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Overview & Description

Hip joint replacement is a surgical procedure to replace the hip joint. The new joint is artificial and has 2 parts. The first part is the hip's socket, called the acetabulum. This is a cup-shaped bone in the pelvis. The second part is the "ball" or head of the femur, also called the thighbone.

These artificial parts together are called a prosthesis. The artificial socket is often made of high-density plastic. The artificial ball, which is attached to a stem, is usually made of a strong, stainless metal. The goal of the surgery is to relieve pain and improve mobility and function in the hip joint.

(1) Who is a candidate for the procedure?

This surgery is most commonly done to relieve severe arthritis, which can wear down the hip joint. People with other conditions, such as injury, bone tumors, and avascular necrosis, or a loss of bone caused by a lack of blood supply, may also need a hip joint replaced. An individual is usually advised to consider this surgery when the following conditions apply:

• The pain is severe enough to restrict not only work and recreation but also the normal activities of daily living.
• The pain is not relieved by arthritis medications.
• The person is not helped by the use of a cane or walker.
• There is significant stiffness of the hip that limits activities.
• Joint X-rays show advanced arthritis or other severe problems.

(2) How is the procedure performed?

The surgeon first removes the diseased bone and cartilage. Replacement pieces are implanted into healthy areas of the pelvis and thighbone. These pieces are then cemented in place.

One method does not require cement and is called cementless hip joint replacement. This allows bone to grow into the prosthesis, and it may last longer than a cemented hip. This can be an important advantage for younger people.

The surgery is usually done in the operating room under general anesthesia, which means the person is put completely to sleep. The procedure usually takes 2 to 3 hours to perform.

Preparation & Expectations

(3) What happens right after the procedure?

After the surgery, the person is taken to the surgery recovery room. This allows a brief period of close observation. Vital signs, such as the blood pressure and pulse, are checked frequently. Close attention is paid to the circulation and sensation in the legs and feet. The hip is usually braced with pillows or a special device that holds the hip in the correct position. The person is given fluids through an intravenous tube, or IV, to replace fluids lost during surgery. A tube may have been placed near the incision to drain fluid. A urinary catheter is often used to drain urine from the bladder until the person is able to use the bathroom. Pain medication will be given as needed.

While in the hospital, the individual will begin physical therapy to strengthen the hip. He or she will also learn how to perform the activities of daily living in ways that can prevent injury to the new hip. For example, proper ways to bend and sit are taught. Most people are sent home from the hospital 5 to 7 days after the surgery.

Home Care and Complications

(4) What happens later at home?

By the time the person leaves the hospital, he or she should be able to get around using crutches or a walker. Physical therapy may be continued after discharge. Some people need to go to a rehabilitation center after leaving the hospital. This is done when a person needs extra time to gain enough independence to be able to get around at home. Complete recovery from this surgery usually takes 3 to 6 months.

(5) What are the potential complications after the procedure?

Surgery may cause bleeding, infection, and allergic reactions to anesthesia. Pain medications or antibiotics may cause stomach upset, allergic reactions, or rash. Following are the most common complications of a hip joint replacement:

• blood clot in the leg, or deep venous thrombosis. To prevent blood clots, medications called blood thinners may be given. The person is asked to move around shortly after surgery and may need to wear support stockings.
• wound infection. To prevent this complication, antibiotics may be given.
• bleeding. Sometimes a blood transfusion may be needed.
• hip dislocation, which means the ball becomes dislodged from the socket. This may occur if the hip is placed in certain positions. The person is taught exercises before leaving the hospital to help prevent this. The individual will also learn which activities to avoid, such as crossing the legs, to prevent hip dislocation.

Any new or worsening symptoms should be reported to the healthcare provider.