Total Hip Replacement
What is a 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. One of the most innovative is anterior total hip replacement. In this procedure, the surgeon reaches the hip joint from the front instead of the back or side. Muscles are split, rather than removed and reattached, which leaves those most important for hip function—the gluteus muscles that attach to the pelvis and femur—undisturbed. The anterior 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.