This information will
help you understand the benefits and limitations of total hip replacement. This
article describes how a normal hip works, the causes of hip pain, what to expect
from hip replacement surgery, and what exercises and activities will help
restore your mobility and strength and enable you to return to everyday
activities. If your hip has been damaged by arthritis, a fracture or other
conditions, common activities such as walking or getting in and out of a chair
may be painful and difficult. Your hip may be stiff and it may be hard to put on
your shoes and socks. You may even feel uncomfortable while resting.
If medications, changes in your everyday activities, and the use of walking aids
such as a cane are not helpful, you may want to consider hip replacement
surgery. By replacing your diseased hip joint with an artificial joint, hip
replacement surgery can relieve your pain, increase motion, and help you get
back to enjoying normal, everyday activities.
The hip is one of the body's largest weight-bearing joints. It consists of two
main parts: a ball (femoral head) at the top of your thighbone (femur) that fits
into a rounded socket (acetabulum) in your pelvis. Bands of tissue called
ligaments (hip capsule) connect the ball to the socket and provide stability to
The bone surfaces of the ball and socket have a smooth durable cover of
articular cartilage that cushions the ends of the bones and enables them to move
A thin, smooth tissue called synovial membrane covers all remaining surfaces of
the hip joint. In a healthy hip, this membrane makes a small amount of fluid
that lubricates and almost eliminates friction in your hip joint.
Normally, all of these parts of your hip work in harmony, allowing you to move
easily and without pain.
Common Causes of Hip Pain and Loss of Hip Mobility
The most common cause of chronic hip pain and disability is arthritis.
Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most
common forms of this disease.
- Osteoarthritis usually occurs in
people 50 years of age and older and often individuals with a family history of
arthritis. It may be caused or accelerated by subtle irregularities in how the
hip developed. In this form of the disease, the articular cartilage cushioning
the bones of the hip wears away. The bones then rub against each other, causing
hip pain and stiffness.
- Rheumatoid arthritis is an
autoimmune disease in which the synovial membrane becomes inflamed, produces too
much synovial fluid, and damages the articular cartilage, leading to pain and
- Traumatic arthritis can follow a
serious hip injury or fracture. A hip fracture can cause a condition known as
osteonecrosis. The articular cartilage becomes damaged and, over time, causes
hip pain and stiffness.
Is Hip Replacement Surgery for You?
Whether to have hip replacement surgery should be a cooperative decision made by
you, your family, your primary care doctor, and your orthopaedic surgeon.
Although many patients who undergo hip replacement surgery ,orthopaedic surgeons
evaluate patients individually. Recommendations for surgery are based on the
extent of your pain, disability, and general health status-not solely on age.
You may benefit from hip replacement surgery if:
- Hip pain limits your everyday activities such as
walking or bending.
- Hip pain continues while resting, either day or
- Stiffness in a hip limits your ability to move or
lift your leg.
- You have little pain relief from anti-inflammatory
drugs or glucosamine sulfate.
- You have harmful or unpleasant side effects from
your hip medications.
- Other treatments such as physical therapy or the
use of a gait aid such as a cane do not relieve hip pain.
The Orthopaedic Evaluation
The orthopaedic evaluation will typically include:
A medical history, in which your orthopaedic surgeon gathers information about
your general health and asks questions about the extent of your hip pain and how
it affects your ability to perform every day activities.
A physical examination to assess hip mobility, strength, and alignment.
X-rays (radiographs) to determine the extent of damage or deformity in your hip.
Occasionally, blood tests or other tests such as MRI (magnetic resonance imaging
or bone scanning may be needed to determine the condition of the bone and soft
tissues of your hip.
What to Expect From Hip
An important factor in deciding whether to have hip replacement surgery
understands what the procedure can and cannot do.
Most people who undergo hip replacement surgery experience a dramatic reduction
of hip pain and a significant improvement in their ability to perform the common
activities of daily living. However, hip replacement surgery will not enable you
to do more than you could before your hip problem developed.
Following surgery, you will be advised to avoid certain activities, including
jogging and high-impact sports, for the rest of your life. You may be asked to
avoid specific positions of the joint that could lead to dislocation.
Even with normal use and activities, an artificial joint (prosthesis) develops
some wear over time. If you participate in high-impact activities or are
overweight, this wear may accelerate and cause the prosthesis to loosen and
Preparing for Surgery
If you decide to have hip replacement surgery, you may be asked to have a
complete physical examination by your primary care doctor before your surgical
procedure. This is needed to assess your health and identify conditions that can
interfere with your surgery or recovery.
Several tests may be needed to help plan your surgery: blood and urine samples
may be tested and a cardiogram and chest x-rays (radiographs) may be obtained.
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If
either is present, contact us to improve your skin before surgery.
One ortwo bottle of blood may
Doctor will advise you which medications you should stop or can continue taking
If you are overweight, your doctor may ask you to lose some weight before
surgery to minimize the stress on your new hip and possibly decrease the risks
Although infections after hip replacement are not common, an infection can occur
if bacteria enter your bloodstream. Because bacteria can enter the bloodstream
during dental procedures, you should consider getting treatment for significant
dental diseases (including tooth extractions and periodontal work) before your
hip replacement surgery. Routine cleaning of your teeth should be delayed for
several weeks after surgery.
Individuals with a history of recent or frequent urinary infections and older
men with prostate disease should consider a urological evaluation before
Although you will be able to walk with crutches or a walker soon after surgery,
you will need some help for several weeks with such tasks as cooking, shopping,
bathing, and laundry.
The following is a list of home modifications that will make your return home
easier during your recovery:
- Securely fastened safety bars or handrails in your
shower or bath
- Secure handrails along all stairways
- A stable chair for your early recovery with a firm
seat cushion (that allows your knees to remain lower than your hips), a firm
back, and two arms
- A raised toilet seat
- A stable chair for bathing
- A dressing stick, a sock aid, and a long-handled
shoe horn for putting on and taking off shoes and socks without excessively
bending your new hip
- A reacher that will allow you to grab objects
without excessive bending of your hips
- Firm pillows for your chairs, sofas, and car that
enable you to sit with your knees lower than your hips
- Removal of all loose carpets and electrical cords
from the areas where you walk in your home
You will most likely be admitted to the hospital on the day of your surgery.
Prior to admission, a member of the anesthesia team will evaluate you. The most
common types of anesthesia for hip replacement surgery are spinal & epidural
anesthesia (which allows you to breath on your own but anesthetizes your body
from the waist down). The anesthetist will discuss with you about type of
The surgical procedure takes a few hours. Your orthopaedic surgeon will remove
the damaged cartilage and bone and then position new metal, plastic, or ceramic
joint surfaces to restore the alignment and function of your hip.
Many different types of
designs and materials are currently used in artificial hip joints. All of them
consist of two basic components: the ball component (made of a highly polished
strong metal or ceramic material) and the socket component (a durable cup made
of plastic, ceramic or metal, which may have an outer metal shell).
Special surgical cement may be used to fill the gap between the prosthesis and
remaining natural bone to secure the artificial joint.
A noncemented prosthesis has also been developed and is used most often in
younger, more active patients with strong bone. The prosthesis may be coated
with textured metal or a special bone-like substance, which allows bone to grow
into the prosthesis.
A combination of a cemented ball and a noncemented socket may be used.
Your orthopaedic surgeon will choose the type of prosthesis that best meets your
After surgery, you will be moved to the recovery room where you will remain for
1 to 2 hours while your recovery from anesthesia is monitored. After you awaken
fully, you will be taken to your hospital room.
POSTOPERATIVE PAIN RELIEF:
You will be pain free postoperatively. Continuous infusion pump via epidural
catheter (certain pain relieving drugs will administered at fixed rate through
epidural catheter) will be given.
Your Stay in the Hospital
You will usually stay in the hospital for a five to seven days.
To avoid lung congestion after surgery, you will be asked to breathe deeply and
To protect your hip during early recovery, a positioning splint, such as a
V-shaped pillow placed between your legs, may be used.
Walking and light activity are important to your recovery and will begin the day
of or the day after your surgery. Most patients who undergo total hip
replacement begin standing and walking with the help of a walking support and a
physical therapist the day after surgery. The physical therapist will teach you
specific exercises to strengthen your hip and restore movement for walking and
other normal daily activities.
The complication rate following hip replacement surgery is low. Serious
complications, such as joint infection, occur in fewer than 2% of patients.
Major medical complications, such as heart attack or stroke, occur even less
Blood clots in the leg veins or pelvis are the most common complication of hip
replacement surgery. Doctor may prescribe one or more measures to prevent blood
clots from forming in your leg veins or, if they do form, measures to prevent
them from becoming symptomatic. These measures may include special support hose,
inflatable leg coverings, ankle pump exercises, and blood thinners.
Leg-length inequality may occur or may become or seem worse after hip
Over years, the hip prosthesis may wear out or loosen. This problem will likely
be less common with newer materials and techniques. When the prosthesis wears,
bone loss may occur because of the small particles produced at the wearing
surface. This process is called osteolysis.
You will have stitches or staples running along your wound or a suture beneath
your skin. The stitches or staples will be removed approximately 2 weeks after
Avoid getting the wound wet until it has thoroughly sealed and dried. A bandage
may be placed over the wound to prevent irritation from clothing or support
Some loss of appetite is common for several weeks after surgery. A balanced
diet, often with an iron supplement, is important to promote proper tissue
healing and restore muscle strength. Be sure to drink plenty of fluids.
Exercise is a critical component of home care, particularly during the first few
weeks after surgery. You should be able to resume most normal light activities
of daily living within 3 to 6 weeks following surgery. Some discomfort with
activity and at night is common for several weeks.
Avoiding Problems After Surgery
Blood Clot Prevention
Follow your orthopaedic surgeon's instructions carefully to minimize the
potential risk of blood clots, which can occur during the first several weeks of
Warning signs of possible blood clots include:
- Pain in your calf and leg that is unrelated to your
- Tenderness or redness of your calf
- Swelling of your thigh, calf, ankle, or foot
Warning signs that a blood clot has traveled to your lung include:
- Shortness of breath
- Chest pain, particularly with breathing
Notify your doctor immediately if you develop any of these signs.
The most common causes of infection following hip replacement surgery are from
bacteria that enter the bloodstream during dental procedures, urinary tract
infections, or skin infections. These bacteria can lodge around your prosthesis.
Following your surgery, you may need to take antibiotics prior to dental work,
including dental cleanings, or any surgical procedure that could allow bacteria
to enter your bloodstream. For many people with joint replacements and normal
immune systems, the Orthopaedic Surgeon recommends antibiotic prophylaxis before
Warning signs of a possible hip replacement infection are:
- Persistent fever (higher than 100°F orally)
- Shaking chills
- Increasing redness, tenderness, or swelling of the
- Drainage from the hip wound
- Increasing hip pain with both activity and rest
Notify your doctor immediately if you develop any of these signs.
A fall during the first few weeks after surgery can damage your new hip and may
result in a need for more surgery. Stairs are a particular hazard until your hip
is strong and mobile. You should use a cane, crutches, a walker, or handrails or
have someone help you until you improve your balance, flexibility, and strength.
Your orthopaedic surgeon and physical therapist will help you decide which
assistive aides will be required following surgery, and when those aides can
safely be discontinued.
To assure proper recovery and prevent dislocation of the prosthesis, you must
take special precautions:
- Do not cross your legs.
- Do not bend your hips more than a right angle
- Do not turn your feet excessively inward or
- Use a pillow between your legs at night when
sleeping until you are advised by your orthopaedic surgeon that you can remove
Your surgeon and physical therapist will give you more instructions prior to
your discharge from the hospital.
How Your New Hip Is Different
You may feel some numbness in the skin around your incision. You also may feel
some stiffness, particularly with excessive bending. These differences often
diminish with time, and most patients find these are minor compared with the
pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and
some buildings. Tell the security agent about your hip replacement if the alarm
After surgery, make sure you also do the following:
- Participate in a regular light exercise program to
maintain proper strength and mobility of your new hip.
- Take special precautions to avoid falls and
injuries. Individuals who have undergone hip replacement surgery and experience
a fracture may require more surgery.
- Notify your dentist that you have had a hip
replacement. You will need to take antibiotics before any dental procedure.
Information for your surgeon regarding the use of antibiotics is available from
- Visit us periodically for routine follow-up
examinations and x-rays (radiographs), even if your hip replacement seems to be