When a hip becomes injured or there is arthritis
present, there is often pain associated with everyday activities.
This pain can affect a person’s functional ability drastically.
It is for this reason that a hip arthroplasty would be recommended.
Hip arthroplasty is a surgery to replace all or part of the hip
joint with an artificial device to restore joint movement.
The hip is made of a ball and a socket joint,
linking the dome at the head of the thigh bone (femur) and the
cup in the pelvic bone. A total hip prosthesis is surgically implanted
to replace the damaged bone within the hip joint. The total hip
prosthesis consists of three parts:
A plastic cup that replaces your hip socket
(acetabulum)
A metal ball that will replace the fractured
femoral head
A metal stem that is attached to the shaft
of the bone to add stability to the prosthesis
You will receive an extensive pre-operative evaluation of your
hip to determine if you are a candidate for a hip replacement
procedure. Evaluation will include assessment of the degree of
disability and impact on your lifestyle, pre-existing medical
conditions, and an evaluation of heart and lung function.
Indications
Hip joint replacement is mostly done in older
people. The operation is usually not recommended for younger people
because of the strain they can put on the artificial hip.
The indications for the replacement of the hip joint include:
Hip pain that has failed to respond to
therapy
Hip osteoarthritis or arthritis confirmed
by x-ray
Inability to work, sleep, or move because
of hip pain
Loose hip prosthesis
Some hip fractures
Hip joint tumors
This surgery is not recommended for:
Current hip infection
Poor skin coverage around hip
Paralysis of the quadriceps muscles
Severe disease of the blood vessels of
the leg and foot
Nerve disease (neuropathy) affecting the
hip
Severe limiting mental dysfunction
Serious physical disease (terminal disease,
such as a metastatic disease)
Morbid obesity (over 300 pounds)
Risks
Serious blood clots
Pneumonia
Infection necessitating removal of the
joint
Joint dislocation
Procedure
The surgery will be performed using general or spinal (epidural)
anesthesia. The orthopedic surgeon makes an incision along the
affected hip joint, exposing the hip joint. The head of the femur
and the cup are cut out and removed. Then a metal ball and the
metal stem are inserted in the femur and a plastic socket is placed
in the enlarged pelvis cup. The artificial components are fixed
in place (sometimes a special cement is used). The muscles and
tendons are then replaced against the bones and the incision is
closed.
You will return from surgery with a large dressing to the hip
area. A small drainage tube will be placed during surgery to help
drain excess fluids from the joint area.
Your Recovery
You will experience moderate to severe pain after surgery. However,
you may receive patient-controlled analgesia (PCA), intravenous
(IV), or epidural analgesics to control your pain for the first
day after surgery. The pain should gradually decrease, and by
the third day after surgery, oral analgesic medications may be
sufficient to control your pain. Try to schedule your pain medications
about one half hour before ambulation or position changes. Pain
medications are also prescribed for you upon leaving the hospital
You will also return from surgery with an IV line in place to
provide hydration and nutrition. The IV will remain in place until
you are taking adequate amounts of oral fluids. If the procedure
is elective, you may be encouraged to donate blood several weeks
prior to surgery to replace any blood lost during the procedure.
Sometimes, the blood that is drained from the wound during surgery
is collected in a special sterile container to be re-infused through
an IV after surgery (autotranfusion).
You will also return from surgery wearing anti-embolism stockings
or an inflatable pneumatic compression stocking. These devices
are used to reduce your risk of developing blood clots, which
are more common after lower extremity surgery. Additionally, you
will be encouraged to start moving and walking early after surgery.
You will be encouraged to get out of bed to a chair on the first
day after surgery. When in bed, perform ankle exercises frequently
to prevent development of blood clots. You may be instructed on
how to use an incentive spirometry device (a plastic device that
indicates how much air is breathed in at one time) to gradually
increase the depth of your respirations, as well as performing
deep breathing and cough procedures in order to prevent pneumonia.
A Foley catheter may be inserted during surgery
to monitor the function of your kidneys and hydration level. This
will be removed on the first or second day after surgery. You
will be encouraged to try to walk to the bathroom with assistance.
If you are unable to walk this far, a special smaller bedpan will
be used to keep the hip in proper alignment.
You will also be on a blood thinner to reduce
the risks of blood clots, with your blood levels constantly monitored
by blood draws. The results will be called in to your physician.
The blood thinning treatment will continue for the next six weeks.
You will remain in the hospital for three
to five days after surgery. However, some people may need further
rehabilitation and assistance after hip replacement surgery. Temporary
placement in a rehabilitation unit or long-tern care center may
be necessary until mobility has improved and you can safely live
independently. These centers will provide intensive physical therapy
to assist in regaining muscle strength and flexibility in the
joint.
Recovery At Home
Driving is not allowed for at least six weeks after surgery. Positioning
is very important after surgery to reduce stress on the new joint
and displacement of the joint. The new hip will not have the same
range of movement of the original joint, although you should eventually
be able to return to your previous level of activity. However,
you should avoid vigorous sports such tennis, skiing, or contact
sports.
You will be using a walker or crutches, and
a raised toilet seat after the surgery. You will need to purchase
or rent these aids for at least six weeks. Physical Therapists
will work with you immediately after surgery.
Special Precautions
Your new joint has a limited range of movement. You will need
to take special precautions to avoid displacement of the joint,
including:
Avoid crossing your legs or ankles, even
when sitting, standing, or lying.
When sitting, keep your feet about six
inches apart.
When sitting, keep your knees below the
level of your hips. Avoid chairs that are too low. You may sit
on a pillow to keep your hips higher that your knees.
When getting up from a chair, slide toward
the edge of the chair and then use your walker or crutches for
support.
Avoid bending over at the waist. You may
consider purchasing a long-handled shoehorn or a sock aid to
help you put on and take off your shoes and socks without bending
over. Also, an extension "reacher" or "grabber "may be helpful
for picking up objects that are too low for you to reach.
When lying in bed, place a pillow between
your legs to keep the joint in proper alignment.
A special abductor pillow or splint may
be used to keep the hip in correct alignment.
Do not turn or reach behind you for objects
not in close range
Expectations After Surgery
Results with a hip prosthesis have been excellent.
The operation relieves pain and stiffness symptoms, and most patients
(over 80%) need no help walking. With time, loosening of the artificial
joint has been observed due to the limited properties of the cement
used to attach the artificial parts to the bones.
If you are a Munson Healthcare patient and have a compliment,
concern, or complaint, please contact one of our Patient
Liaisons.
