Hip Replacement

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Overview

Hip replacement, also called total hip replacement, is a surgical procedure in which damaged parts of the hip joint are replaced with artificial parts (prosthesis). The goals of total hip replacement are to relieve pain, improve function of the hip joint, and increase mobility.

The hip joint is one of the largest weight-bearing joints in the body. It is a ball-and-socket joint in which the thighbone (femur) fits into a rounded socket (acetabulum) in the pelvis. The top of the thighbone (femoral head) is connected to the socket with bands of connective tissue (ligaments), which help to make the hip joint stable. A thin layer of smooth, elastic tissue (articular cartilage) cushions the ends of the bones within the hip joint.

The most common cause for hip damage is osteoarthritis. Other conditions that can damage the hip joint include the following:

• Bone tumor
  
• Injury
  
• Osteonecrosis (death of bone tissue caused by inadequate blood supply to the bone)
  
• Rheumatoid arthritis
  

Damage to the hip joint can cause pain and interfere with daily life. Treatment may include physical therapy, exercises to strengthen the muscles surrounding the hip joint, walking aids (e.g., canes, walkers), and medications (e.g., acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]). In some cases, stronger medications, topical pain relievers (analgesics), corticosteroids (e.g., prednisone, cortisone), and joint lubricants may be used.

When these treatment methods are ineffective, a procedure called an osteotomy may be performed. In an osteotomy, bones in the hip are realigned to shift pressure and weight to a healthy bone surface. If hip function worsens and pain continues, total hip replacement may be necessary.

Surgical Procedure

Total hip replacement can be performed using traditional surgery or a minimally invasive method. The procedure, which usually takes a few hours, may be performed under general or regional anesthesia. Sedation may also be given before the patient is taken into the operating room.

General anesthesia, which renders the patient completely unconscious, is given intravenously or inhaled through a breathing mask. Once the anesthesia has taken effect, patients need assistance breathing (e.g. oral airway, endotracheal tube). Regional anesthesia (e.g., spinal, epidural) may be used to numb the hip area. Some patients feel pressure or tugging during surgery when regional anesthesia is used.

Patients are closely monitored by the anesthesiologist throughout the surgery. Heart rate, blood pressure, and blood oxygen levels are continuously recorded. The amount of anesthesia received is carefully controlled and adjusted for the duration of the hip replacement surgery.

In traditional open surgery, an incision (usually 6 to 8 inches in length) is made in the hip and the damaged tissue is removed and replaced with artificial parts (prosthesis). The healthy portions of the hip joint are left intact.

Minimally invasive hip replacement surgery, which is performed through smaller incisions, may be used in patients who are aged 50 or younger and are generally in good health. Minimally invasive hip replacement requires a shorter recovery time than traditional surgery, but this procedure may increase the risk for complications such as nerve damage, infection, and poor positioning of the artificial hip.

The artificial parts of the hip joint can be attached to healthy bone using special cement (called cemented procedure) or can be made from a substance that allows healthy bone to grow into the surface and hold them in place (called biologic fixation). A hybrid replacement involves a combination of cemented and uncemented parts.

The type of artificial joint used depends on a number of factors, including the age, activity level, and overall health of the patient. Cemented hip replacements often are preferred for older patients, less active patients, and patients who have osteoporosis. Biologic fixation joints often are used in younger patients and more active patients.

Both types of artificial hip joints have similar success rates. Patients who have uncemented replacement require a longer recovery time to allow the bone to grow (usually about 3 months) and may experience pain while the bone forms. Patients who have chronic conditions (e.g., Parkinson's disease), muscle weakness, or advanced hip damage, and those who are generally in poor health, may have lower rates of success.

Hip Replacement Resources

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