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hip replacement
 Why replace the hip?
What is total hip replacement?
Preparing for the surgery
The surgery
After surgery
Why replace the hip?
In a normal hip joint, a smooth lining, known as cartilage, covers the bone. This surface, along with a small amount of joint fluid, allows the joint to move smoothly.
Various diseases, such as osteoarthritis, cause the smooth cartilage lining to break down. This may be due to normal wear and tear as we get older or to other factors. As the smooth lining of the joint disappears, it becomes painful and stiff.
Indications for Total Hip Replacement include:
Severe pain in the hip associated with activity
Severe hip pain at night
Severe interference with daily activities and work
What is Total Hip Replacement
Total Hip Replacement involves the removal of the head of the femur (thigh bone) and the surface layer of its socket in the pelvis. The head of the femur is replaced with a metallic ball and stem, which fits into the canal of the femur. The socket is replaced with a combination of plastic, metal, or ceramic.
Preparing for the surgery
- Evaluation before the Surgery
- Patients are usually asked to see their primary care physician for a general exam.
- The anesthesiologist will also evaluate the patient prior to the operation and discuss the type of anesthetic.
- Routine tests are performed 2 to 7 days before surgery. These help establish if the patient is fit for surgery.
Precautions before the surgery
- Aspirin or other medications containing aspirin, or anti-inflammatories should be discontinued 1 to 2 weeks before surgery to minimize bleeding.
- If you are on a blood thinner, such as Coumadin, it should be discontinued at least several days prior to surgery, in consultation with your prescribing doctor.
- It is important to take vitamins and iron supplements before and after the operation.
- If you are overweight, try to lose weight in order to decrease the stress on the new hip.
- If you smoke, stop smoking.
- Hip surgery will not be performed when active infections are present elsewhere in the body, such as bladder or skin.
The surgery
A first time hip operation may last 1 to 3 hours. There are a number of different approaches to the hip, either from the front, back, or side of the hip. Each surgeon has his own preference.
The steps of the operation include:
An incision is made in the skin extending 5 to 10 inches along the side of the hip.
The head of the femur (thigh bone) is dislocated, and then removed to make way for the new artificial bone component.
The socket and femur are then prepared with special instruments to accept the artificial hip.
The appropriate artificial joint is then inserted and fixed to the bone either with bone cement, or tightly fitted with out cement. Fixation screws may be necessary.
Various sizes of the femoral prosthesis (the artificial thigh bone component) may then be used to equalize leg length.
The new hip is replaced into the new socket.
The stability of the new joint is maintained by the tension of the hip and thigh muscles, allowing motion and function without dislocation.
The wound is closed with suture or staples
A drain may be used to catch any oozing from the surgical wound.
After surgery
Most patients will return home in 3 to 4 days after hip surgery, depending upon the age and physical ability. The physical therapist will give patients a list of exercises to improve the strength around the hip and thigh. The therapist will also give advice on how to avoid dislocating the new joint.
If the joint has been fixed with cement, a patient may bear full weight through the leg when he or she begins to walk to the day after the surgery, with the support of crutches or a walker for the first 3 to 4 weeks, followed by a cane for another 3 to 4 weeks.
If cement is not used, the patient will not be allowed to bear full weight for 1 to 4 weeks depending upon the surgeon's choice. Crutches or a walker may be used during this time, thereafter, a cane should be used for an additional 2 to 4 weeks.
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