When pain and stiffness in your hip keep you from your daily activities, you may need a total hip replacement. The development of total hip replacement began over 40 years ago. Today, more than 200,000 people in the United States annually undergo hip replacement surgery to diminish pain and stiffness and restore mobility.
The most frequent source of debilitating hip pain is arthritis. It is estimated that 40 million people in the United States have some form of arthritis. That’s one in every seven people, one in every three families. Of the more than 100 types of arthritis, the following three are the most common causes of joint damage.
Osteoarthritis is a disease which involves the breakdown of tissues that allow joints to move smoothly. The layers of cartilage and synovium become damaged and wear away, leaving the underlying bones unprotected from wearing against each other. Osteoarthritis occurs primarily in people over 60.
Rheumatoid arthritis is a systemic disease because it may attack any or all joints in the body. It affects women more often than men and can strike young and old alike. With rheumatoid arthritis, the body’s immune system produces a chemical that attacks and destroys the synovial lining covering the joint capsule, the protective cartilage and the joint surface, causing pain, swelling, joint damage and loss of mobility.
Trauma-related arthritis, which results when the joint is injured, is the third most common form of arthritis. It also causes joint damage, pain and loss of mobility.
When conservative methods of treatment fail to provide adequate relief, total hip replacement is considered. If your X-rays show destruction of the joint, you and your surgeon will decide if the degree of pain, deterioration and loss of movement is severe enough that you should undergo the operation.
Today, your orthopaedic surgeon can replace your problem hip thanks to the development of total hip implants, which have been shown to provide long-term relief. Total joint replacement is a remarkably successful operation that has transformed the lives of many people by enabling them to be active with reduced or no pain.
A joint is a junction where two or more bones meet. The hip joint forms where the top of the femur (thigh bone) meets the acetabulum (the socket of the pelvic bone). The top of the femur is ball-shaped and fits snugly in the socket formed by the acetabulum. The bones of the hip joint are covered by a layer of smooth, shiny cartilage that cushions and protects the bones while allowing easy motion. Surrounding the hip joint is the synovial lining, which produces a moisturizing lubricant. Tough fibers, called ligaments, connect the bones of the joint and hold them in place, while adding strength and elasticity for movement. Muscles and tendons also play an important role in keeping the joint stable.
Total hip replacement or “arthroplasty” is the replacement of the ball and socket of the hip joint with artificial parts called prostheses. There are two main components used in total hip replacement. The femoral component is made of metal and replaces the ball. The acetabular component replaces the socket and may be made entirely of a very hard medical-grade plastic called polyethylene. It may also be made of a metal and polyethylene combination in which the polyethylene cup is placed inside a metal shell. The acetabular component is then secured inside the natural pelvic socket.
The natural ball portion of the femur (thigh bone) is removed during surgery and the inside of the femur (the canal) is drilled and enlarged to fit the femoral component of the hip prosthesis. The socket portion of the pelvis is also enlarged with a special surgical instrument to make room for the new artificial socket component. The femoral component is inserted down the enlarged shaft of the thigh bone. The acetabular component is inserted into the enlarged socket. The ball and socket are then fitted together and stabilized with the surrounding ligaments and muscles, just as your original hip had been.
An orthopaedic surgeon specializes in problems affecting bones and joints. Your hip evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary. It helps the surgeon understand your pain, limitations in activity and the progression of your hip problem.
After your history is taken, a physical exam is performed. The range of motion of your hips and knees are measured and your muscle strength is evaluated. The surgeon will observe how you walk, sit, bend and move.
X-rays are taken of your hip joint. You should bring any X-rays that may have been taken of your hip in the past. These X-rays will help your surgeon plan the surgery and evaluate the fit of your new hip prosthesis.
A small amount of fluid may be taken from your hip joint to check for infection or other causes of hip pain.
After your initial orthopaedic evaluation, the surgeon will discuss possible alternatives to surgery. If the X-rays show severe joint damage and no other means of treatment has provided relief, total hip replacement may be recommended.
You may be asked to see your family physician or an internal medicine doctor for a more thorough medical evaluation. To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop two weeks prior to surgery. If you are taking aspirin or certain arthritis medications, inform your surgeon; you may need to stop taking these two weeks before surgery. If you are taking aspirin under the direction of a physician for vascular or cardiacreasons, your doctor may advise you to continue taking it as directed. Your doctor may want you to donate your own blood ahead of time for a possible transfusion during surgery.
You will probably be admitted to the hospital the morning of surgery. You cannot eat or drink anything after midnight the day of surgery. The day of your surgery, you will be taken to the operating room about a half hour early.
In order to receive medications and blood transfusions during surgery, an intravenous (IV) line will be started. The anesthesiologist will speak to you before surgery, and discuss the type of anesthetic to be used.
You will awaken after your surgery in the Post-Anesthesia Recovery Room. You will remain there until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You may feel as though you only left your room for a few minutes. If you experience pain, medication will be available.
You may have a tube or drain coming through the surgical dressing that is attached to a drainage apparatus. This system provides gentle, continuous suction to remove any blood that may accumulate in the surgical area. The drain will probably be removed several days after surgery. Your dressing will be changed and a smaller one applied.
You may move the leg that was not operated on as soon as you awaken. As you lie on your back, flexing the unoperated hip will reduce aching in your lower back. The nurse will help you find comfortable positions. You may turn with a pillow between your legs. The nurse will encourage you to do ankle pumping exercises every hour to protect against blood clots An IV may remain in your arm for several days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon.
To prevent problems in your lungs, you may receive an incentive spirometer after surgery to encourage you to cough and breathe deeply. This is used every hour while you are awake.
It is normal to feel discomfort after surgery. Inform the nurse of your pain, and medication will be ordered.