A Guide to Hip Replacement Surgery
This article explains hip replacement surgery, including the types, risks, and recovery.
Hip replacement surgery can help people with hip damage from arthritis, injury, or other conditions regain mobility. The goals are to relieve pain and improve function. Hip arthroplasty is another name for this surgery.
The hip joint is where the thigh bone (femur) and the hip bone (pelvis) meet. It is a ball-and-socket joint. The ball-shaped area at the top of the femur fits into a socket-shaped area in the pelvis.
The hip joint also contains ligaments, tendons, cartilage, and lubricating fluid.
Hip replacement surgery involves removing and replacing one or both sides of the hip joint. To replace the ball of the joint, a metal stem with a metal or ceramic ball goes into the femur.
To replace the socket of the joint, a metal or plastic socket replaces the damaged one. A spacer or lining, made of either plastic or ceramic, goes between them. Doctors rarely use all metal parts due to the risk of complications.
There are three main options for hip replacement:
- Total hip replacement: This surgery involves removing and replacing both sides of the joint — the ball and the socket.
- Partial hip replacement (hemiarthroplasty): This surgery involves removing only the ball of the femur. Doctors mainly use this to treat hip fractures in people who are older.
- Hip resurfacing: This surgery involves replacing the socket of the joint. It also involves trimming the ball and capping it with a metal covering.
A hip replacement is a surgery with risks and potential complications. You may have other treatment options. Consider getting a second opinion before having a hip replacement.
Aside from the three types of hip replacements, there are a few different replacement methods. The three major methods of replacements are:
- Cemented replacement: This method uses surgical cement to attach the prosthesis to the bone.
- Uncemented replacement: This method uses a prosthesis with a special coating that promotes bone growth into the prosthesis. Recovery involves time for your bone to grow and securely attach to the prosthesis. This method also tends to cause more thigh pain after surgery.
- Hybrid replacement: This method uses a cemented femoral stem and an uncemented socket.
The best method for you depends on the reason for the surgery and other factors. Ask your doctor about the right choice for you and why.
Doctors may recommend hip replacement to treat various hip conditions. Your doctor may consider this surgery for hip joint damage and pain due to the following:
- Hip dysplasia: This means the hip bones do not align correctly. It is usually a condition people are born with.
- Hip joint infections: Hip joint infections include septic arthritis.
- Hip joint injuries: Hip injuries including fractures, torn ligaments, and torn cartilage, may lead to irreversible joint damage.
- Osteoarthritis: Osteoarthritis is a degenerative joint disease. The breakdown of cartilage and bones within the joint results in pain, stiffness, and swelling. It is the most common reason for a hip replacement. Stem cell therapy can sometimes treat this condition instead.
- Osteonecrosis: This rare condition involves the death of bone tissue.
- Rheumatoid arthritis: This is an autoimmune disease that causes joint inflammation.
It may be time to explore hip replacement if:
- other treatments are not working
- pain occurs at rest
- pain or stiffness limits your daily activities
An orthopedic surgeon performs hip replacements. This doctor specializes in treating diseases of the bones and connective tissues.
Some orthopedic surgeons develop further expertise in treating specific joints. Look for a surgeon who focuses on treating hip conditions.
A hip replacement takes place in a hospital or surgical center using one of the following approaches:
Minimally invasive hip replacement
A minimally invasive hip replacement involves either one 3–6 inch or two 2–3 inch incisions in your hip. Surgeons use special instruments to perform the surgery through these incisions.
Minimally invasive surgery generally leads to a faster recovery and less pain than open surgery. This is because it causes less damage to tissues and muscles. However, minimally invasive surgery has an increased risk of injury to nerves, arteries, and veins. There is also an increased risk of bone fracture, wound breakdown, and improper positioning of implants.
Open hip replacement
Open hip replacement involves a 10–12 inch incision in your hip. The incision may be smaller depending on your anatomy. Open surgery lets surgeons directly view and access the surgical area. However, it involves more cutting and damage to muscle and other tissues. This leads to a longer recovery and more pain than minimally invasive surgery. Despite this, open surgery may be a better and safer method for some people.
Your diagnosis, age, medical history, general health, and personal preference all play a role in choosing the method of surgery. Ask your doctor about your options and find out which one may be best for you.
Types of anesthesia
Your surgeon will use either regional anesthesia or general anesthesia, depending on the specific procedure.
- General anesthesia: This is a combination of IV medication — that is, medication administered through a vein — and possibly additional gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
- Regional anesthesia: This type of anethesia uses a nerve block, an epidural, or spinal anesthetic. It numbs certain nerves so you do not feel anything from the waist down. You will be awake, but will have sedation to keep you relaxed and comfortable.
What to expect the day of your surgery
On the day of your surgery, you can generally expect the following:
- You will talk with a preoperative nurse.
- You will remove all clothing and jewelry and dress in a hospital gown.
- You will talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
- A team member will start an IV.
- The orthopedic surgeon will visit with you, talk about your procedure, and mark the hip being replaced.
- The anesthesiologist or nurse anesthetist will start your anesthesia. With general anesthesia, you will not remember anything else until you wake up.
As with all surgeries, hip replacement involves risks and potential complications. Complications may become serious and life threatening in some cases. They can develop during the procedure or throughout your recovery.
General risks of surgery
The general risks of surgery include:
- anesthesia reaction, such as an allergic reaction and problems with breathing
- bleeding, which can lead to shock
- blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis and can travel to your lungs, causing a pulmonary embolism
Potential complications of hip replacement
Most hip replacements are successful. Less than 2% of patients develop serious complications. Complications can include:
- continuing pain
- dislocation of the new joint
- joint stiffness
- loosening of the new joint, causing pain and the possibility of another surgery to secure the new joint
- nerve, muscle, or blood vessel damage
- uneven leg lengths occurring or worsening after a total hip replacement
- wear and tear of the new joint requiring another replacement
Reducing your risk of complications
To reduce the risk of certain complications, follow your treatment plan and:
- Alert all members of your care team if you have any allergies.
- Be careful to avoid falls after surgery.
- Follow activity and dietary recommendations before surgery and during recovery.
- Follow lifestyle recommendations, including losing weight, stopping smoking, and avoiding alchol.
- Manage existing conditions including diabetes or high blood pressure.
- Take your medications exactly as directed.
- Tell your doctor right away about any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling, or drainage.
- Answer all questions about your medical history and medications: This includes prescription and over-the-counter medications, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Arrange for a ride home after surgery: If possible, ask a friend, partner, relative, or other trusted person to drive you home from surgery.
- Getting preoperative testing as directed: Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, ECG, blood tests, and others.
- Lose excess weight: Talk with your doctor before your surgery about a balanced diet and exercise plan to lose weight, if necessary.
- Do not eat or drink before surgery as directed: Your surgery may be canceled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
- Prepare your home: Make sure you have a safe recovery area and will be able to reach necessities after surgery.
- Stop smoking as soon as possible: Even quitting for a just few days can be beneficial and can help the healing process.
- Take or stop medications exactly as directed: For hip replacement surgery, your doctor may ask you to stop or start taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Knowing what to expect can help make your road to recovery after a hip replacement as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, and your vital signs are stable. For some types of hip replacement, you may go home the same day. With a total hip replacement, it is common to stay in the hospital for a day or two.
A physical therapist will help you to begin walking the day after surgery. You will need to use crutches or a walker for several days after your surgery. You will also learn exercises to strengthen the hip, and how to properly use your new hip joint. Physical therapy usually continues for 6–8 weeks.
Recovery after surgery is a gradual process. Recovery time varies depending on the specific procedure, type of anesthesia, your general health, your age, and other factors. Full recovery can take a few months. Most people return to routine activities after this recovery period.
Will I feel pain?
There will be pain after a hip replacement. Controlling pain is important for healing and a smooth recovery. Pain management allows you to fully participate in physical therapy and rehabilitation.
Contact your doctor if you are in pain despite following your pain management plan or if your pain gets worse or changes in any way. It could be a sign of a complication.
When should I call my doctor?
For questions between appointments, contact your doctor’s office. However, you should seek immediate medical care if you have any of the following:
- breathing problems or shortness of breath
- confusion or changes in level of alertness
- chest pain, pressure, or tightness
- redness, swelling, or drainage of pus around your incision
- inability to urinate or move your bowels
- leg pain, redness, or swelling, which could mean you have a blood clot
- unexpected bleeding
Fever is another concern. It is common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
Hip replacement may cure your condition or reduce your symptoms so you can lead an active life. It may relieve your pain and restore the range of motion to your hip.
However, you may need to make changes to your everyday life, such as:
- Avoid contact sports and high impact sports, such as jogging or tennis.
- Notify your dentist that you have had a total hip replacement, as you may need to take antibiotics before dental procedures.
- Participate in low impact sports, such as walking, swimming, cross country skiing, or stationary biking.
- Practice strength training and range-of-motion exercises as recommended by a healthcare professional.
- Take extra precautions to avoid falls and injuries.
Hip replacement can help you regain use of your hip with less pain and stiffness. There are several types of hip replacements and a few ways to perform the surgery. Each type has benefits and downsides. Talk with your doctor to find out if the surgery is right for you and which option is best for you.