Total Hip Replacement

Total hip replacement is a procedure in which the doctor removes a painful hip joint and inserts an artificial joint.

When is it used?

This procedure is done when your hip is painful, usually because of arthritis, and other treatments have not worked.

Alternatives to this procedure include:

• medical therapy
  
• limiting activity and using a walking aid such as a cane or walker
  
• avoiding activities that make the pain worse, such as climbing stairs or walking long distances
  
• using heat packs to relieve pain
  
• physical therapy
  
• having the hip joint fused together
  
• choosing not to have treatment while recognizing the risks of your condition.
  

You should ask your doctor whether any of these choices would be of benefit to you.

How do I prepare for a total hip replacement?

You can talk to someone who has had a hip replacement to get an idea of what the procedure and recovery period are like. Because you may need blood transfusions during the operation or during recovery after the operation, you may want to donate some of your own blood before the procedure.

Talk to your doctor about what to expect both in the hospital and after discharge from the hospital.

Allow for time to rest after the operation and find people to help you with your day-to-day duties and care for at least the first week at home.

Follow any instructions your doctor may give you. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

General or spinal anesthesia is given. General anesthesia will place you in a deep sleep and prevent you from feeling pain during the operation. Spinal anesthesia is when medication is injected into the back that should keep you from feeling pain during the operation.

In the operating room you will be positioned either on your side or back. The doctor makes a cut along the side of your hip, and dissects through the muscles to expose the hip joint. The doctor then dislocates the hip and uses reamers to make the hip socket a perfect hemisphere. A new plastic socket will be inserted and either cemented or pressed into place. The ball portion of the joint (femoral head) will then be cut off and a metal ball attached to a stem will be inserted into the thighbone (femur). The wound is then closed and one or two drains may be put in to help drain any fluid or blood from the new joint.

You may need a blood transfusion(s). The hospital will use your own blood if you donated before surgery or it will use matched blood.

What happens after the procedure?

You may stay in the hospital for about 4 to 6 days, depending how fast your hip heals. While in bed you may have a wedge-shaped cushion between your legs to keep the new ball and socket joint in place. A tube (catheter) may be placed in your bladder if you have trouble urinating. Physical therapy is usually begun the day after surgery, and within days most people are walking with a walker, cane, or crutches. After the hospital you may require more intensive therapy in a rehabilitation hospital for another week or two.

Do not participate in sports or any heavy activity after healing. The replacement hip is designed only for usual day-to day activity.

You can expect your orthopedic surgeon to follow you closely after your operation. The surgeon will plan physical therapy and rehabilitation for you. This therapy may last for weeks to months after your surgery and will be designed so that you will gain maximum benefit from your hip replacement.

You should ask your doctor what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

The primary reason for having a total hip replacement is pain relief. You may resume a more normal life. The problems of a painful hip joint, such as limited range of motion and constraints on how far you can walk, are usually improved.

What are the risks associated with this procedure?

• There are risks when you have general anesthesia. In the elderly, mild to severe confusion can occur which may last from hours to weeks after general anesthesia. Discuss these risks with your doctor.
  
• In rare cases, you may have an allergic reaction to the drug used in spinal anesthesia. Spinal or epidural anesthesia is usually considered safer than general anesthesia.
  
• There is a risk of infection from the operation.
  
• A blood clot may form in the veins of the legs, escape into the bloodstream, and block an artery in the lungs. You may be given a medication to thin the blood to try to avoid this which can predispose you to bleeding.
  
• Your legs may not be of equal length after the operation.
  
• Rarely other bones may be broken during surgery. This may require a longer hospital stay.
  
• The nerves in the hip area may be injured from swelling or pressure. This can cause some numbness or weakness that usually improves.
  
• The new hip joint will not move as well as a normal joint. It can be dislocated more easily. You must be careful not to sit too low or to cross your legs.
  
• At the time of surgery the new ball joint is forced into the femur (thigh bone) where the bone marrow is. As a result, pieces of fat in the bone marrow may become loose, enter the bloodstream, and get into the lungs.
  
• If you need a blood transfusion and have not donated your own blood, the hospital tries to match the blood. However, it is not possible to avoid reactions to donated blood 100% of the time. There is also the risk of acquiring blood-borne diseases, although the risk is low. The replacement parts will become loose or break with time. However, this does not usually occur for about 15 years and some artificial hips have lasted over 20 years.
  

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You develop a fever.
  
• You become short of breath or cough up blood.
  
• You develop chest pain.
  
• You develop symptoms of infection.
  
• There is unusual swelling, warmth, or redness of your calf, thigh, or hip.
  
• Fluid begins to drain from your incision. <
  

Call the doctor during office hours if:

• You have questions about the procedure or its result.
  
• You want to make another appointment.

Developed by iMcKesson Clinical Reference Products.
Published by iMcKesson Clinical Reference Products.
Copyright © 1995-2000 iMcKesson LLC. All rights reserved.

Adapted from content provided by iMcKesson, LLC
Review Date: 6/9/2001