JOINT/Hip Replacement Overview
The hip joint is made up of a ball-and-socket. The socket is made of bone and cartilage, and the ball is the top of the thighbone, also known as the femoral head.
Hip replacement surgery is an operation used to replace the damaged ball-and-socket with new and durable artificial synthetic parts that mimic the ball-and-socket.
Sometimes, either the socket of the hip or the thighbone is injured or becomes diseased. This can result in pain, trouble with walking, or difficulty with everyday tasks. You may have already tried pain relief methods such as medications, physical therapy, supports, or braces. If the pain doesn’t subside, your doctor may recommend hip replacement surgery.
Who Needs a Hip Replacement?
According to the American Academy of Orthopaedic Surgeons (AAOS), most people who have hip joint replacements are between ages 50 and 80. These surgeries are usually performed for arthritis of the hip. Arthritis is a disease that breaks down cartilage (the cushion between bones). Without cartilage, the bones rub against each other, which can cause severe pain.
A hip replacement may be used for three types of arthritis:
rheumatoid arthritis — an autoimmune disease that leads to joint inflammation
traumatic arthritis — damage to the joint caused by an injury
osteoarthritis — a degenerative form of arthritis that’s most common in older adults
Doctors usually try to control arthritis discomfort with the use of walkers or canes, a low-impact exercise program, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. If these measures fail, a hip joint replacement is the best solution. You should consider a hip joint replacement if you can’t sleep or sit comfortably because of the pain, or if your arthritis limits your activities.
Hip replacements can also be used for other health conditions. For instance, they’re sometimes used if a tumor grows in the hip joint. Hip replacements may also be used in an emergency to fix a fracture in the hip joint or the thighbone. A condition called avascular necrosis of the hip often requires a total hip replacement.
How Is the New Hip Constructed?
The replacement hip is made up of four components:
- a metal socket
- a liner to help the ball move easily within the socket
- a metal or ceramic ball to replace the femoral head
- a metal rod used to stabilize the thigh bone to which the ball is attached
- There are different options of joint prosthesis. Most surgeons use uncemented joint prosthesis, which allows bone to grow into the prosthesis over time.
A cemented prosthesis, on the other hand, is attached to the hip with bone cement for quicker adhesion. While both options have similar success rates, they have differences in terms of recovery.
Uncemented joints take longer to attach to the bone, so the recovery time is longer. Cemented versions, while quicker, are best used for older adults or for people who are not as active.
Another option to consider is a muscle sparing hip replacement. Unlike traditional hip surgery, this procedure spares cuts through the muscles, which reduces pain and recovery time.
Muscle sparing procedures are commonly performed through anterior or posterior. The main difference between anterior and posterior is the location of the incision. Anterior incisions are made in the front by the upper thigh, while posterior incisions are made in the back of the hip.
What Happens During Hip Replacement Surgery?
Hip replacement surgery can be performed traditionally or by using what is considered a minimally-invasive technique. The main difference between the two procedures is the size of the incision.
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During standard hip replacement surgery, you are given general anesthesia to relax your muscles and put you into a temporary deep sleep. This will prevent you from feeling any pain during the surgery or have any awareness of the procedure. A spinal anesthetic may be given to help prevent pain as an alternative.
The doctor will then make a cut along the side of the hip and move the muscles connected to the top of the thighbone to expose the hip joint. Next, the ball portion of the joint is removed by cutting the thighbone with a saw. Then an artificial joint is attached to the thighbone using either cement or a special material that allows the remaining bone to attach to the new joint.
The doctor then prepares the surface of the hipbone — removing any damaged cartilage — and attaches the replacement socket part to the hipbone. The new ball part of the thighbone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.
While most hip replacement surgeries today are performed using the standard technique (one 8 to 10 inch cut along the side of the hip), in recent years, some doctors have been using a minimally-invasive technique. In the minimally-invasive approach, doctors make one to two cuts from 2 to 5 inches long. The same procedure is performed through these small cuts as with standard hip replacement surgery.
When it’s time for your operation to begin, you will be taken into the operating room. There, you may be given a general anesthetic or a medicine that makes you sleep through the surgery so you don’t feel pain.
If your surgeon believes that you have other health issues that might make general anesthesia difficult or risky (such as heart or lung conditions), they may recommend a localized or regional anesthetic. This is a small amount of medication injected into your spine that makes everything below your waist numb. Some people who receive a localized or regional anesthetic are also given sedatives to help them remain calm during the surgery.
The procedure takes anywhere from one to three hours.
What Happens After Your Surgery?
You will wake up in a recovery room. The staff will monitor your vital signs and give you medicine for your pain. When they are sure that you are stable, you will be transferred to a room in the hospital.
Your hospital stay will last three to five days. The day after the surgery, a physical therapist will help you get up and take a few steps. Some people go home immediately after discharge from the hospital, although they continue to work with a physical therapist on an outpatient basis. Other people choose to go to a rehabilitation facility or a skilled nursing facility to receive additional care and inpatient therapy services.
It’s important to prepare for your recovery, so you are able to move about easier. For example, you might consider:
having someone on hand to help you during the first few weeks of recovery
arranging for someone to drive you to and from therapy appointments
Full recovery from a hip joint replacement takes about three to six months. A cemented joint prosthesis has the longest recovery time.