· A · A · A ·
Print this page

Hip joint replacement

guidelines for patients

Dr Rob Nicholas

Total hip replacement information

This describes how a normal hip works, the cause of pain, what to expect from hip
replacement surgery, and what exercises and activities will help restore your mobility and strength and enable you to return to everyday activities.

If your hip has been damaged by arthritis, a fracture or other conditions, common activities such as walking, getting in and out of a chair may be painful and difficult.
Your hip may be stiff and it may be hard to put on your socks and shoes. You may even feel uncomfortable while resting.

If medication, changes in your everyday activities, and the use of walking aids such as a cane are not helpful, you may want to consider hip replacement surgery. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can relieve your pain, increase motion and help you get back to enjoying normal everyday activities.

First performed in 1960, hip replacement surgery is one of the most important surgical advances of the last century. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement.

Anatomy

The hip is one of the body’s largest weight bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket ( acetabulum) in your pelvis.

The bone surfaces of the ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bone and enables them to move easily.

A new hip joint can help improve mobility and reduce pain.

You may benefit from hip surgery if:

What to expect from hip replacement surgery

An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do.

Most people who undergo hip replacement surgery experience dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.

However, hip replacement surgery will not enable you to do more than you could before your hip problem developed.

Following surgery, you will be advised to avoid certain activities, including jogging and high impact sports, for the rest of your life. You may be asked to avoid specific positions of the joint that could lead to dislocation.

Even with normal use and activities, an artificial joint (prosthesis) develops some wear over time.

If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.

Preparing for surgery

Medical evaluation
If you decide to have hip replacement surgery, you may be asked to have a complete physical examination by a physician before your surgical procedure. This is needed to assess your health and identify conditions that can interfere with your surgery or recovery.

Tests
Several tests may be needed to help plan your surgery: blood and urine samples may be tested and a cardiogram and chest x/rays( radiographs) may be obtained.

Preparing your skin
Your skin should have not have any infections or irritations before surgery. If either present, contact your orthopaedic surgeon for a programme to improve your skin before surgery.

Medication
Stop Disprin and anti-inflammatory drugs seven days before surgery. Ask your doctor if you are not sure.

Weight Loss
If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.

Social Planning
Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing and laundry.

If you live alone, your orthopaedic surgeon’s office or a discharge planner at the hospital can help you to make advance arrangements to have someone assist you at your home.

A short stay in an extended–care facility during your recovery after surgery may also be arranged.

Home Planning
The following is a list of home modifications that will make your return home easier during your recovery:

Your Surgery

You will most likely be admitted to the hospital on the day before surgery. Prior to admission the anaesthetist will evaluate you. The most common type of anaesthesia for hip replacement surgery are general anaesthesia (which puts you to sleep throughout the procedure and uses a machine to help you breathe) or epidural anaesthesia ( which allows you to breathe on your own but anaesthetizes your body from the waist down).

The anaesthetist will discuss these choices with you and help you to decide which type of anaesthesia is best for you.

The surgical procedure takes a few hours. Your orthpaedic surgeon will remove the damaged cartilage and bone and then position the new metal, plastic, or ceramic joint surfaces to restore the alignment and function of your hip.

Many different types of designs and materials are currently used in artificial hip joints. All of them consists of two basic components: the ball component (made of a highly polished strong metal or ceramic material) and the socket component (a durable cup made of plastic, ceramic or metal, which may have an outer shell).

Special surgical cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint.

A non-cemented prosthesis has also been developed and is used most often in younger, more active patients with strong bone. The prosthesis maybe coated with thetextured metal or a special bone-like substance, which allows to bone to grow into the prosthesis.

A combination of a cemented ball and non-cemented socket may be used.

Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs, having discussed the various options with you.

After surgery, you will be moved to the recovery room where you will remain while the recovery from anaesthesia is monitored. After you awaken fully, you will be taken to the surgical high care ward for the first 24 hours, and thereafter to your own ward.

Total Hip Replacement
Normal and Arthritic Hip Joints

 

Your stay in hospital

You will usually stay in the hospital for five to eight days.
Walking and light activity are important to your recovery and will begin the day after
surgery. Most patients who undergo total hip replacement begin standing and walking with the help of a walking support and a physiotherapist the day after surgery. The physiotherapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities. You will also be taught the correct posture to prevent dislocation.

Complications

The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit recovery.

Blood clots in the leg veins or pelvis are the most common complication of the hip replacement surgery. Your doctor may prescribe one or more measures to prevent blood clots from forming in your leg veins . These measures include special support hose, ankle/ foot pumps and blood thinners.

Leg – length inequality may occur or become or seem worse after the hip replacement. Your orthopaedic surgeon will take this into account, in addition to other issues, including the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe raise after surgery.

Other complications such as dislocation, nerve and blood vessel injury, bleeding, fracture and stiffness can occur. In a small number of patients, some pain can continue or new pain can occur after surgery.

Over years hip prosthesis may wear or loosen. When the prosthesis wears, bone loss may occur because of the small particles produced at the wearing surface. This process is called osteolysis.

Recovery

The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon’s instructions regarding home care during the first few weeks after surgery.

Wound care
You will have a suture beneath your skin and it dissolves and need not be removed.
The dressing is waterproof and can get wet.

Remove the dressing ten days after surgery and then leave the wound open (it can get wet)

Diet
Some loss of appetite is common for several weeks after surgery. A balanced diet is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids. Take a multivitamin.

Activity
Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks and up to four months . Full recovery takes twelve months.

Your activity programme should include:

Avoiding Falls
A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone to help you until you improve your balance and flexibility, and strength.

Your orthopaedic surgeon and physiotherapist will help decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

Other Precautions
To assure proper recovery and prevent dislocation of the prosthesis, you must take
special precautions.