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HIP REPLACEMENT SURGERY
WHAT IS IT?
The hips are among the body’s largest weight-bearing joints. When they’re healthy, your hips allow you to move easily and painlessly. But for people with arthritis or hip injury, just walking can bring on stiffness and crippling aches.

Each year, more than 160,000 Americans have hip replacement surgery in which damaged parts of the hip bone are removed and artificial parts are implanted to take their place. Hip replacement surgery can help relieve pain and restore movement.

A hip implant, called a prosthesis, is made mostly of metal. It looks like the ball-and-socket joint it replaces-and works like it, too. Surgery to implant the prosthesis, called total hip arthroplasty, takes a few hours and almost always succeeds in helping a patient resume normal activity without pain. Most people who have the surgery are over 60. But younger people may need it too.

Although hip replacement is generally safe, it’s still major surgery. Your doctor will most likely suggest other options first, such as using a cane, taking medications for pain and inflammation, or trying physical therapy. If you are still unable to control the pain, your doctor will probably suggest hip replacement surgery. If you do have hip replacement surgery, you’ll spend a few days in the hospital. You will most likely be able to begin walking again within days of the operation, but complete healing can take from three to six months.
WHAT IS HAPPENING?
The hip joint has two main parts: the rounded socket in your pelvis, and the ball at the top of your thighbone that fits into it. In a healthy hip, the ball glides freely within the socket. That’s because both bone surfaces are cushioned with a tough tissue called cartilage. Also, the synovial membrane, a tissue between the joints, makes synovial fluid. Synovial fluid lubricates the hip cartilage.

Sometimes injury or disease can weaken the hip. One bad fall can crack a bone and cause lasting damage. More commonly, arthritis wears down hip cartilage over many years, leaving it frayed and pitted. When this happens, unpadded bone surfaces grate against each other, often creating bumps called bone spurs. This makes the hip feel stiff and sore when you move. Sometimes bone spurs break off and strike through the cartilage into a bone.

As time passes, hip trouble can make getting out of a chair or walking hard or painful. In the worst cases, the joints may ache even while you’re resting. Then you may need hip replacement surgery.
WHAT CAUSES IT?
Many of the factors that increase your risk of needing a hip replacement, such as arthritis, are related to getting older.

Osteoarthritis
Osteoarthritis results when the cartilage that cushions bones wears down. When this happens, the ends of bones can rub against one another, causing pain and stiffness. People who have injured a joint are especially prone to osteoarthritis. This type of arthritis mostly strikes middle-aged and elderly people and affects more women than men.

Rheumatoid arthritis
This disease can attack joints throughout the entire body. It causes joint pain and swelling that can damage cartilage. Rheumatoid arthritis usually appears during middle age, but some people get it in their twenties or thirties. Women get rheumatoid arthritis more often than men.

Other problems that affect the hip
Hip replacement may also be recommended for people with a hip trauma or fracture, loss of bone in the hip due to reduced blood supply, and bone tumors.
WHAT YOU CAN DO FOR YOURSELF
There are several things you can do after surgery to restore your strength and avoid complications.

Exercise
Physical therapy will help make your new hip strong and flexible. Sometimes, therapy starts the day after surgery, with standing, or gentle exercises that contract and relax specific muscles to strengthen the hip. Most likely, you’ll start walking again in the days following surgery. Often, you begin by using a walker, then crutches, then a cane. Sticking with your exercises at home will help restore strength and flexibility.

Watch your balance
You may not be as sure on your feet as you were before, and a fall shortly after surgery can damage your new hip. To prevent spills, steady yourself with a cane and wear low-heeled, rubber-soled shoes. Remove rugs and electrical cords from walking areas so you don’t trip. Use handrails when using stairs and in the shower.

Avoid jarring movements
You’ll have to give up running, tennis, contact sports, and other activities with fast, jarring movements for the rest of your life. They can loosen the hip or damage it. Instead, exercise by swimming, riding a stationary bike, or walking.

Get a shoe lift
Some hip replacement patients find that the surgery makes one leg just a bit longer than the other one. If this happens, a shoe lift will help.

Inform other doctors
Because your implant is made of substances foreign to your body, it may attract certain infections. So be sure to tell all of your doctors and any other health-care providers who treat you about your surgery. To prevent infection, you will need to take antibiotics whenever you have any type of surgery or even dental work.

Stay in touch
See your surgeon regularly for routine follow-up care and X-rays.
WHAT YOUR DOCTOR CAN DO FOR YOU
If your doctor thinks you might benefit from hip replacement surgery, he or she will refer you to an orthopedic surgeon. Besides the surgery itself, there are many things your doctor and your surgeon can do to ensure that your hip replacement is a success.

Before surgery
When you meet with the orthopedic surgeon, he or she will ask how much your hip pain has affected your life. The surgeon will also want to know what medicines you take. Then he or she will ask you about other injuries or medical problems you’ve had, especially those that affect the joints.

The surgeon will also watch you walk, sit, bend, and move to get a better idea of how badly you need a hip replacement. He or she will check how far you can move your leg in different directions and ask you how much various movements hurt. The surgeon will then take X-rays to check the hip joint and plan a precise fit for the implant. Other tests, such as a blood test or a bone scan, may also be done to find out more about the condition of the bone and surrounding tissue.

Your surgeon will also tell you about the surgery’s risks. Advances in the way the surgery is performed have reduced the risks of hip replacement surgery. But there is a slight chance of hip dislocation, inflammation, infection, blood clots, pneumonia, or abnormal bone growth. Discuss any concerns you have with your doctor.

During surgery
Before the surgery begins, an anesthesiologist will give you either general or spinal anesthesia so you feel no pain during surgery. General anesthesia will put you to sleep. Spinal anesthesia will numb you from the waist down but will not put you to sleep. A tube may also be inserted into a vein to transfuse blood, if necessary, or to give you medications.

As you lie on your side, your surgeon will make an incision that is about eight inches long over your hip, and will then cut down through fat and muscle until reaching the neck of the thighbone, or femur. After muscles are moved away from the femur, a second surgeon will reach in with a special hook and pull the femur head out of its socket, a cup-shaped bone in your pelvis.

With your hip joint apart, your surgeon will prepare to put in the prosthesis. First, he or she removes the top of your femur. After hollowing out the bone, the surgeon inserts the prosthesis-a metal shaft with a ball at the top-into the center of the femur. Your implant may or not be cemented into place, depending upon which type is used. Some prostheses are designed with tiny pores so that bone will grow into and around the shaft, and cement won’t be needed.

Next, the surgeon drills your natural socket clean and inserts a new cup lined with high-strength plastic. After testing how well the new ball joint fits into the cup, the surgeon seals bleeding vessels, attaches muscles back to the femur, and closes the wound. Your surgery is complete.

After surgery
Right after the operation, you’ll spend one or two hours in the recovery room, where you will be monitored.

During the rest of your hospital stay, your surgeon, physical therapist, nurses, and perhaps your family doctor will work as a team to provide you with medicine (such as antibiotics and painkillers), nutrition, and guidance in resuming normal activity with your new hip. Your therapist will teach you exercises to help build strength in your hip and will show you how to move safely. You may be given a “reacher” with a long handle, which will allow you to pick up things that are out of reach.

After you leave the hospital, you may need to stay in a nursing center for a short time if you don’t have help at home. Once you go home, your doctor will keep in touch with you as you slowly return to your daily activities such as driving, gardening, and housework.