Primary Hip Replacement

The surgery to replace a worn-out or damaged hip joint is known as Hip Replacement Surgery or total hip arthroplasty. The old joint is replaced with an artificial joint or prosthesis by the surgeon. The surgery may be opted for because of a hip fracture or for severe pain due to arthritis.

Various types of arthritis may affect the hip joint:

  • Osteoarthritis: mostly middle-aged and older adults are affected by osteoarthritis–a degenerative disease of joints. It causes the breakdown of joint cartilage and adjacent bone in the hips.
  • Rheumatoid arthritis: may lead to severe pain and stiffness in the joints. This may be due to inflammation of the synovial lining of the joint. The inflammation causes extra synovial fluid to accumulate in the area leading to severe pain and stiffness.
  • Traumatic arthritis: This type of arthritis is caused by an injury. The hip cartilage may also be damaged due to this.

The hip replacement surgery replaces the parts of the hip joint that have been damaged. The hip pain that can’t be controlled by other treatments gets relieved by this procedure.

Whereas traditional hip replacement requires an incision several inches long over the hip joint, a newer approach uses 1 or 2 smaller incisions to do the surgery known as minimally invasive hip replacement. But this procedure is not beneficial for all people who require a hip replacement. According to your need, you will be given the treatment.

Why might I need hip replacement surgery?

Hip replacement surgery is the most apt for treating pain and disability in the hip which arises due to osteoarthritis.

Osteoarthritis is the reason for the loss of joint cartilage in the hip. Cartilage damage may cause pain and inhibit the movement of the bones. People suffering from a degenerative joint disease may be hampered in doing normal activities that involve bending at the hip, including walking and sitting.

The hip joint may also be damaged from other forms of arthritis like rheumatoid arthritis or arthritis resulting from a hip injury.

Hip fractures may also be treated by the hip replacement surgical procedure. A fracture in the hip may be caused by an injury often from a fall. Pain arising out of a fracture can become very acute. Walking or even moving the leg can cause pain.

If non-surgical medical treatments don’t control your arthritis pain, then a hip replacement treatment may be recommended. Some medical treatments for a degenerative joint disease include :

  • Anti-inflammatory medicines
  • Glucosamine and chondroitin sulfate
  • Medicines for pain relief
  • Limiting the activities that are painful
  • Assistive devices for walking such as a cane
  • Physical therapy
What are the risks of hip replacement surgery?

Any surgery consists of some risk or complications. Some possible complications may include:

  • Bleeding
  • Infection
  • Blood clots in the legs or lungs
  • Dislocation
  • Need for revision or additional hip surgery
  • Nerve injury that causes weakness, numbness, or both

Some other risks may also be involved depending on your specific health condition. Any health concerns should be discussed before the surgery.

How do I get ready for hip replacement surgery?

  • The procedure involved in the surgery will be explained to you and you will be given the chance to ask any questions that you might have about the procedure.
  • A consent form is needed to be signed that gives your permission to do the procedure. The form should be read carefully and clarification of any doubts should be done if something is not clear.
  • Apart from complete health history, a physical examination may be done to make sure that your vital statistics are good enough before having the surgery. Blood tests or other diagnostic tests may be conducted.
    If you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia (both local and general) then it should be conveyed to the health care professional beforehand.
  • Your healthcare professional should be intimated about all your medications. including prescription and over-the-counter medicines, and herbal supplements as well.
  • If you have a history of bleeding disorders or if you are taking any blood-thinners (anticoagulants), aspirin, or other medicines that affect blood clotting it should be informed to the concerned health care professional as you may need to stop taking these medicines before the surgery.
  • Confirmed pregnancy or if you think you may be pregnant should be divulged too.
  • Fasting for 8 hours before the surgery is mandatory. This usually means after midnight.
  • Medicine (sedative) before the surgery may be given to you to help you relax.
  • A physical therapist may come and meet you before surgery to talk about the rehabilitation process after the surgery.
  • Smoking if doing should be stopped before your surgery as smoking can delay wound healing and slow down the recovery process.
  • If needed, lose some weight.
  • Conditioning exercises should be done as prescribed to strengthen muscles.
  • Someone should be there to help around the house for a week or two after you are discharged from the hospital.
  • Based on your health condition, your healthcare professional may order other specific tests or exams.
How do I get ready for hip replacement surgery?
  • The procedure involved in the surgery will be explained to you and you will be given the chance to ask any questions that you might have about the procedure.
  • A consent form is needed to be signed that gives your permission to do the procedure. The form should be read carefully and clarification of any doubts should be done if something is not clear.
  • Apart from complete health history, a physical examination may be done to make sure that your vital statistics are good enough before having the surgery. Blood tests or other diagnostic tests may be conducted.
    If you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia (both local and general) then it should be conveyed to the health care professional beforehand.
  • Your healthcare professional should be intimated about all your medications. including prescription and over-the-counter medicines, and herbal supplements as well.
  • If you have a history of bleeding disorders or if you are taking any blood-thinners (anticoagulants), aspirin, or other medicines that affect blood clotting it should be informed to the concerned health care professional as you may need to stop taking these medicines before the surgery.
  • Confirmed pregnancy or if you think you may be pregnant should be divulged too.
  • Fasting for 8 hours before the surgery is mandatory. This usually means after midnight.
  • Medicine (sedative) before the surgery may be given to you to help you relax.
  • A physical therapist may come and meet you before surgery to talk about the rehabilitation process after the surgery.
  • Smoking if doing should be stopped before your surgery as smoking can delay wound healing and slow down the recovery process.
  • If needed, lose some weight.
  • Conditioning exercises should be done as prescribed to strengthen muscles.
  • Someone should be there to help around the house for a week or two after you are discharged from the hospital.
  • Based on your health condition, your healthcare professional may order other specific tests or exams.
What happens during hip replacement surgery?

The patient will be required to stay in the hospital after the Hip Replacement surgical procedure. The procedure adopted may differ considering your health condition and the expert’s practices.
Hip replacement surgery is under the effect of general anaesthesia or sedated under spinal anaesthesia. Your anesthesiologist will discuss this with you before the surgery.

In general, hip replacement surgery follows this process:

  • You will be given a gown to wear.
  • An IV (intravenous) line may be started.
  • You will be positioned on the operating table.
  • A urinary catheter may be inserted after the administration of anesthesia.
  • The anesthesiologist will be on constant watch of your heart rate, blood pressure, breathing, and blood oxygen level during the surgical procedure.
  • The skin over the surgical site will be cleaned with an antiseptic solution.
  • An incision in the hip area will be done by the concerned surgeon.
  • The damaged parts of the hip joint will then be removed and replaced with the prosthesis. The hip prosthesis is made up of a stem that goes into the thighbone (femur), the head joint (ball) that fits into the stem, and a cup that is inserted into the socket of the hip joint. The stem and cup are both made of metal. The ball is made up of metal or ceramic. The cup’s liner may be made of plastic or ceramic. The 2 most common types of artificial hip prostheses used are cemented prostheses and uncemented prostheses. A cemented prosthesis is attached to the bone with surgical cement. An uncemented prosthesis is attached to the bone with a porous surface. The bone grows onto this surface to attach to the prosthesis. Sometimes a combination of the 2 types is used to replace a hip.
  • After the procedure is over the incision will be closed with stitches or surgical staples. To remove the fluid a drain may be placed in the incision site
  • Then the site will be covered with a sterile dressing or bandage.
What happens after hip replacement surgery?

In the hospital

After the surgery, you will be taken to the recovery room for the recovery process. Once your vital statistics like blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Hip replacement surgery usually requires a stay in the hospital for several days.

It is important to start moving the new joint after surgery. Soon after the surgery, a physical therapist will meet you to discuss and plan an exercise rehabilitation program for you. To facilitate your participation in exercise your pain will be controlled with medicine. You will be given an exercise plan to follow both in the hospital and after discharge.
Depending upon your recovery status you will be discharged home or to a rehabilitation center. In either case, your healthcare professional will make sure for the continuation of physical therapy until you regain muscle strength and a good range of motion.

At Home

Once you are at home, it is important to follow a certain regime like to keep the surgical area clean and dry. You will be given specific bathing instructions to be followed until the stitches or surgical staples are removed. If all goes well the stitches or surgical staples will be removed during a follow-up visit to your healthcare professional.

Be sure to take only recommended medicines by your healthcare professional as some medicines like Aspirin or other pain medicines may increase the chance of bleeding.