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Hip Replacement
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Hip Replacement

(Arthroplasty, Hip)

En Español (Spanish Version)

Definition

This is a surgical procedure to remove a diseased or injured hip joint and to insert an artificial ball-and-socket joint. The artificial joint is called a prosthesis.

Left Total Hip Replacement

Hip Replacement

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Hip joint

Reasons for Procedure

Hip replacement is most often performed to alleviate hip pain and disability due to arthritis . This procedure is considered when pain and stiffness limit normal activities and are not relieved by other measures, such as rest, medications, or physical therapy.

Risk Factors for Complications During the Procedure

  • Pre-existing medical condition, such as heart or lung problems
  • Obesity
  • Any infection, such as urinary tract infection or gum disease (both of these conditions increase the risk of bacteria entering the bloodstream and infecting the joint)
  • Previous episodes involving vein clots in the legs

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • X-rays of joint
  • Blood tests
  • Possibly an MRI scan—a test that uses a strong magnetic field and radio waves to make pictures of the inside of the body
  • Possibly a CT Scan—a special type of X-ray

In the time leading up to the procedure:

  • You want to be in the best physical shape possible prior to surgery. If you are overweight, lose excess pounds to decrease the amount of stress on your new joint and make the surgery easier for your surgeon to perform. Pool exercise may be a good option.
  • To enhance safety and recovery, make home modifications:
    • Install safety bars, a raised toilet seat, a shower bench and hose, and handrails on stairways and steps.
    • Remove throw rugs and check extension cords.
    • Purchase a stable, firm-backed arm chair that allows the knees to remain lower than the hips.
    • Purchase reachers and dressing aids to make daily activities easier to complete.
  • Review your regular medications with the surgeon to determine if any, such as blood thinners or anti-inflammatory medications, should be stopped a week before surgery.
  • Inform your surgeon if you become ill or have fevers in the days before the planned surgery.
  • Arrange for a ride to and from the hospital.
  • Arrange for help at home after returning from the hospital.
  • The night before, eat a light meal and do not eat or drink anything after midnight. If you have diabetes, you may need to adjust your medications with a change in diet.
  • If you smoke, try to decrease or stop smoking.

During Procedure

You will typically receive IV fluids and medications, blood products and anesthesia.

Anesthesia

General anesthesia is typically used.

Description of the Procedure

The surgeon makes an incision along the joint, moves aside muscles, and removes the damaged bone and cartilage of the hip joint. The remaining bone is prepared to receive the prosthesis, and the new plastic and metal joint is placed in position. Depending on the type of prosthesis, the surgeon may use bone cement to hold one or both parts of the artificial hip firmly to the hip socket and the thighbone. The incision is closed with stitches or staples, which will be removed in about two weeks.

Blood and fluid loss from this surgery are often significant and may require blood transfusions. You will be given IV antibiotics just prior to the start of surgery and possibly during the procedure; antibiotics are generally discontinued within 24 hours of surgery.

Placement of Prosthesis

hip replacement hardware

© 2008 Nucleus Medical Art, Inc.

After Procedure

Be extra careful to prevent falls and maintain correct hip placement. Ask your surgeon to explain the correct hip placement. The purpose of this is to prevent dislocation of the new hip joint. Usually, this means you should avoid excess hip flexion and prevent your toe from pointing inward. Do not cross you legs.

You may need to receive an anticoagulation medication or wear compression boots or stockings for a while after surgery to prevent blood clots from forming in the legs.

Major surgery is demanding on the body. You may require rehabilitation after surgery to regain mobility, strength and general conditioning.

How Long Will It Take?

This major surgery typically requires many hours to complete.

Will It Hurt?

Anesthesia prevents pain during surgery. You'll likely experience pain while recovering, but you will receive medications to relieve the discomfort.

Possible Complications

  • Infection
  • Blood clots occurring in a vein or traveling to the lungs
  • Excessive swelling or bleeding
  • Injury to nearby nerves or blood vessels
  • Anesthesia-related problems
  • The ball portion of the prosthesis dislocates from its normal position in the hip

Average Hospital Stay

Typical stay is 4-6 days in the acute care hospital where the surgery is performed. If further inpatient rehabilitation is required, this may involve staying in a rehabilitation unit for a few more days to focus on regaining function.

Postoperative Care

  • In the first few days, breathe deeply and cough 10-20 times every hour to decrease the risk of fluid build-up in the lungs that can cause pneumonia .
  • Keep the incision area clean and dry.
  • Expect to get up and walk with help using a walker on the day after surgery.
  • Be cautious; a fall can damage or dislocate the new joint. Do not try to walk without help at first.
  • Place a V-shaped pillow between your legs to maintain correct positioning of the hip.
  • To help maintain proper alignment and prevent dislocations, do not cross your legs, flex your hips more than 90°, or turn your feet very far inward or outward.
  • You may be sent home with blood-thinning medications; be careful to take these medications exactly as prescribed.
  • Only take medications recommended by your doctor; do not take over-the-counter remedies without your doctor's approval.
  • Inform your dentist of your surgery; you'll need antibiotics before all future dental procedures to decrease the risk of bacteria entering the bloodstream and traveling to the prosthesis. Delay dental cleaning for a month or more after the surgery.
  • Maintain a healthy weight; obesity can increase wear on the joint, cause it to loosen, and cause pain.
  • Refrain from jogging and other high-impact sports, which can also increase wear on the joint, cause it to loosen, and cause pain.

Outcome

Within six weeks, you should be able to resume normal light activities. To speed your recovery and protect future joint function, follow the recommended activity and rehabilitation program.

A replacement hip typically lasts 10-15 years, and may require revision after that time.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge around incision site
  • Pain and/or swelling in the feet, calves, or legs
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Increased hip pain

RESOURCES

American Academy of Physical Medicine and Rehabilitation
http://www.aapmr.org/condtreat/rehab/hip.htm

Mayo Clinic
http://www.mayoclinic.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org/

The Arthritis Society
http://www.arthritis.ca/custom%20home/default.asp?s=1

References:

American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/ .

Geerts WH. Pineo GF. Heit JA. Bergqvist D. Lassen MR. Colwell CW. Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest . 126(3 Suppl):338S-400S, 2004 Sep.

Skerker RS, Mulford GJ. Frontera: Essentials of Physical Medicine and Rehabilitation . 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch. 56.



Last reviewed December 2007 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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