hip typically lasts 10-15 years.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occur:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge around incision site
    • Pain and/or swelling in the feet, calves, or legs
    • Cough, shortness of breath, chest pain
    • Severe nausea or vomiting
    • Hip pain that you cannot control with the medicines you have been given or that becomes worse
    • Numbness, tingling, or loss of feeling in your leg, knee, or foot
    • Pain, burning, urgency or frequency of urination, or persistent blood in the urine
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org/Pages/default.aspx

    National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

    CANADIAN RESOURCES

    The Arthritis Society http://www.arthritis.ca

    Canadian Orthopaedic Association http://www.coa-aco.org

    References

    Al Muderis M, Bohling U, Grittner U, Gerdesmeyer L, Scholz J. Cementless total hip arthroplasty using the Spongiosa-I fully coated cancellous metal surface: a minimum twenty-year follow-up. J Bone Joint Surg Am. 2011 Jun 1;93(11):1039-1044.

    Activities after hip replacement. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00356. Accessed November 18, 2008.

    Antibiotic prophylaxis for bacteremia in patients with joint replacements. American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/news/aaosnow/may09/cover2.asp. Published February 2009. Accessed November 10, 2009.

    Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl 3):338S-400S.

    Hip fracture. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated July 2009. Accessed July 21, 2009.

    Hip replacement. National Institute of Arthritis, Musculoskeletal, and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Hip%5FReplacement/default.asp. Accessed November 17, 2008.

    Lindström D, Azodi, Sadr O, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. AnnSurg. 2008;248:739-745.

    Minimally invasive hip replacement surgery. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00404. Accessed November 17, 2008.

    Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. Surgical technique. J Bone Joint Surg Am. 2009 Mar 1;91 Suppl 2 Pt 1:50-73.

    Skerker RS, Mulford GJ. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Hanley and Belfus; 2002 (chap 56).

    Who needs a hip replacement? NIH SeniorHealth website. Available at: http://nihseniorhealth.gov/hipreplacement/whoneeds/01.html. Accessed March 11, 2013.

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