Hip Arthroplasty

Hip replacement, Total hip arthroplasty, Hip prosthesis

Hip arthroplasty, commonly known as hip replacement, is one of the most successful surgeries in modern medicine, performed more than 450,000 times each year in the United States to help people overcome severe hip pain and return to everyday activities.

Table of contents

• What is hip arthroplasty?
• Understanding the hip joint
• Common causes requiring hip replacement
• When is hip replacement needed?
• Types of hip replacement surgery
• What happens during the procedure
• Hip implant materials and durability
• Recovery and rehabilitation
• Benefits of hip replacement
• Potential risks and complications
• Life after hip replacement

What is hip arthroplasty?

Hip arthroplasty is a surgical procedure to remove damaged sections of the hip joint and replace them with artificial parts. These replacement parts are usually made of metal, ceramic, and hard plastic. This artificial joint, called a prosthesis (an artificial body part), helps reduce pain and improve function.^[1]

Hip replacement is surgery for people with severe hip damage. During the operation, the surgeon removes damaged cartilage and bone from your hip joint and replaces them with new, man-made parts.^[3] Hip arthroplasty is one of the most cost-effective and consistently successful surgeries performed in orthopedics, providing reliable outcomes for patients suffering from end-stage degenerative hip osteoarthritis.^[4]

Understanding the hip joint

The hip is one of the body’s largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum (the cup-shaped part of the pelvis bone). The ball is the femoral head (the rounded top of the thighbone, also called the femur), which is the upper end of the thighbone.^[2]

The bone surfaces of the ball and socket are covered with articular cartilage (a smooth tissue that cushions the ends of bones). This smooth tissue enables the bones to move easily. A thin tissue called the synovial membrane (a lining that produces lubricating fluid) surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.^[2]

Bands of tissue called ligaments (strong connective tissue) connect the ball to the socket and provide stability to the joint. The hip joint stability is achieved through a dynamic interplay between these bone structures and soft tissue components.^[4]

• Hip joint
• Femur (thighbone)
• Pelvis

Common causes requiring hip replacement

The most common cause of damage requiring hip replacement is osteoarthritis (wear-and-tear arthritis). Osteoarthritis causes pain, swelling, and reduced motion in your joints. It damages the slick cartilage that covers the ends of bones and helps joints move smoothly.^[1]

Several conditions can damage the hip joint, sometimes making hip replacement necessary:^[1]

• Osteoarthritis: Commonly known as wear-and-tear arthritis, it affects millions of Americans
• Rheumatoid arthritis: Caused by an overactive immune system, this condition produces a type of inflammation that can erode cartilage and occasionally underlying bone. This can result in a joint that is damaged or changes shape
• Osteonecrosis: If there isn’t enough blood supplied to the ball portion of the hip joint, the bone might collapse and change shape. Osteonecrosis might result from a dislocation or fracture that disrupts the blood supply to the bone
• Traumatic injuries such as hip fractures from sports injuries, car accidents, or falls
• Congenital hip disorders

Other underlying diagnoses include hip osteonecrosis, congenital hip disorders, and inflammatory arthritis.^[4] Post-traumatic arthritis can also develop after an injury, compromising the hip’s function and movement.^[6]

When is hip replacement needed?

Hip replacement might be an option if hip pain interferes with daily activities and nonsurgical treatments haven’t helped or are no longer effective.^[1] If other treatments such as physical therapy, pain medicines, and exercise haven’t helped, hip replacement surgery might be an option for you.^[3]

Common signs that you may need hip replacement include:^[5]

• Severe hip pain that is not relieved by medication and that interferes with your work, sleep, everyday activity, or quality of life
• Hip stiffness that restricts motion and makes it difficult to walk or perform other routine activities, such as putting on shoes and socks

Additional symptoms that may indicate you need a hip replacement include:^[6]

• Chronic hip pain that persists when rest, physical therapy, or anti-inflammatory medications don’t help
• Limited mobility and difficulty walking, climbing stairs, or performing routine activities
• Reduced range of motion or inability to bend, flex, or rotate your hip
• Inflammation or swelling around the hip joint that doesn’t improve with rest
• Joint instability where the hip joint feels unstable or gives out unexpectedly

If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or 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 shoes and socks. You may even feel uncomfortable while resting.^[2]

Types of hip replacement surgery

Hip arthroplasty is the most common and successful type of hip replacement. However, there are different surgical approaches and types available:^[5]

Total hip replacement is the most common type. During this procedure, the surgeon replaces the entire hip joint with artificial components. This is performed primarily to relieve hip pain and stiffness caused by hip arthritis. It involves replacing both the ball at the top of the femur and the socket it fits into.^[5]

Partial hip replacement, also called hemiarthroplasty, involves replacing only part of the hip. These are rare and typically used only in specific circumstances, such as certain types of hip fractures or to remove certain types of tumors.^[5]

Hip resurfacing is another type of hip replacement that might be appropriate in some patients.^[5]

There are also different surgical approaches to performing hip replacement:^[5]

• Posterior approach: The incision is made on the back of the hip
• Anterior approach: The incision is made on the front of the hip, sometimes called the “mini-anterior approach” or “muscle-sparing hip replacement”

Both approaches offer pain relief and improvement in walking and movement within weeks of surgery with comparable, low complication rates. In some instances, the orthopedic surgeon may choose to employ robotic technologies during the surgery.^[5]

What happens during the procedure

Hip replacement surgery usually takes one to two hours to complete.^[5] Most hip replacements are performed with regional anesthesia, which blocks pain in a large area of your body but doesn’t completely put you to sleep. Some providers refer to this as a spinal block or a spinal.^[11]

During a hip replacement surgery, your orthopedic surgeon will typically follow these steps:^[11]

• Remove bone and cartilage from your existing hip joint
• Insert the prosthesis, which typically includes replacing the top of your femur with a metal or ceramic implant (the ball) and resurfacing the socket of your hip joint with a metal and plastic cup that fits inside your pelvic bone
• Secure the hip implants in place
• Close the surgery site with stitches

Your surgeon will have three goals during the surgery: implants that fit appropriately, proper positioning and alignment, and restoring function while minimizing complications.^[19]

Hip implant materials and durability

Replacement parts for hip arthroplasty are usually made of metal, ceramic, and hard plastic.^[1] Hip prostheses are designed to mimic the ball-and-socket action of the hip joint.^[1]

Modern hip prostheses are designed to last 15 to 20 years or more, depending on the type of material used and the patient’s activity level.^[20] With proper care and appropriate activity levels, many people who have a hip replacement live with it for the rest of their lives.^[11]

Recovery and rehabilitation

Your hospital stay will typically last from one to two days, depending on the speed of your recovery. If your hip replacement is done on an outpatient basis, you will go home on the same day as surgery.^[14] Most patients should be able to go home the day of surgery or the day after surgery.^[15]

Before you are discharged from the hospital, you will need to accomplish several goals, such as:^[14]

• Getting in and out of bed by yourself
• Having acceptable pain control
• Being able to eat, drink, and use the bathroom
• Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs
• Being able to perform the prescribed home exercises
• Understanding any hip precautions you may have been given to prevent injury and ensure proper healing

You will need rehabilitation and physical therapy after your surgery, though it’s less extensive than it is for many other types of joint replacement surgery. The standard protocol for patients is two weeks of recovery and rehabilitation at home, and then outpatient physical therapy for anywhere from two to four weeks.^[15]

The best therapy after a hip replacement is walking. It’s important to get up and move the hip a lot. You should also change your position regularly when you’re sitting.^[15] Getting up and moving after hip replacement surgery can help you recover more quickly and reduce your risk of blood clots.^[18]

You will start physical therapy in the hospital after your surgery, often in the postoperative recovery area. After you leave the hospital, physical therapy will continue to be important for your recovery. In most cases, you will have physical therapy at home a few times a week for two to three weeks following surgery, followed by weekly physical therapy at an outpatient clinic for up to two to three months after surgery.^[18]

Up to three months is expected for rehabilitation following your operation. If you have a physically demanding job though, your return to work may take longer.^[16] It’s important to balance rest and recovery with gentle exercise. While it’s important to rest to allow yourself time to recover, it’s also important to get moving, as staying still for too long can cause stiffness which could hinder recovery.^[16]

You may need to use a walker, cane, or crutches for a few weeks after hip replacement to help you keep your balance as you become more active.^[18] The pain usually peaks a few days after surgery but gradually improves over the next few weeks.^[18]

Benefits of hip replacement

Total hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities. Total hip replacement surgery is one of the most successful operations in all of medicine. Since the early 1960s, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement.^[2]

A hip replacement can:^[3]

• Relieve pain
• Help your hip joint work better
• Improve walking and other movements

Overall, hip arthroplasty provides consistent short-term and long-term pain relief and positive patient-reported clinical and functional outcomes. In general, hip arthroplasty provides even more reliable and consistent positive results compared to total knee arthroplasty.^[4]

Once you’re fully recovered, you should have increased mobility. A hip replacement surgery usually makes it easier to walk, climb stairs and do other physical activities.^[11] After three months of recovery, many patients are encouraged to be active with activities like hiking, biking, and swimming.^[15]

Potential risks and complications

Hip replacement surgeries are usually very successful, and complications are rare. However, like all surgeries, there are some risks. The most common problem after surgery is hip dislocation. Because a man-made hip is smaller than the original joint, the ball can come out of its socket.^[3]

Potential complications can include:^[11]

• Blood clots in your legs (deep vein thrombosis) or lungs (pulmonary embolism)
• Broken bones around the prosthesis
• Infections
• Issues with the prosthesis, including it loosening or dislocating
• Stiffness in your joint

Warning signs of infection include:^[14]

• Persistent fever (higher than 100°)
• Shaking chills
• Increasing redness, tenderness or swelling of your wound
• Drainage from your wound

Life after hip replacement

After having a total hip replacement, you may expect your lifestyle to be a lot like how it was before surgery, but without the pain.^[14] Most people who have a hip replacement experience a dramatic decrease in their symptoms, especially pain and stiffness.^[11]

Patients often tell doctors that they wish they hadn’t waited so long to have the operation.^[15] There are few long-term limitations after hip replacement. The only physical activity that is generally not recommended is running, as replacement joints function very well but are not designed for marathon running. If you treat them with respect, they will last you the rest of your life.^[15]

With a hip replacement, you might need to avoid certain activities, such as jogging and high-impact sports.^[3] To extend the lifespan of the prosthesis, it is recommended to maintain an active yet not overly strenuous lifestyle. Low-impact exercises such as swimming, yoga, and Pilates are ideal for staying fit without putting unnecessary pressure on the hip.^[20]

However, some patients may need revision surgery over time, especially if the prosthesis wears out or becomes loose.^[20] In the long term, most patients who have had successful hip replacement surgery experience significant improvements in their quality of life. Once recovery has progressed and rehabilitation has run its course, many people return to enjoying physical activities that were previously impossible due to pain.^[20]