Surgical Information - Procedures
Total Hip Replacement
What is total hip replacement?
Total hip replacement is a surgical procedure to replace the weight-bearing surfaces of the hip joint. The most common reasons for hip replacement surgery are to relieve pain and replace joint cartilage damaged by osteoarthritis, rheumatoid arthritis and a variety of other conditions that lead to arthritis of the hip.
During total hip replacement, the surgeon removes the damaged femoral head (the rounded end of the upper thighbone) and cartilage from the hip socket. The femoral head is replaced with a metal or ceramic ball that is fixed solidly to a metallic stem inserted into the upper part of the femur (thighbone). The socket is usually replaced with a plastic liner fixed into a metal shell. This new, artificial ball-and-socket assembly creates a painless, cushioning effect much like the original cartilage in your hip.
Today, most hip replacement surgeries are minimally invasive, with numerous benefits to the patient. These include smaller incisions, less tissue trauma, bleeding and post-operative pain, shorter hospital stays, faster recovery, and earlier return to work and activities
There are several appropriate and successful surgical approaches for hip replacement: anterior, anterolateral and posterior. There are risks and benefits to each. All are highly successful techniques when done well. The anterior or anterolateral approach is potentially less traumatic for patients, leg length may be more accurately controlled and the risk of dislocation may be reduced.
Currently, all total hip patients, regardless of approach, are allowed full weight bearing immediately and receive the benefits of minimally invasive techniques.
The hip joint lies between the femur and the pelvis, surrounded by protective muscle and cushioned by rubbery cartilage. It is the largest ball-and-socket joint in your body. The "ball" is the femoral head. The "socket" is a concave depression in the lower side of the pelvis called the acetabulum.
Hip arthritis occurs when the cartilage of the hip joint gradually erodes. Without the cushioning effect of cartilage, the bones of the hip joint rub together. The hip can't move easily and becomes stiff, swollen and painful.
When is surgery recommended?
If you have hip pain that limits everyday activities, secondary to arthritis, and all non-surgical methods of treatment have failed – including weight loss, anti-inflammatory medications, cortisone injections and physical therapy – then you should consider surgery.
Hip replacement surgery is now much less invasive, with less tendon and muscle trauma, less bleeding, less pain and less life interruption. Patients recover much more quickly and return to work and activities within weeks rather than months.
Most patients with advanced hip arthritis are considered good candidates for minimally invasive total hip replacement surgery. However, each patient should be carefully screened to determine the most appropriate type of procedure.
What is the recovery time?
Minimally invasive approaches, improved implant material and design, and refined surgical techniques have dramatically reduced recovery time. For these patients, the typical recovery period is now weeks rather than months. Most patients are up and walking immediately following surgery and regain range of motion, strength and flexibility after several weeks of physical therapy. Hospital stays have been reduced to one or two days and the vast majority of patients can go directly home without having to use a rehabilitation center.
Total Hip Replacement FAQs
- How do I know it is time for a hip replacement?
How do I know it is time for a hip replacement?
If all non-surgical methods of treatment fail, a diagnosis of arthritis is confirmed, other medical problems are developing as a result of arthritis, requirements for pain medications are increasing and significant lifestyle changes have occurred as a result, then you should consider hip replacement surgery.
- Am I too young for a hip replacement?
Am I too young for a hip replacement?
Years ago, hip replacement surgery was reserved for elderly patients due to a high complication rate and lack of implant durability. Modern techniques have allowed orthopaedic surgeons to base surgical decisions on a patient's pain and disability, and not necessarily chronological age. Most patients who undergo total hip replacement are between the ages of 50 and 80, but surgeons evaluate patients individually and primarily on their physiologic age and demands.
- How long will a hip replacement last?
How long will a hip replacement last?
Thanks to improvements in materials and design, the vast majority of hip implants will last 20 years or more based on current scientific studies. It is likely that current techniques and materials will prove to last even longer.
- How long is my recovery?
How long is my recovery?
Recovery varies by patient and demand. The typical recovery period involves one to two days in the hospital, and four to six weeks in an organized physical therapy rehabilitation program.
- How much work will I miss?
How much work will I miss?
It depends on your profession and location of your job. If your work is sedentary and local, you may return as early as two to four weeks after your surgery. If your job is more rigorous and involves travel, your time off from work may be longer.
- Do you use minimally invasive surgery?
Do you use minimally invasive surgery?
Yes, most hip replacement surgeries are minimally invasive, with numerous benefits to the patient, including smaller incisions, less tissue trauma, bleeding and post-operative pain, shorter hospital stays, faster recovery, and earlier return to work and activities – in weeks rather than months.
- How long will my scar be?
How long will my scar be?
The typical scar is approximately three to five inches long. It is dictated by many factors, mostly patient size.
- Can I have both hips replaced at the same time?
Can I have both hips replaced at the same time?
Double hip surgeries may be right for some patients. Commonwealth's total joint replacement surgeons carefully assess each patient to determine the best course of action that minimizes the inherent complications of joint replacement surgery such as infection, blood clots and blood loss.
- My mother had a long recovery after her hip
replacement. Will mine be like that?
My mother had a long recovery after her hip replacement. Will mine be like that?
The standard of care for total hip replacement has improved dramatically in recent years with the development of new minimally invasive approaches, improved implant materials and designs, and refined surgical techniques. Patients are up and active sooner and function returns much more quickly. Today, almost all total hip patients walk into their hospital room with assistance hours after their surgery. Long hospitals stays, long incisions and severe longstanding pain as experienced by prior generations of hip replacement patients are no longer part of today's modern procedures.
- Will I be able to run afterwards?
Will I be able to run afterwards?
Moderate running and other high-impact sports are allowed after hip replacement. Lower-impact exercises, such as walking, biking, swimming or using an elliptical trainer, are encouraged. Patients are reminded that continuous high-impact activities can lead to premature wear and premature failure of the implant.
- What happens when I go through airport security?
What happens when I go through airport security?
Because hip implants contain metal, there's a chance they could set off an airport metal detector. If this happens, the TSA agent may use a wand or a pat-down to ensure that the metal is inside your body.
- What type of material do you use?
What type of material do you use?
Ceramic-on-plastic or metal-on-plastic implants are most commonly used. Ceramic-on-ceramic and metal-on-ceramic implants are options that are currently under investigation. A patient's age, activity level, overall health and the condition of the bone are the main factors considered when choosing the optimum type of joint replacement implant.
- Do you use that new anterior approach I've
Do you use that new anterior approach I've heard about?
Commonwealth surgeons use a variety of appropriate approaches for total hip replacement, including the anterior approach. Surgeons carefully assess each patient to determine the best surgical approach to recommend.
- Will my legs be the same length?
Will my legs be the same length?
Every effort is made using pre-operative planning and intraoperative techniques to achieve equal leg length in hip replacement patients. Many times, this requires a balance between the patient's anatomy and the stability of the implant to achieve appropriate leg length. While this cannot always be guaranteed, very small differences in leg length can occur. Most are negligible and unnoticed by the patient.
- Do you use the metal hip that has had problems?
Do you use the metal hip that has had problems?
Unfortunately, sometimes innovations in medicine can lead to problems. This is clearly the case with a specific metal-on-metal total hip implant, but not all metal-on-metal implants. The problem implant isn't used by any Commonwealth surgeons.
- How many total hips have you done?
How many total hips have you done?
This is a good question to ask your total hip surgeon, because results generally correlate with surgical experience. Most total joint surgeons at Commonwealth have done hundreds if not thousands of hip and knee replacements.