Total hip replacement (THR) is a surgical procedure to remove and replace
your damaged hip joint with an artificial joint (called a prosthesis).
The procedure may be performed if you fracture your hip or if you have
hip pain, swelling and stiffness that interferes with your ability to
perform daily activities and is not relieved by physical therapy, anti-inflammatory
medications or steroid injections.
According to the American Academy of Orthopaedic Surgeons, more than 285,
000 total hip replacement surgeries are performed each year.
The hip is one of your body’s largest joints. It is a ball and socket
joint meaning the ball-shaped femoral head, located at the top of the
thigh bone, fits inside a socket formed by the acetabulum, which is part
of the pelvis bone. The ends of the bones are coated with a thin layer
of cartilage where they touch to provide protection and help them move easily.
A thin tissue called the sinuvial membrane surrounds the hip joint to cushion
the bones and keep the cartilage lubricated to eliminate friction. A band
of ligaments holds the ball to the socket to keep the joint stable.
Causes of hip pain
When any of these parts fail to work in harmony, the result can be pain,
weakness or impaired function. The most common cause of hip pain is arthritis
including osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
With arthritis, the protective layer of cartilage may peel away until
the bones grind against each other, causing acute pain. Other causes of
hip pain include avascular necrosis and childhood hip disease.
Signs that you may be a candidate for hip surgery
With severe arthritis, you may be unable to move or bend at the hip which
can severely limit your mobility and quality of life. After all other
treatments are exhausted, including medications, physical therapy and
assistive devices such as a walking cane, total hip replacement may be
considered. Hip replacement is also a treatment for some hip fractures,
hip deformities and infection.
There are no age or weight restrictions for THR surgery, but most candidates
are between the ages of 50-80. In addition to a complete medical evaluation
of your hip, diagnostic tests such as X-ray or MRI may be performed.
Most candidates have:
- Hip pain that limits everyday activities such as walking or bending
- Hip pain that continues with resting
- Stiffness in the hip that limits the ability to move or lift the leg
- No relief from other treatments such as medications, physical therapy and
How THR works
During a THR procedure, your surgeon removes damaged bone and cartilage
and replaces it with prosthetic components. Typical steps include:
- Remove damaged cartilage from the bone surface
- Shape the bone surfaces to receive the prosthetic components
- Place the prosthetic components
- Insert a spacer between the new ball and socket to allow for a smooth gliding surface
Preparing for THR
For the best outcome with your joint replacement, you must know what to
expect before, during and after your surgery. Through our Joint Care Plus
program, you will be involved in every step of your treatment and recovery
from pre-operative teaching to post-operative care and exercise. Your
team includes physicians, physician assistants, care management, nurses,
and physical and occupational therapists specializing in total joint care.
Your care team’s goal is to keep you motivated for an optimal recovery.
They will encourage you to prepare, eat well and do your exercises so
you can quickly gain strength and mobility to become more independent.
Give yourself a leg-up in the process by learning and practicing the post-surgical
exercises in advance of your procedure.
In addition to a scheduled 30-minute telephone nurse interview to review
your medical history and medications, you will schedule an appointment
with the Pre-Admission Testing (PAT) nurse practitioner. During this comprehensive
pre-surgical evaluation, typically 3-4 weeks before your surgery, the
nurse practitioner identifies your risks so a plan can be put in place
to prevent complications. The appointment takes approximately one hour
during which blood and urine samples may be taken, and you will have an
EKG. The nurse practitioner can also answer your specific questions about
the procedure or the preparations you need to make.
Preparing your home
Part of your pre-operative teaching includes how to prepare yourself and
your home for your post-operative care. We want you to be as independent
in your home as possible and reduce the risk of injuries due to falls.
If you live alone, you will want to make arrangements for a friend or
family member to stay with you for at least one week following your discharge
from the hospital. These steps will help you prepare your home:
- Make sure light switches are accessible
- Put away throw rugs or tack them down
- Make sure stairways are well lit
- Make sure handrails on the stairway are sturdy
- Clear floors of clutter
- Clearly mark raised thresholds
- Clear loose cords from your floor
- Program your phone with emergency numbers
- Make sure furniture has good back and arm support
- Create a lighted path from bedroom to bathroom
- Keep a charged flashlight near your bed
- Install safety and guard bars by your bath tub (if possible)
- Place rubber mats in and in front of your bath tub
- Use a wide sturdy step for high cabinets
What to pack
You won’t need much during your approximately three-day hospital
recovery. Bring a positive attitude and the motivation to work hard along
with these items:
- Loose fitting clothes (scrubs, sweats, tee shirts) that won’t rub
- Closed shoes like sneakers (we provide floor gripping socks)
- A list of your medications and dosages (do not bring any medications from home)
Talk to your doctor about which medications to take on the morning of your
Several hours after your surgery, you will be asked to sit up and dangle
your legs from the bed. You may also stand up and take a few assisted
steps. The first full day after your surgery will include individual therapy
as well as group physical therapy sessions where you will begin learning
to walk with your new joint. Our team will assure that you are using the
correct techniques so you are safe and will not hinder your recovery.
In fact, getting mobile is an important part of the process! We also carefully
monitor your pain and assure that it is under control so you can progress
through your rehabilitation.
During physical therapy you will learn exercises that you must perform
on your own even following your discharge from the hospital. We will also
teach you movements to avoid until you are fully recovered.
After hospital discharge
Your discharge plan is completely customized. Based on your needs and your
surgeon’s preferences, we will arrange for a visit from a homecare
nurse. Arrangements will also be made for you to continue your physical
therapy three times a week for at least four weeks.
Individuals with many stairs in their home or who cannot arrange for a
caregiver to be with them for the first week, may need to recover at a
skilled nursing facility until they are able to be independent at home.
The key to optimizing your total hip replacement results is your commitment
to performing the exercises that build your strength and range of motion.
Our staff is dedicated to providing the motivation and support you need
to be successful.
watch this informative video prior to your surgery.
Anterior Approach To Hip Replacement
Some surgeons use an anterior approach when performing hip replacement
surgery. This less invasive alternative to traditional hip replacement
provides the same outcomes, but because the surgeon can access the hip
joint without cutting through major muscle groups, which can take up to
6 months to heal, you are likely to experience less pain and be less restricted
with your movement during recovery. You can typically get back to your
normal routine more quickly following this type of procedure.
About the procedure
All of the preparatory steps for surgery are the same with the anterior
approach. The major difference is during the procedure itself. You lay
on your back on a specially designed operating table that enables the
surgeon to access your hip joint through a 4 to 6 inch incision in the
front of your hip rather than the side or the back. Your surgeon can follow
a natural pathway between muscles and tendons to remove and replace your
Recovery is similar to that with a traditional hip replacement. Physical
and occupational therapy will still be an important part of your recovery
as you work to gain strength and range of motion. Because the muscles
around your hip joint remain intact, you will have reduced risk of dislocation
of the new ball from its socket during the first months of recovery.
Because of the pressure placed on your femur during the procedure, the
anterior approach is not recommended if you have osteoporosis. Your surgeon
will recommend the best approach based on your risks and needs.
Source: American Association of Orthopaedic Surgeons