Hip Joint Replacement

This surgery is most commonly done to relieve severe arthritis, which can wear down the hip joint.

People with other conditions, such as injury, bone tumors, and avascular necrosis (a loss of bone caused by a lack of blood supply to it), may also need a hip joint replaced.

An individual is usually advised to consider this surgery when the following conditions apply:

• The pain is severe enough to restrict not only work and recreation but also the normal activities of daily living.
• The pain is not relieved by arthritis medications.
• The person is not helped by the use of a cane or walker.
• There is significant stiffness of the hip that limits activities.
• Joint X-rays show advanced arthritis or other severe problems.

The surgeon first removes the diseased bone and cartilage. Replacement pieces are implanted into healthy areas of the pelvis and thighbone. These pieces are then cemented in place.

One method does not require cement and is called a "cementless" hip joint replacement. This allows bone to grow into the prosthesis, and it may last longer than a cemented hip. This can be an important advantage for younger people.

The surgery is usually done in the operating room under general anesthesia, which means the person is put completely to sleep. The procedure usually takes 2 to 3 hours to perform.

After the surgery, the person is taken to the surgery recovery room. This allows a brief period of close observation. Vital signs, such as the blood pressure and pulse, are checked frequently. Close attention is paid to the circulation and sensation in the legs and feet.

The hip is usually braced with pillows or a special device that holds the hip in the correct position. The person is given fluids through an intravenous tube to replace fluids lost during surgery. A tube may have been placed near the incision to drain fluid. A urinary catheter is often used to drain urine from the bladder until the person is able to use the bathroom.

Pain medication will be given as needed. While in the hospital, the individual will begin physical therapy to strengthen the hip. He or she will also learn how to perform the activities of daily living in ways that can prevent injury to the new hip. For example, proper ways to bend and sit are taught. Most people are sent home from the hospital 5 to 7 days after the surgery.

By the time the person leaves the hospital, he or she should be able to get around using crutches or a walker. Physical therapy may be continued after discharge.

If a person needs extra time to gain enough independence to maneuver at home, he or she may go to a rehabilitation center after leaving the hospital. Complete recovery from this surgery usually takes 3 to 6 months.

Surgery may be complicated by bleeding, infection, or an allergic reaction to the anesthetic. Pain medications or antibiotics may cause stomach upset, allergic reactions, or rash.

The most common complications of a hip joint replacement include:

• a blood clot in the leg, called deep venous thrombosis. To prevent blood clots, medications called blood thinners may be given. The person is asked to move around shortly after surgery and may need to wear support stockings.
• wound infection. To prevent this complication, antibiotics may be given.
• bleeding. Sometimes a blood transfusion may be needed.
• hip dislocation, which means the ball becomes dislodged from the socket. This may occur if the hip is placed in certain positions.

Before leaving the hospital, the person is taught exercises to help prevent this. The individual will also learn which activities to avoid, such as crossing the legs, to prevent hip dislocation.

Any new or worsening symptoms should be reported to the healthcare professional.