Hip Replacement Surgery
What is hip replacement surgery?
Hip replacement—also known as hip arthroplasty—is a procedure designed to provide relief from hip pain by replacing damaged parts (ball and socket) of the joint. The surgery is performed when all other methods of treatment have failed to alleviate the pain and discomfort that:
- Becomes worse when walking, even with help from a walker or cane
- Continues despite pain medication
- Hinders the ability to go up and down stairs
- Interrupts sleep and affects many activities of daily life
- Makes it challenging to rise from a sitting position
A patients can either have either a partial hip replacement, which only replaces the ball at the end of the thighbone that fits into the socket (usually performed for repair of a fracture), or a total hip replacement, which replaces the ball and the socket. The replacement parts are usually made of metal, special plastic and/or ceramic.
Why might hip replacement surgery be required?
Aside from a serious trauma to the hip (e.g., fracture from fall or a car accident), hip replacement may become necessary when certain conditions damage the joint. These include:
- Osteoarthritis, which a disease that damages the cartilage that covers the ends of bones and helps them move
- Osteonecrosis, a condition where in which an inadequate blood supply to the ball at the end of the thighbone causes the bone to deteriorate
- Rheumatoid arthritis, a disease that causes the immune system to inflame the cartilage and underlying bone, resulting in damage
What are the different types of hip replacements?
Hip replacements—both total and partial—can have different approaches. This means that the surgeon chooses where to access the hip joint as well as what tissues are disrupted in the process.
The Anterior Approach
With an anterior approach, the surgeon enters the surgical site from the front of the hip or groin area. This approach allows the surgeon to avoid cutting any major muscles, possibly leading to less blood loss, post-operative pain and relative faster recovery. It also minimizes the risks of the hip potentially dislocating.
However, an anterior approach is a highly- technical technique procedure due to the angle it is performed at, and it is not an ideal option for patients who are obese, overly muscular or have poor bone quality.
The Posterolateral Approach
Considered to be the more traditional of the two approaches, the posterolateral approach—also known as the posterior approach—accesses the hip joint from the back of the hip. Though it is performed more regularly than the anterior approach, and results are similar to the anterior approach with a lower risk of complications.
Revision Surgery
In addition to the different approaches, revision surgery is also an option should the primary hip replacement (when the hip and/or its parts are replaced initially) fail over time. This can be due to issues such as:
- Allergic reaction to materials the parts are made of
- Fracture
- Infection
- Recurring dislocation
- Wear of the artificial parts
Depending on the nature of damage to the existing hip replacement, revision surgery is likely to be longer and more complex procedure than the primary hip replacement. In some situations, only certain parts need to be replaced. In others, all of the parts need to be completely replaced and the bone surrounding the hip needs to be rebuilt with metal or bone grafts.
Robotic-Assisted Hip Replacement
Many hip replacements can be performed with robotic assistance. With this technology, a computed tomography (CT) scan of the hip joint is obtained prior to surgery to get more details about the anatomy and damage to the joint. Once the patient-specific preplanning is done by the surgeon, the surgeon can monitor the orientation of ball and socket during the procedure which may improve accuracy.
Discuss with your surgeon the optimal approach for your specific situation.
What happens prior to a hip replacement procedure?
Before the procedure, the patients meets with the surgeon for a thorough examination that includes:
- Examination of the hip to determine range of motion and the strength of the muscles surrounding the hip
- Medical history and medications being taken
- Tests, including blood analysis, X-ray and potentially a magnetic resonance imaging (MRI) scan
The patient should take this opportunity to discuss any questions or concerns regarding the procedure or pre- and post-operative care.
What is recovery like following a hip replacement?
The surgery is an inpatient procedure. On the day of surgery or the day after, a physical therapist will get the patient up and moving and teach the patient how to strengthen the muscles around the hip through certain exercises. The patient is provided with medication to manage the pain for a time and usually will be able to return home two to three days after the procedure. If there are non-dissolvable stiches or skin staples closing the incision, they are usually removed about two weeks after the surgery.
In the majority of cases, the patients should be able to return to most of the activities of daily life within 8 to 12 weeks.
For more information on hip replacements or to schedule an appointment with a specialist, contact us today.