Hip Replacement Surgery, Procedure, Risks and Recovery
A hip replacement surgery is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant).
Adults of any age can be considered for a hip replacement surgery, although most are done on patients between the ages of 60 and 80.
A modern artificial hip joint is designed to last for at least 15 years. Most patients have a significant reduction in pain and improvement in their range of movement.
During hip replacement surgery, a surgeon removes the damaged sections of the hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.
Also called total hip arthroplasty, hip replacement surgery might be an option if hip pain interferes with daily activities and nonsurgical treatments haven't helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement surgery.
When a hip replacement surgery is needed
Hip replacement surgery is usually necessary when the hip joint is worn or damaged so that your mobility is reduced and you are in pain even while resting. Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:
- Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.
- Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.
- Osteonecrosis. If there isn't enough blood supplied to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone might collapse and deform.
The most common reason for hip replacement surgery is osteoarthritis. Other conditions that can cause hip joint damage include:
- Hip fracture
- Septic arthritis
- Disorders that cause unusual bone growth (bone dysplasia)
Hip replacement surgery may be an option if hip pain:
- Persists, despite pain medication
- Worsens with walking, even with a cane or walker
- Interferes with sleep
- Affects the ability to walk up or down stairs
- Makes it difficult to rise from a seated position
A hip replacement surgery is a major surgery, so it is usually only recommended if other treatments, such as physiotherapy or steroid injections, have not helped reduce pain or improve mobility. You may be offered hip replacement surgery if:
- You have severe pain, swelling and stiffness in your hip joint and your mobility is reduced
- Your hip pain is so severe that it interferes with your quality of life and sleep
- Everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- You're feeling depressed because of the pain and lack of mobility
- You cannot work or have a social life
- You'll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
Risks of hip replacement surgery:
Risks associated with hip replacement surgery can include:
- Blood clots. Clots can form in the leg veins after hip replacement surgery. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. Blood-thinning medications can reduce this risk.
- Infections can occur at the site of the incision of hip replacement surgery and in the deeper tissue near the new hip. Most infections are treated with antibiotics, but a major infection near the new hip after hip replacement surgery might require surgery to remove and replace the artificial parts.
- During hip replacement surgery, healthy portions of the hip joint might fracture. Sometimes the fractures are small enough to heal on their own, but larger fractures might need to be stabilized with wires, screws, and possibly a metal plate or bone grafts.
- Certain positions can cause the ball of the new joint to come out of the socket, particularly in the first few months after hip replacement surgery. If the hip dislocates, a brace can help keep the hip in the correct position. If the hip keeps dislocating, surgery may be needed to stabilize it.
- Change in leg length. Surgeons take steps to avoid the problem, but occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contracture of muscles around the hip. In these cases, progressively strengthening and stretching those muscles might help. Small differences in leg length usually aren't noticeable after a few months.
- Although this complication is rare with newer implants, the new joint might not become solidly fixed to the bone or might loosen over time, causing pain in the hip. Surgery might be needed to fix the problem.
- Nerve damage. Rarely, nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.
- The artificial hip parts might wear out eventually, especially for people who have hip replacement surgery when they're relatively young and active. If this happens, you might need a second hip replacement surgery. However, new materials are making implants last longer.
Hip replacement surgery procedure:
A hip replacement surgery can be done under a general anesthesia (where you're asleep during the operation) or under a spinal anesthesia (where you're awake but have no feeling from the waist down). Sometimes you may have an epidural, which is similar to a spinal anesthesia. The surgeon makes a cut (incision) into the hip, removes the damaged hip joint and replaces it with an artificial joint or implant. The surgery usually takes around 1 to 2 hours to complete.
Hip resurfacing is an alternative type of operation to hip replacement surgery. This involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface. This type of operation removes less bone. However, it is usually only done on men who are very active and have larger hips. Resurfacing is much less popular now due to concerns about the metal surface causing damage to soft tissues around the hip.
Hip replacement surgery recovery:
After hip replacement surgery, you'll be moved to a recovery area for a few hours while your anesthesia wears off. Medical staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.
You'll be asked to breathe deeply, cough or blow into a device to help keep fluid out of your lungs. How long you stay after hip replacement surgery depends on your individual needs. Many people can go home that same day. You'll usually be in hospital for 3 to 5 days, but recovery time can vary.
Once you're ready to be discharged, your hospital will give you advice about looking after your hip at home after hip replacement surgery. You'll need to use a frame or crutches at first and a physiotherapist will teach you exercises to help strengthen your hip muscles after hip replacement surgery.
An occupational therapist will check if you need any equipment to help you manage at home. You may also be enrolled in an exercise program that's designed to help you regain and then improve the use of your hip joint after hip replacement surgery.
It's usually possible to return to light activities or office-based work within around 6 weeks. However, everyone recovers differently and it's best to speak to your doctor or physiotherapist about when to return to normal activities.
Full recovery from a hip replacement surgery varies from person to person, but most people are doing well three months after the hip replacement surgery. Improvements typically continue during the first year after hip replacement surgery.
The new hip joint can reduce pain and increase the hip's range of motion. But don't expect to do everything you could do before the hip became painful.
High-impact activities, such as running or playing basketball, might be too stressful on the artificial joint. But in time, most people can participate in lower-impact activities — such as swimming, golfing and bicycle riding.
Daily activity and exercise can help you regain the use of your joint and muscles after hip replacement surgery. A physical therapist can recommend strengthening and mobility exercises and can help you learn how to use a walking aid, such as a walker, a cane or crutches. As therapy progresses, you'll gradually increase the amount of weight you put on your leg until you're able to walk without assistance.
Before you leave the hospital, you and your caregivers will get tips on caring for your new hip after hip replacement surgery. For a smooth transition:
Blood clot prevention
- Arrange to have a friend or relative prepare some meals in advance
- Place everyday items at waist level, so you won't have to bend down or reach up
- Consider getting a raised toilet seat and a shower chair for your recovery at home
- Put your phone, tissues, TV remote, medicine and books near the area where you'll be spending most of your time during recovery after hip replacement surgery.
After hip replacement surgery, you'll temporarily be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:
- Moving early. You'll be encouraged to sit up and walk with crutches or a walker soon after hip replacement surgery.
- Applying pressure. Both during and after hip replacement surgery, you might wear elastic compression stockings or inflatable air sleeves on your lower legs. The air sleeves squeeze and release your legs. That helps keep blood from pooling in the leg veins, reducing the chance that clots will form.
- Blood-thinning medications. Your surgeon might prescribe an injected or oral blood thinner after hip replacement surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you might need blood thinners for several weeks after hip replacement surgery.
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