What is Hip Joint Replacement
Hip joint replacement, or hip arthroplasty, is a surgical procedure wherein damaged sections of the hip joint, including the femur’s head and pelvic socket, are replaced with prosthetic parts made of durable materials like metal, ceramic, or rigid plastic. This artificial joint alleviates debilitating pain, enabling smoother mobility and improved daily functionality for patients undergoing the procedure.
Total Hip Replacement vs Partial Hip Replacement
The hip joint comprises the femur’s head and the pelvic bone socket.
- Total hip replacement encompasses the replacement of both these components.
- Partial hip replacement involves the replacement of solely the femur's head.
- Hip resurfacing means the femur's head receives an artificial covering, facilitating smoother movement within the socket and preserving more of the natural bone structure.
Who Needs Hip Replacement
Hip joint replacement becomes necessary in various conditions that significantly impact a person’s mobility and quality of life:
- Osteoarthritis: Gradual breakdown of the cartilage covering the thigh bone's head and the pelvic socket leads to debilitating pain and restricted movement.
- Rheumatoid Arthritis: Inflammation in the joint's synovial fluid results in persistent pain and functional limitations.
- Osteonecrosis: Insufficient blood supply to the thigh bone's head, often due to dislocation or fracture, can lead to its collapse or deformation, necessitating intervention.
Additionally, individuals may require hip replacement due to persistent hip pain that:
- Persists despite medication
- Worsens during walking, even with supportive aids like a cane or walker
- Disrupts sleep patterns
- Causes difficulty climbing up or down the stairs
- Causes difficulty in standing from a sitting position
Parts of Hip Replacement
Hip replacement involves various components depending on the extent of the damage:
- A cup-shaped prosthesis designed to fit snugly into the pelvic bone socket.
- Cup liner, reducing friction between the thigh bone's head and the pelvic socket.
- Ball prosthesis to replace the damaged head of the thigh bone.
- Stem prosthesis, replacing the neck of the thigh bone supporting the head.
Because these prosthetic parts can be made from metal, ceramic, or durable plastic, a hip replacement can consist of prosthetic parts made from different materials. The most popular are:
Metal-on-Polyethylene
This hip replacement features a metal ball prosthesis and a plastic cup prosthesis or liner, widely compatible with various cases.
Ceramic-on-Polyethylene
A preference for younger and more active individuals, this hip replacement involves a ceramic ball prosthesis and a plastic cup prosthesis or liner. It has a high wear resistance and minimal risk of corrosion.
Surgical Techniques on Total Hip Replacement
Performing hip joint replacement involves accessing the hip joint through incisions in the skin and muscles. Here, we outline three primary surgical approaches surgeons use for total hip replacement:
Posterior Approach vs. Direct Anterior Approach
In the posterior approach, the surgeon makes an incision on the back of the thigh, close to the buttocks, and dissects through the gluteus maximus muscle.
In the direct anterior approach, the surgeon accesses the hip joint by incising the front of the hip and maneuvering muscles and tendons aside to reach the joint.
Research conducted in 2021 indicates that while the posterior approach typically results in a shorter operative time, the anterior approach often leads to shorter hospital stays and quicker returns to functional activities for patients.
Ceramic-on-Polyethylene
In this technique, the surgeon creates an incision on the side of the hip and detaches several gluteus medius tendons to access the joint.
Benefits and Risks of Total Hip Replacement
Statistics indicate that approximately 90% of individuals who have undergone total hip replacement have experienced a remarkable ten-year relief from severe hip pain.
While total hip replacement offers significant benefits, certain risks exist, as with any surgical intervention. However, serious complications arise in less than 2% of cases.
Potential risks associated with total hip replacement include:
- Blood Clots: Blood clot formation in leg veins can pose risks of vessel blockage in critical areas like the lung, heart, or brain. Therefore, blood-thinning medication is often administered to mitigate this risk post-surgery.
- Infection: The incision or the tissue near the hip prosthetics may become infected, necessitating antibiotics. Severe infections affecting bones near the hip prosthetics might require further excision and prosthetic replacement
- Nerve Damage: Although rare, nerve damage during excision can lead to numbness, weakness, and pain.
Furthermore, risks related to prosthetic parts involve:
- Fractures: Healthy parts of hip bones may fracture during surgery. While more minor fractures can heal independently, more extensive fractures may require surgical stabilization.
- Dislocation: The new hip joint may dislocate when put into certain positions because the muscles are too weak to stabilize it post-surgery. If hip dislocation persists, it might require surgical intervention.
- Leg Length Discrepancy: The new hip joint may result in the leg being longer or shorter than the other, which can often be addressed through muscle strengthening and stretching exercises.
- Joint Loosening: Although rare with newer implants, the joint may loosen over time, leading to hip pain. Surgical intervention might be necessary in such cases to address joint instability.
How to Prepare for Knee Joint Replacement Surgery
Preparation for hip joint replacement surgery is a comprehensive process to facilitate a smoother post-surgery recovery phase. This includes:
- Mobility Aid Arrangements: Planning for using walkers, crutches, or canes post-surgery requires specific home adjustments. This can involve removing rugs that can cause slips, arranging living spaces on the ground floor to avoid stair use, and installing bathroom grab bars.
- Transportation Planning: Arranging transportation is vital, especially for returning home after surgery.
- Assistance Planning: Organizing assistance for daily tasks like cooking, cleaning, shopping, laundry, and bathing during the initial recovery phase.
Approximately two weeks before the scheduled procedure, a comprehensive health assessment by the healthcare provider covers the following:
- Medication Review: Evaluating medications, particularly those impacting blood clotting or immune functions.
- Consultations with Specialists: Coordinating with specialists to ensure patient safety while considering other medical conditions.
- Lifestyle Modifications: Advising patients to refrain from smoking and alcohol consumption due to their potential impacts on oxygen supply and blood clotting.
Typically, patients are instructed to fast for eight hours before the scheduled surgery, starting at midnight.
What to Expect During Surgery
The surgery using the above mentioned techniques is completed within 1-2 hours. During this time:
- The patient is administered general anesthesia to make them unconscious throughout the procedure or
- The patient is given a spinal block that numbs the lower half of the body.
Either approach ensures that patients remain comfortable throughout the surgery, facilitating a smooth and controlled environment for the medical team to perform the hip joint replacement procedure.
After the Surgery
Recovery duration following hip joint replacement varies; some individuals may require 1-2 days to recuperate from surgery and anesthesia effects. Alternatively, certain patients might go home on the same day after spending a few hours in a recovery area.
Before hospital discharge, the patient’s medical team ensures:
Patient's Optimal Independence
The team assesses the patient’s optimal independence in activities such as getting in and out of bed, eating, drinking, using the bathroom, walking with an assistive device on level surfaces, and navigating 2 to 3 stair steps.
Sometimes, individuals may require a stay at a rehabilitation center to ensure the safe execution of daily activities before returning home.
Home Exercise Guidance
The patient is taught how to do specific home exercises recommended. These exercises will help strengthen hip muscles after the surgery and maintain range of movement.
Understanding Hip Precautions
The patient is educated on hip precautions to prevent injury and facilitate a successful recovery.
Hip Joint Replacement Treatment and Recovery
The recovery timeline to resume light activities typically spans 3-6 weeks post-surgery. Most return to their daily activities with independence within three months. However, the full recovery period can take a year or more.
Post-discharge care ensures optimal recovery without complications. The following measures are essential:
Wound Care
- Incision Maintenance: Maintaining cleanliness and dryness of the wound as guided by healthcare providers. This includes when to change the dressing and when the patient can bathe.
- Suture/Staple Removal: Sutures or staples are removed in the scheduled follow-up visit.
Leg Strengthening and Mobility through Physical Therapy
- Progressive Exercises: Home and physical therapy exercises are upgraded as the hip progressively regains functional strength, stability, and range of movement.
- Gradual Weight Shifting: A physical therapist guides the patient on gradually bearing weight on the hip throughout the sessions until they can independently walk.
Diet
- Blood Thinner Interactions: Patients on blood thinners may be advised to avoid Vitamin K supplements and foods rich in Vitamin K to prevent dangerous blood thinning.
- Adequate Fluid Intake: Encouraging patients to consume ample fluids to help thin the blood and promote healing.
- Weight Management: Being within the healthy weight range reduces stress on the hip joint.
Blood Clot Prevention
To mitigate the risk of blood clots, the following steps are undertaken:
- Encouraging Activity: Patients are encouraged to sit up and walk with mobility aids to prevent inactivity.
- Blood Thinner Medications: Prescription of blood thinners for several weeks, depending on the patient's activity level, condition, and age.
- Compression Therapy: Elastic compression on the lower legs prevents blood pooling. In some cases, pump sleeves aid blood circulation back to the heart.
Swelling Prevention and Pain Management
- Medications: Prescribed pain relievers, anti-inflammatories, and blood thinners, if necessary, to mitigate clotting risks. Antibiotics may be prescribed to prevent infection.
- Ice Therapy: The application of ice aids in pain relief and reduces swelling.
- Elevation and Compression: Mild to moderate swelling is a common symptom for 3 to 6 months after surgery. Slightly elevating the leg and employing compression techniques help manage swelling.
- Ankle Pumps: moving the foot with the toes pointed up then down helps relieve swelling.
Restrictions During Recovery Until Your Healthcare Provider Confirms It is Safe to Do So
During the recovery period post-hip joint replacement surgery, your healthcare provider might advise when to resume specific normal activities:
- Driving Restriction: Until the patient discontinues drowsiness-causing pain medication and regains strength and reflexes. The healthcare provider will help the patient determine when they can safely drive by assessing their level of independence and health.
- Work Resumption: Depending on the job's physical demands and the patient's recovery, the healthcare provider may recommend the patient take a leave for several days to weeks.
- Sleeping Positions: Certain sleeping positions, like lying on the side, might risk dislocating the new hip joint. Using a pillow between the knees or avoiding lying on the side can prevent this.
- Sexual Activities: Consulting the healthcare provider regarding the safe resumption of sexual activities post-surgery is recommended.
- Air Travel: A metal prosthetic might trigger metal detectors at airports. Carrying a medical alert card is advised. Consulting a healthcare provider before air travel is also vital due to potential swelling and pressure changes affecting the operated leg.
Hip Movements and Positions Precautions
What Can You NOT Do After a Hip Replacement?
Certain movements and positions can risk dislocating the new hip joint:
- Avoid crossing legs for 6-8 weeks.
- Prevent raising the knee higher than the hip.
- Minimize leaning forward while seated or in the process of sitting down.
- Avoid tasks like reaching for items on the floor or pulling up blankets in bed.
- Avoid waist bending beyond 90 degrees.
- When bending down, avoid turning the feet inward or outward.
What Can You Do After a Hip Replacement?
Conversely, here are recommended hip movements and positions to maintain the joint’s stability:
- Keep the leg facing forward.
- Maintain the operated leg in front in the process of sitting or standing.
- If kneeling, do so on the operated leg to keep the hip straight.
- For posterior hip surgeries, utilize a high chair to prevent the hip from bending beyond 90 degrees to avoid aggravating the incision site.
When to Call Your Healthcare Provider
Immediate contact with your healthcare provider is essential if you experience:
Signs and Symptoms of Infection
- Fever of 101°F or higher
- Shaking chills
- Incision site has:
- Inflammation
- Swelling
- Discharge of pus
- Persistent bleeding
- Exacerbation of pain during movement and rest
Signs and Symptoms of Blood Clotting
- Tenderness in the calf muscles
- Redness or tenderness on the upper or lower leg
- Swelling in the operated leg (foot, ankle, calf, or thigh) that doesn't alleviate with elevation
Signs and Symptoms of Blood Clot in the Lungs
- Shortness of breath
- Sudden chest pain
- Chest pain with coughing
Will the Hip Joint Replacement Last, or Will It Need to be Replaced?
A review from 2019 suggests that approximately 58% of hip replacements are anticipated to endure for up to 25 years.
To optimize the longevity of hip replacements and mitigate stress on the prosthetic joint, patients are advised to consider specific activities:
- Low-Impact Exercises: Engaging in activities like walking, swimming, or cycling helps maintain fitness levels while exerting minimal stress on the artificial joint.
- Avoidance of High-Impact Activities: Running or jumping can strain the hip joint replacement, potentially accelerating wear or complications.
See our dedicated page to learn more about Joint Replacements.