Total Hip Replacement

Total Hip Replacement Facts

Total hip replacement (THR) is a treatment option for late-stage degenerative hip disease, also known as osteoarthritis or degenerative arthritis. THR is one of the most successful and common surgical procedures in orthopedic surgery. In addition to marked reduction in pain and improvement in sleep, most people regain range of motion, physical ability, and quality of life.

  • The hip joint is composed of a ball and socket, with the surface of each covered by cartilage.
  • A number of conditions and diseases can cause the cartilage surfaces to degenerate, which in turn leads to pain, stiffness, loss of hip joint range of motion, and disability.
  • Surgeons replace both the ball (femoral head) and socket (acetabulum) during total hip replacement surgery.

Risks of Total Hip Replacement

  • Infection: A small number of people can develop an infection with a total hip replacement. This complication can require further surgery to remove the prosthetic components and clean out the joint along with a course of antibiotics lasting six to eight weeks.
  • Deep venous thrombosis (DVT): A blood clot (thrombosis) may form in veins of your pelvis, thigh, or leg. After surgery, you will receive blood-thinning medication, such as aspirin or warfarin (Coumadin), to prevent clots from forming.
  • Pulmonary embolism (PE): An embolism occurs when a clot breaks free and travels to your lungs. An embolism potentially can cause serious respiratory difficulty. The risk of having one is less than 1%.
  • Bleeding: As with any surgery, you will experience bleeding both during and after the procedure. You often will need a blood transfusion.
  • Nerve injury: You have a small risk of injuring the nerves that allow sensation and movement of your leg. Often this problem, if it occurs, will go away over time.
  • Anesthesia: Any type of anesthesia has risks associated with it. Discuss these with your doctor.
  • Fracture: Other bones may be broken during surgery. These breaks may affect your rehabilitation and require a longer hospital stay.
  • Dislocation: Your new hip will not move as well as a normal joint and thus can be dislocated more easily. You must be cautious not to sit too low or to cross your legs.

Total Hip Replacement Preparation

  • Talk to someone who has undergone hip replacement surgery to become familiar with the procedure and the recovery period.
  • Your doctor will evaluate your overall health to ensure that you are well enough to safely withstand the surgery. Any unstable medical conditions or infections must be treated before surgery.
  • Allow time to rest after the operation and find people to help with your care and daily activities for the first few weeks.
  • Because you may need blood transfusions during the operation or recovery period, you may want to donate some of your own blood before the procedure to be given back to you.
  • Do not eat or drink anything after midnight on the day of your surgery. Follow any other instructions your doctor gives you.

During the Total Hip Replacement Procedure

  • You will arrive at the hospital usually on the day of surgery.
  • An anesthesiologist will meet with you to discuss various options for anesthesia.
    • You may have general anesthesia, in which you will be completely unconscious.
    • You may have regional anesthesia that will numb you from the waist down and keep you moderately sedated.
  • The surgeon will expose your hip joint and dislocate the ball from the socket.
    • The doctor removes the head from the femur (thighbone) and reams away the surface of the socket.
    • The doctor secures in place a prosthetic cup (socket) made of polyethylene.
    • The surgeon then secures a metal head (ball) and stem into the femur either by a press fit or with bone cement.
    • The doctor places the ball into the cup and takes your new hip through a range of motion to ensure proper stability and mobility.
    • The surgeon closes your incision, and you are brought to the recovery room.

After the Total Hip Replacement Procedure

You will stay in the hospital for four to seven days.

  • The first night you will be confined to bed with a wedge-shaped pillow between your legs to keep the new hip joint in place.
  • A tube placed in the new hip joint during surgery to drain any fluid or blood likely will be removed the next day.
  • If you are having trouble urinating, another tube likely will be placed in your bladder.
  • Normally you will begin physical therapy the day after surgery, and within days you can walk with a walker, cane, or crutches.

Next Steps after Total Hip Replacement

After the four to seven days of hospital care, you will be sent either home or to a rehabilitation center.

  • Your destination will depend on how quickly your new hip heals and on your ability to get around and perform your daily activities.
  • Therapy will continue at home or at the rehabilitation center and may last for weeks to months after your surgery. This therapy will be designed so that you will gain the most benefit from your replacement hip.
  • Ask your doctor about other instructions and precautions and when to come back for a checkup.

When to Seek Medical Care for Total Hip Replacement Complications

Call your doctor immediately if any of the following occur:

  • You become short of breath or have difficulty breathing.
  • You have pain or a crushing sensation in your chest.
  • You feel your heart is racing or beating irregularly.
  • You develop a fever.
  • You show signs of an infection -- increasing redness and warmth along the incision site or drainage of fluid from the incision.
  • Your calf, thigh, or hip becomes unusually swollen, warm, red, or painful.

If you develop problems or symptoms and cannot reach your doctor, go to the nearest emergency department for immediate consultation.

Reviewed on 11/20/2017

Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCE:

Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.

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