Dr. MJ Bazos MD,
Questions And Answers About Hip
What Is a Hip
Hip replacement, or
arthroplasty, is a surgical procedure in which the diseased parts of the hip
joint are removed and replaced with new, artificial parts. These artificial
parts are called the prosthesis. The goals of hip replacement surgery are to
improve mobility by relieving pain and improve function of the hip joint.
Who Should Have Hip Replacement
The most common reason that
people have hip replacement surgery is the wearing down of the hip joint that
results from osteoarthritis. Other conditions, such as rheumatoid arthritis (a
chronic inflammatory disease that causes joint pain, stiffness, and swelling),
avascular necrosis (loss of bone caused by insufficient blood supply), injury,
and bone tumors also may lead to breakdown of the hip joint and the need for hip
Before suggesting hip
replacement surgery, the doctor is likely to try walking aids such as a cane, or
non-surgical therapies such as medication and physical therapy. These therapies
are not always effective in relieving pain and improving the function of the hip
joint. Hip replacement may be an option if persistent pain and disability
interfere with daily activities. Before a doctor recommends hip replacement,
joint damage should be detectable on x rays.
In the past, hip replacement surgery
was an option primarily for people over 60 years of age. Typically, older people
are less active and put less strain on the artificial hip than do younger, more
active people. In recent years, however, doctors have found that hip replacement
surgery can be very successful in younger people as well. New technology has
improved the artificial parts, allowing them to withstand more stress and
strain. A more important factor than age in determining the success of hip
replacement is the overall health and activity level of the patient.
For some people who would otherwise
qualify, hip replacement may be problematic. For example, people who suffer from
severe muscle weakness or Parkinson's disease are more likely than healthy
people to damage or dislocate an artificial hip. Because people who are at high
risk for infections or in poor health are less likely to recover successfully,
doctors may not recommend hip replacement surgery for these patients.
What Are Alternatives to Total Hip
Before considering a
total hip replacement, the doctor may try other methods of treatment, such as an
exercise program and medication. An exercise program can strengthen the muscles
in the hip joint and sometimes improve positioning of the hip and relieve pain.
The doctor also may treat inflammation
in the hip with nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common
NSAIDs are aspirin and ibuprofen. Many of these medications are available
without a prescription, although a doctor also can prescribe NSAIDs in stronger
In a small number of cases, the
doctor may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs
do not relieve pain. Corticosteroids reduce joint inflammation and are
frequently used to treat rheumatic diseases such as rheumatoid arthritis.
Corticosteroids are not always a treatment option because they can cause further
damage to the bones in the joint. Some people experience side effects from
corticosteroids such as increased appetite, weight gain, and lower resistance to
infections. A doctor must prescribe and monitor corticosteroid treatment.
Because corticosteroids alter the body's natural hormone production, patients
should not stop taking them suddenly and should follow the doctor's instructions
for discontinuing treatment.
physical therapy and medication do not relieve pain and improve joint function,
the doctor may suggest corrective surgery that is less complex than a hip
replacement, such as an osteotomy. Osteotomy is surgical repositioning of the
joint. The surgeon cuts away damaged bone and tissue and restores the joint to
its proper position. The goal of this surgery is to restore the joint to its
correct position, which helps to distribute weight evenly in the joint. For some
people, an osteotomy relieves pain. Recovery from an osteotomy takes 6 to 12
months. After an osteotomy, the function of the hip joint may continue to worsen
and the patient may need additional treatment. The length of time before another
surgery is needed varies greatly and depends on the condition of the joint
before the procedure.
What Does Hip
Replacement Surgery Involve?
joint is located where the upper end of the femur meets the acetabulum. The
femur, or thigh bone, looks like a long stem with a ball on the end. The
acetabulum is a socket or cup-like structure in the pelvis, or hip bone. This
"ball and socket" arrangement allows a wide range of motion, including sitting,
standing, walking, and other daily activities.
During hip replacement, the surgeon
removes the diseased bone tissue and cartilage from the hip joint. The healthy
parts of the hip are left intact. Then the surgeon replaces the head of the
femur (the ball) and the acetabulum (the socket) with new, artificial parts. The
new hip is made of materials that allow a natural, gliding motion of the joint.
Hip replacement surgery usually lasts 2 to 3 hours.
Sometimes the surgeon will use a
special glue, or cement, to bond the new parts of the hip joint to the existing,
healthy bone. This is referred to as a "cemented" procedure. In an uncemented
procedure, the artificial parts are made of porous material that allows the
patient's own bone to grow into the pores and hold the new parts in place.
Doctors sometimes use a "hybrid" replacement, which consists of a cemented femur
part and an uncemented acetabular part.
Is a Cemented or Uncemented
were developed 40 years ago. Uncemented prostheses were developed about 20 years
ago to try to avoid the possibility of loosening parts and the breaking off of
cement particles, which sometimes happen in the cemented replacement. Because
each person's condition is unique, the doctor and patient must weigh the
advantages and disadvantages to decide which type of prosthesis is better.
For some people, an uncemented
prosthesis may last longer than cemented replacements because there is no cement
that can break away. And, if the patient needs an additional hip replacement
(which is likely in younger people), also known as a revision, the surgery
sometimes is easier if the person has an uncemented prosthesis.
The primary disadvantage of an
uncemented prosthesis is the extended recovery period. Because it takes a long
time for the natural bone to grow and attach to the prosthesis, people with
uncemented replacements must limit activities for up to 3 months to protect the
hip joint. The process of natural bone growth also can cause thigh pain for
several months after the surgery.
Research has proven the effectiveness
of cemented prostheses to reduce pain and increase joint mobility. These results
usually are noticeable immediately after surgery. Cemented replacements are more
frequently used than cementless ones for older, less active people and people
with weak bones, such as those who have osteoporosis.
What Can Be Expected Immediately
Patients are allowed
only limited movement immediately after hip replacement surgery. When the
patient is in bed, the hip usually is braced with pillows or a special device
that holds the hip in the correct position. The patient may receive fluids
through an intravenous tube to replace fluids lost during surgery. There also
may be a tube located near the incision to drain fluid and a tube (catheter) may
be used to drain urine until the patient is able to use the bathroom. The doctor
will prescribe medicine for pain or discomfort.
How Long Are Recovery and
On the day after
surgery or sometimes on the day of surgery, therapists will teach the patient
exercises that will improve recovery. A respiratory therapist may ask the
patient to breathe deeply, cough, or blow into a simple device that measures
lung capacity. These exercises reduce the collection of fluid in the lungs after
A physical therapist may
teach the patient exercises, such as contracting and relaxing certain muscles,
that can strengthen the hip. Because the new, artificial hip has a more limited
range of movement than an undiseased hip, the physical therapist also will teach
the patient proper techniques for simple activities of daily living, such as
bending and sitting, to prevent injury to the new hip. As early as 1 to 2 days
after surgery, a patient may be able to sit on the edge of the bed, stand, and
even walk with assistance.
do not spend more than 10 days in the hospital after hip replacement surgery.
Full recovery from the surgery takes about 3 to 6 months, depending on the type
of surgery, the overall health of the patient, and the success of
How to Prepare for
Surgery and Recovery
People can do
many things before and after they have surgery to make everyday tasks easier and
help speed their recovery.
•Learn what to expect before, during, and
after surgery. Request information written for patients from the doctor or
contact one of the organizations listed near the end of this fact sheet.
•Arrange for someone to help you around
the house for a week or two after coming home from the hospital.
•Arrange for transportation to and from
•Set up a "recovery station" at home.
Place the television remote control, radio, telephone, medicine, tissues, waste
basket, and pitcher and glass next to the spot where you will spend the most
time while you recover.
•Place items you use every day at arm
level to avoid reaching up or bending down.
•Stock up on kitchen staples and prepare
food in advance, such as frozen casseroles or soups that can be reheated and
•Follow the doctor's instructions.
•Work with a physical therapist or other
health care professional to rehabilitate your hip.
•Wear an apron for carrying things around
the house. This leaves hands and arms free for balance or to use crutches.
•Use a long-handled "reacher" to turn on
lights or grab things that are beyond arm's length. Hospital personnel may
provide one of these or suggest where to buy one.
What Are Possible Complications of
Hip Replacement Surgery?
American Academy of Orthopaedic Surgeons, approximately 120,000 hip replacement
operations are performed each year in the United States and less than 10%
require further surgery. New technology and advances in surgical techniques have
greatly reduced the risks involved with hip replacements.
The most common problem that may happen
soon after hip replacement surgery is hip dislocation. Because the artificial
ball and socket are smaller than the normal ones, the ball can become dislodged
from the socket if the hip is placed in certain positions. The most dangerous
position usually is pulling the knees up to the chest.
The most common later complication of
hip replacement surgery is an inflammatory reaction to tiny particles that
gradually wear off of the artificial joint surfaces and are absorbed by the
surrounding tissues. The inflammation may trigger the action of special cells
that eat away some of the bone, causing the implant to loosen. To treat this
complication, the doctor may use anti-inflammatory medications or recommend
revision surgery (replacement of an artificial joint). Medical scientists are
experimenting with new materials that last longer and cause less inflammation.
Less common complications of hip
replacement surgery include infection, blood clots, and heterotopic bone
formation (bone growth beyond the normal edges of bone).
When Is Revision Surgery Necessary?
Hip replacement is one of the most
successful orthopaedic surgeries performed—more than 90% of people who
have hip replacement surgery will never need revision surgery. However, because
more younger people are having hip replacements, and wearing away of the joint
surface becomes a problem after 15 to 20 years, revision surgery is becoming
more common. Revision surgery is more difficult than first-time hip replacement
surgery, and the outcome is generally not as good, so it is important to explore
all available options before having additional surgery.
Doctors consider revision surgery
for two reasons: if medication and lifestyle changes do not relieve pain and
disability; or if x rays of the hip show that damage has occurred to the
artificial hip that must be corrected before it is too late for a successful
revision. This surgery is usually considered only when bone loss, wearing of the
joint surfaces, or joint loosening shows up on an x ray. Other possible reasons
for revision surgery include fracture, dislocation of the artificial parts, and
What Types of Exercise
Are Most Suitable for Someone With a Total Hip Replacement?
Proper exercise can reduce joint pain
and stiffness and increase flexibility and muscle strength. People who have an
artificial hip should talk to their doctor or physical therapist about
developing an appropriate exercise program. Most exercise programs begin with
safe range-of-motion activities and muscle strengthening exercises. The doctor
or therapist will decide when the patient can move on to more demanding
activities. Many doctors recommend avoiding high-impact activities, such as
basketball, jogging, and tennis. These activities can damage the new hip or
cause loosening of its parts. Some recommended exercises are cross-country
skiing, swimming, walking, and stationary bicycling. These exercises can
increase muscle strength and cardiovascular fitness without injuring the new
What Hip Replacement Research
Is Being Done?
To help avoid
unsuccessful surgery, researchers are studying the types of patients most likely
to benefit from a hip replacement. Researchers also are developing new surgical
techniques, materials, and designs of prostheses, and studying ways to reduce
the inflammatory response of the body to the prosthesis. Other areas of research
address recovery and rehabilitation programs, such as home health and outpatient