All About Hip Replacements

If hip pain limits your ability to walk, work, or perform simple activities, you may want to talk to your doctor about a hip replacement.

In hip replacement surgery, the diseased parts of the hip joint are removed and replaced with artificial parts, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The aim of hip replacement surgery is to make it less painful to move the joint, as well as improve its function.

Today, total hip replacement surgery is a common procedure done to relieve pain and debilitation caused by osteoarthritis, rheumatoid arthritis, fractures, dislocations, and other hip-related problems, according to the American Academy of Orthopaedic Surgeons. Over 231,000 hip replacements are done each year in this country, and a very low percentage need further surgery.

Osteoarthritis

The most common reason that people have hip replacement surgery is the wearing down of the hip joint that results from osteoarthritis. Hip replacement is recommended only after careful evaluation of the problem and after other measures such as canes, medication, or physical therapy fail to bring relief.

Although hip replacements were once reserved for people older than 60, they now offered to younger adults, as well, the NIAMS says. Hip replacement parts have improved, making them more durable and longer lasting.

In most cases, it takes about four months for full recovery after surgery. At that point, a person is relatively pain-free, has full hip mobility, and can walk with minimal or no limp. In some cases, fixing one hip reduces the stress on the other hip, thus giving the person another two to three years before needing another operation.

People with chronic diseases that leave their muscles weakened are not good candidates for hip replacement surgery, because they are more likely to damage or dislocate an artificial hip, according to the NIAMS. Also, people at high risk for infections or who are in poor health are not good candidates for this type of surgery.

Surgery details

Hip replacement operations usually take about two hours. The hospitalization time is typically three to four days. The hip joint is made up of the femur (thighbone) and the acetabulum, a socket structure in the pelvis. The surgeon replaces the head of the femur and the acetabulum with artificial parts.

The new hip parts may be cemented in place or they may be made of porous material that allows the person's own bone to grow into the replacement parts to hold them, the NIAMS says. Sometimes, the surgery includes both cemented parts and uncemented parts.

A younger adult may have an uncemented replacement because it may be easier to do an additional replacement when needed. An uncemented replacement requires a longer recovery time, however, because the process of new bone growth may take up to three months.

A cemented replacement often is used for older people who are less active and for people with osteoporosis.

After discharge from the hospital, some people who live alone may require a stay at a rehabilitation center for a few days.

Recovery varies with the person, the type of surgery, and the success of rehabilitation. Most people use a walker for about four weeks after the surgery and start driving their cars within two to four weeks. Most gradually increase their activities and can play golf, doubles tennis, or bowl after about 12 weeks. More active sports, such as singles tennis and jogging, generally aren't recommended.

After surgery, pain relievers are used to treat any discomfort, often much less than the pain the person had in the months and years before the operation.

Common problems

Blood clots in the legs or pelvis area are the most common post-surgical complication from hip replacement surgery. Preventive measures for blood clots include blood-thinning medication, elastic support hose, exercises for the lower legs, and inflatable cuffs that alternately squeeze and release the lower legs to help improve blood flow.

Other complications of hip replacement surgery may include infection, bleeding, dislocation of the hip joint, nerve or blood vessel injury, and stiffness.

A common problem that occurs later is a type of inflammation called osteolysis. Newer types of plastic are now available which may reduce the risk of hip replacement failure.