Total Hip Replacement

Whether you have just begun exploring treatment options or have already decided to undergo total hip replacement surgery, this article will help you understand the benefits and limitations of total hip replacement.

If your hip has been damaged by arthritis, a fracture (a break in the bone), 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 supports do not adequately help your symptoms, you may consider total hip replacement surgery. Total hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.

Hip Anatomy

The hip is one of the body’s largest joints. It is a ball-and-socket joint.

The socket is formed by the acetabulum, which is part of the pelvis bone.
The ball is the femoral head, which is the upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.

A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

Normal Hip Anatomy

Common Causes of Hip Pain

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis are the most common forms of this disease.

Osteoarthritis. This is an age-related wear-and-tear type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed inflammatory arthritis.
Posttraumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
Osteonecrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called osteonecrosis (also sometimes referred to as avascular necrosis). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause osteonecrosis.
Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

In hip osteoarthritis, the smooth articular cartilage wears away and becomes frayed and rough.

Overview of Hip Replacement Surgery

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone.
A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
A plastic, ceramic, or metal spacer (also called a liner) is inserted between the new ball and the socket to allow for a smooth gliding surface.

(Left) The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip.

Is Total Hip Replacement Surgery for You?

The decision to have total hip replacement surgery should be made together by you, your family, and your orthopedic surgeon. This process usually begins with a consultation with an orthopedic specialist for an initial evaluation.

When Surgery Is Recommended

There are several reasons why your orthopaedic surgeon may recommend total hip replacement surgery. People who benefit from hip replacement surgery often have:

Hip pain that limits everyday activities, such as walking or bending
Hip pain that continues while resting, either during the day or at night
Stiffness in a hip that limits the ability to move or lift the leg
Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

Candidates for Surgery

There are some reasons why Dr. Prashant Bhutani may suggest total hip replacement surgery and when it’s necessary.

Hip pain that restricts normal daily activities, such as walking, sitting, or sleeping
Feel pain continues while doing resting (Day & Night)
Low pain relief from painkillers drugs, physical treatment, or exercise supports
Stiffness in the hip that restricts the capability to push or raise the leg a sufferer may not walk and stand without using crutches.

Recovery Process at Home after Total Hip Replacement Surgery

After the surgery, Dr. Lalit Modi would recommend a recovery process when you get back home. So here are some of the recommendations that help the patients to overcome with the Total Hip Replacement Surgery.

After the total hip joint replacement surgery, Turning or rotating on the involved leg should avoid at least 6 to 12 months.
Should not overpass the affected leg behind the midline of the body nor use the affected leg.
Do not turn at the hip through 90 degrees.
Should not play some games or do huge exercise.

What can do at home after Total Hip Replacement Surgery

Sit in a firm, upright-back chair.
Remove all throw carpets and keep floors clutter-free.
Use a tilted bathroom seat.
Keep excited pets elsewhere until you have recovered fully.
Join in a daily light exercise schedule to prepare for proper health and movement of your new hip.
Have to go up and down the stairs once or twice a day.
Use proper precautions to withdraw injuries. If you crack or break a bone in your affected leg, you may need an extra operation.

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