Total Hip Replacement

In total hip replacement, a surgeon will replace your damaged hip joint with an artificial joint. A joint is made of two or more bones, some cartilage, connective ligaments, and the muscles that control the movement of the joint. Normally, cartilage covers the ends of the bones to help them slide on each other smoothly. If your cartilage is diseased, movement at the joint can be very painful. Total hip replacement surgery will remove the areas of the joint that are causing pain and replace them with artificial parts that will move smoothly and reduce the pain you feel in your hip.

Total joint replacements are designed to help you walk and do routine daily activities without pain. They are not designed for and will not hold up to the stresses of vigorous athletic activity.

The artificial parts that are used for hip replacement surgery are together called a "prosthesis". The prosthesis includes a sturdy plastic cup to replace the hip socket (acetabulum). This component may have a metal backing and a metal shaft that has a smooth ball at one end. The pieces may actually be fitted together to work like the top of your thigh bone (femur). The ball fits into the socket of the plastic cup.

The plastic cup is very strong and is usually made of a material called polyethylene. The metal ball and stem are usually made of stainless steel, titanium, or other metal alloy. The shaft end of the metal piece will be fitted down into your femur bone. There are two ways that the prosthesis can be attached to your bone:

• A cemented prosthesis uses a special type of cement to hold the pieces of your artificial joint in place.
• A different method of fixation is to use an uncemented prosthesis that is made of a material that is "porous". This means the material has tiny holes in it that your bone can grow into. Your doctor will decide which of these two methods is best for your surgery. It is common for the surgeon to use cement for the thigh component and to use an uncemented socket.

Before Surgery

• You may begin an exercise program for before your surgery that will help you during your recovery.
• Work with your doctor to think ahead about your rehabilitation time after surgery; you may need to have some additional help at home for a few weeks.
• Your doctor may have you take some antibiotic medications before and after your surgery to help reduce the risk of infection.
• Your doctor may suggest that you donate some of your own blood so that it will be available if your body needs it during surgery. You can donate blood up to 5 weeks before your operation.
• You should not have any skin infections or irritations on your hip or leg at the time of surgery. Call you surgeon prior to the surgery if any of these problems occur. You should wash your leg with soap before going to the surgical center for your procedure.

Complications
The complication rate following total hip replacement is low. Serious complications occur in fewer than 2% of patients. Talk with your doctor before surgery about the risks of hip replacement surgery. Some of the risks include the possibility of infection, loosening of the prosthesis attachment to your bone, prosthetic breakage, and joint stiffness. Any of these complications can limit or prolong your recovery.

A deep vein thrombosis, or DVT, is the most common serious complication with joint replacement surgery. A DVT occurs when the blood in your veins forms a clot or thrombus. This most commonly happens in your calves. The clot may extend into the thighs or pelvis. If a portion of the blood clot breaks loose, it may travel in your veins up your lungs and get caught there. This can block blood flow in the lungs. This is called a pulmonary embolism and can be dangerous. To prevent this, you doctor may put you on a blood thinning medication that will prevent those clots from forming. You can also wear stockings on your legs that will help the circulation in your legs. While in the hospital you may be given compression stockings to help decrease the risk of DVT.

The Day of your Surgery
You will probably need to be at the surgery center or hospital a couple of hours before your surgery. The nurses may give you an intravenous (IV) line so you can receive fluids and medications. You will be given anesthesia that will numb the hip area, or you may be given general anesthesia that will let you "sleep" through the joint replacement surgery.

During the Surgery
After the anesthesia takes effect, the doctors will make an incision over the hip and will replace your joint with the prosthesis pieces. After the joint is replaced, the doctor will close the incision with sutures or staples.

After Surgery
After your surgery, will have intravenous (IV) medications for about a day to help reduce the risk of infection, to help prevent blood clots, and to help control pain. Most patients do have some pain following surgery while their muscles and tissues heal. You will probably stay in the hospital less than one week. Once you are out of the hospital, you will need to walk with crutches, a cane or a walker for three to four weeks to allow your tissues to heal from the surgery. Your doctor will help you get involved in some physical therapy to help move your recovery process along by regaining muscle strength and motion around your joint. Most hip replacement patients are fully recovered in three to six months.

Starting an exercise program will help with the recovery process. Talk with your orthopaedic surgeon about the best exercise program to help your recovery process. Swimming and walking are exercises that will put minimal stress on your hip and will help you regain strength and improve your overall health. You probably will be advised against doing activities (such as running and tennis) that put a lot of stress on your hip.