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Hip joint replacement

Definition

Hip joint replacement is surgery to replace all or part of the hip joint with an artificial joint. The artificial joint is called a prosthesis.

Alternative Names

Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty

Description

The artificial hip joint has four parts:

• A socket that replaces your old hip socket. The socket is usually made of metal.
• The liner, which fits inside the socket. It is usually plastic, but some surgeons are now trying other materials, like ceramic and metal. The liner allows the hip to move smoothly.
• A metal or ceramic ball that will replace the round head (top) of your thigh bone.
• A metal stem that is attached to the shaft of the thigh bone to make the joint more stable.

You may receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain. You may have a spinal or epidural anesthesia. In this kind of anesthesia, medicine is put into your back to make you numb below your waist.

After you receive anesthesia, your surgeon will make a surgical cut to open up your hip joint. Often this cut is over the buttocks. Then your surgeon will:

• Remove the head of your thigh bone.
• Clean out your hip socket and remove the remaining cartilage and damaged or arthritic bone.
• Put the new hip socket in place, then insert the metal stem into your thigh bone.
• Secure all the new parts in place, sometimes with a special cement.
• Place a liner and ball that fit your body in the artificial joint.
• Repair the muscles and tendons around the new joint.
• Close the surgical cut.

This surgery usually takes 1 to 3 hours.

Why the Procedure Is Performed

The most common reason to have a hip joint replaced is to relieve severe arthritis pain that is limiting your activities.

Hip joint replacement is usually done in people age 60 and older. Younger people who have a hip replaced may put extra stress on the artificial hip. That extra stress can cause it to wear out. Part or all of the joint may need to be replaced again if that happens.

Your doctor may recommend a hip replacement for these problems:

• You can't sleep through the night because of hip pain
• Your hip pain has not gotten better with other treatments
• Hip pain limits or prevents you from doing your normal activities, such as bathing, preparing meals, doing household chores, and walking

Other reasons for replacing the hip joint are:

• Fractures in the thigh bone. Older adults often have hip replacement for this reason.
• Hip joint tumors

Even when you need a hip replacement, some medical problems may lead your doctor to recommend that you not have it done. Some of these problems are:

• History of infection, which can spread to the replaced joint
• Morbid obesity (weighing over 300 pounds)
• Severe mental dysfunction
• Unhealthy skin around the hip
• Very weak quadriceps, the muscles in the front of your thigh. Weak quadriceps could make it very hard for you to walk and use your hip.

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Bleeding
• Blood clots in the legs that may travel to the lungs
• Heart attack or stroke during surgery
• Infection, including in the lungs, urinary tract, and chest

Some risks of this surgery are:

• Allergic reaction to the artificial joint
• Dislocation of the artificial joint
• Extra bone growth that can cause stiffness
• Infection that requires removing the joint
• Injury to nerves or blood vessels
• Loosening of the artificial joint over time
• Mental confusion (dementia): Many people who fracture a hip already have some problems thinking clearly. Sometimes, having a fracture and surgery can make this worse.
• Pneumonia
• Pressure sores (also called pressure ulcers or bed sores) from being in bed or a chair for long periods of time.

People who have a prosthesis, such as an artificial joint, need to carefully protect themselves against infection. You should carry a medical identification card in your wallet that says you have a prosthesis. You should take antibiotics before any dental work or invasive medical procedures.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

During the 2 weeks before your surgery:

• Prepare your home.
• Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
• Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
• If you smoke, you need to stop. Ask your doctor or nurse for help. Smoking will slow down wound and bone healing.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using crutches or a walker.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 3 to 5 days. But full recovery will take from 2 to 3 months to a year.

After surgery:

• You will have a large dressing (bandage) over your surgical cut. A small drainage tube may be placed during surgery to help drain blood that collects in your hip joint after surgery.
• You will have an IV (a catheter or tube, that is inserted into a vein, usually in your arm). You will receive fluids through the IV until you are able to drink on your own.
• You may have a Foley catheter inserted into your bladder to drain urine. Usually it is removed 2 or 3 days after surgery.
• You will wear special compression stockings on your legs. These stockings improve blood flow and reduce your risk of getting blood clots.
• Most people will also take blood-thinning medicine to reduce the risk of blood clots.
• You may be taught how to use a device called a spirometer and do deep breathing and coughing exercises. Doing these exercises will help prevent pneumonia.
• Your doctor will prescribe pain medicines to control your pain. Your doctor may also prescribe antibiotics to prevent infection.

You will be encouraged to start moving and walking as soon as the first day after surgery.

• You will be helped out of bed to a chair on the first day after surgery. You may even be asked to try walking.
• When you are in bed, bend and straighten your ankles often. You will also be taught other leg exercises to do while you are in bed to prevent blood clots. It is important to do these exercises.
• You will be encouraged to do as much as you can for yourself by the second day. This includes going to the bathroom and taking walks in the hallways, always with someone helping you.
• You will learn the proper positions for your legs and hips.

Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At a rehab center, you will learn how to safely do your daily activities on your own.

Outlook (Prognosis)

Hip replacement surgery results are usually excellent. Most or all of your pain and stiffness should go away.

Some people may have problems with infection, loosening, or even dislocation of the new hip joint.

Over time -- sometimes as long as 15 - 20 years -- the artificial hip joint will loosen. You may need a second replacement.

Younger, more active people may wear out parts of their new hip. It may need to be replaced before the artificial hip loosens.

References

Eikelboom JW, Karthikeyan G, Fagel N, Hirsh J. American Association of Orthopaedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest. 2009;135:513-520.

Harkess JW. Arthroplasty of the hip. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 7.

Jones CA. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007;33(1):71-86.

St Clair SF. Hip and knee arthroplasty in the geriatric population. Clin Geriatr Med. 2006;22(3): 515-533.

Schmalzried TP. Metal-metal bearing surfaces in hip arthroplasty. Orthopedics. 2009;32.