The hip is a ball and socket joint, linking the "ball" at the head of the thigh bone (femur) with the cup-shaped "socket" in the pelvic bone. A total hip prosthesis is surgically implanted to replace the damaged bone within the hip joint.
The total hip prosthesis consists of three parts:
- A cup that replaces your hip socket. The cup is usually plastic, although some centers are trying other materials like ceramic and metal.
- A metal or ceramic ball that will replace the fractured head of the thigh bone.
- A metal stem that is attached to the shaft of the bone to add stability to the prosthesis.
If the surgery is a hemi-arthroplasty, the only bone replaced with a prosthetic device is the head of the femur.
Steps to Hip Replacement Surgery
You will receive an extensive preoperative evaluation of your hip to determine if you are a candidate for a hip replacement procedure.
Your health care provider will assess the degree of disability, impact on your lifestyle, and pre-existing medical conditions. The health care provider will also evaluate your heart and lung function.
The surgery will be performed using general or spinal anesthesia. The orthopedic surgeon makes a surgical cut, often over the buttocks, to expose the hip joint. The head of the thigh bone is removed and removed. Then, the hip socket is cleaned out and a tool called a reamer removes all of the remaining cartilage and arthritic bone.
The new socket is implanted, after which the metal stem is inserted into the thigh bone. The artificial components are fixed in place, sometimes with a special cement. The muscles and tendons are then replaced against the bones and the surgical cut is closed.
You will return from surgery with a large dressing on the hip area. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area. Many surgeons also place a knee immobilizer or special pillow between the legs in the operating room to prevent the hip from dislocating.
You will have moderate to severe pain after surgery. However, you will receive painkillers for the first day or more after surgery. Painkillers may be given through a vein ( intravenously, or IV) through the spinal cord (an epidural), or by way of a special patient-controlled analgesia (PCA) device.
You may be instructed on how to use a device called a spirometer, which shows how much air you breathe in at one time. You'll be shown how to gradually increase the depth of each breath you take and to perform deep breathing and cough procedures to prevent pneumonia.
Hip Surgery Recovery
Most of our patients are in the hospital anywhere from one to two nights. Some even go home day of surgery. Only rarely are patients discharged to a rehabilitation center or skilled nursing facility.
Be careful after surgery that you don't dislocate the artificial hip. The new hip will not have the same range of movement of the original joint, although you should eventually be able to return to your previous level of activity. While you should avoid vigorous sports such skiing or contact sports, many people go on to play tennis and golf quite successfully.
The use of crutches or a walker may be necessary for as long as 3 months, although most people who did not use them before are able to walk without them in several weeks.
Many surgeons place their patients on blood thinners for several weeks after surgery to help prevent blood clots. These may be taken in the form of pills (either Coumadin or aspirin) or injections.
When can I resume activities after hip surgery?
Start moving and walking early after surgery. On the first day after surgery, you should get out of bed to a chair. When in bed, perform ankle exercises frequently to prevent the development of blood clots.
What special precautions should I follow after hip surgery?
The new joint has a limited range of movement. You will need to take special precautions to avoid displacing the joint, including:
- Avoid crossing your legs or ankles even when sitting, standing, or lying.
- When sitting, keep your feet about 6 inches apart.
- When sitting, keep your knees below the level of your hips. Avoid chairs that are too low. You may sit on a pillow to keep your hips higher than your knees.
- When getting up from a chair, slide toward the edge of the chair and then use your walker or crutches for support.
- Avoid bending over at the waist. You may consider purchasing a long-handled shoehorn or a sock aid to help you put on and take off your shoes and socks without bending over. Also, an extension reacher or grabber may be helpful for picking up objects that are too low for you to reach.
- When lying in bed, place a pillow between your legs to keep the joint in proper alignment.
- A special pillow or splint may be used to keep the hip in correct alignment.
- An elevated toilet seat may be necessary to keep the knees lower than the hips when sitting on the toilet.