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Total Hip Replacement

Hip Replacement Surgery
The hip joint is an important joint in the body and it bears the weight of the body. The hip joint is a ball-and-socket joint and consists of a hip socket contained in the pelvic bone (i.e. the acetabulum) and the ball which is formed by the upper end of the thigh bone (i.e. the femoral head).
What is Total Hip Replacement?
Hip replacement is a surgical procedure in which the hip joint is replaced by a artificial joint. The diseased joint is removed and both the socket (acetabulum) and the ball (femoral head) are replaced with a metal ball and plastic cup, referred to as the prosthesis (artificial joint).
What are the types of surgery?
Hip replacement surgeries are of following types:
1. Total hip replacement: In this surgery, the complete hip joint – the socket and the ball is replaced with an artificial joint. It is performed for patients in whom both the socket and the ball are diseased.
2. Partial hip replacement: In this surgery, only a part of the joint, i.e. the ball is replaced with the artificial steel ball while the original socket is retained. It is performed for patients with fractures.
In a typical surgery, a 10 -12 inch incision is made through the muscle around the hip to expose the damaged joint and it is replaced. In a minimally invasive surgery one or two small incisions are made. This method requires a shorter time for recovery compared to the traditional surgery.
What are the causes of pain in the hip joint?
Several problems in the hip may occur as a result of several years of wear and tear, disease or injury. The ones that commonly lead to a need for hip replacement are:
  • Fractures of the hip
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Traumatic Arthritis
  • Avascular necrosis
Osteoarthritis is the most common cause of hip pain and the symptoms are:
  • Pain referred to the knee.
  • Sharp pain while walking
  • Grating or cracking sensation
  • Tenderness around the hip.
  • Stiffness in your hips, thighs, groins, and buttocks
What are the implications of hip pain?
If the hip pain is not treated, it may cause restriction of joint movement and stiffness in your joints. You may have difficulty in walking and managing your daily activities.
What are the treatment options?
The treatment for hip pain depends on the severity of the condition. The available treatment options for hip pain are:
  • Medications such as NSAIDs (non-steroidal anti-inflammatory drugs) can help you to manage the pain. Sometimes corticosteroids may be injected to lower the inflammation that exacerbates the pain.
  • Physical therapy and certain exercises can help you to manage the pain and stiffness.  
  • Canes or walkers can be used as supportive aids which help you to relieve the pain.
  • After being treated and if the pain persists and interferes with your daily activities, your doctor may suggest a hip replacement.
What happens during the hip replacement surgery?
The hip replacement surgery takes around 1 to 2 hours. The surgery may be done under regional anaesthesia or general anaesthesia.
  • After giving anesthesia, the surgeon takes the incision over the side of the hip.
  • The affected bone and cartilage are removed through the incision.
  • The surgeon then replaces the head of the femur and acetabulum with the prosthetic hip.  
  • The wound is then closed either with stitches or clips, and a dressing is applied to the wound.
How do you prepare for hip replacement surgery?
In the period leading up to surgery your surgeon will ask you to:
  • quit smoking.
  • Exercise and control your diet to lose weight which will help with early recovery.
  • Stop food supplements containing vitamin E and fish oil etc. as they are associated with abnormal bleeding and clotting problems.
  • On your doctor’s advice you may be asked to stop taking anti-coagulant medications such as aspirin, platelet inhibitors and heparin or heparin derivatives to reduce the risk of bleeding.
A day before the surgery:
  • An anesthesiologist will review your medical history and reports and discuss the anesthesia with you. 
  • You should not eat or drink anything from midnight the night before surgery (at least 8-10 hours before surgery) and have only a light dinner. Follow instructions about any medication and preparing for surgery with an antiseptic bath. 
What can you expect post-surgery?
After the surgery you will be in the Recovery Unit for a period of up to 4 hours. You will be given medication to control pain. 
Care is taken to prevent blood clots at the lower extremities through the use of compression devices. Patients are encouraged to actively move their lower extremities to mobilize blood flow and prevent blood clots. Medication will be given to thin the blood and prevent clots. 
Take the medication and antibiotics prescribed by your physician. 
Drink plenty of water and include foods that are high in fiber in your diet to avoid the risk of constipation. 
You should eat healthy food to encourage a quick recovery.
When can you first walk after surgery?
After surgery, your physiotherapist will support you in walking and exercising.
You will be able to walk with support on the second day after surgery.  Your physiotherapist will help you with exercises and to walk and regain your mobility. Initially you may feel discomfort and may notice swelling of your legs while exercising and walking but this will settle.
How soon can you return to normal activities?
You can resume normal activities after discharge from the hospital. You need to be careful while doing certain activities which may cause stress on the joint - you must restrict squatting and sitting on low surfaces for 3 months after surgery. You will have to use supportive aids like canes or walkers for a few days.
When can the patient return home after a hip replacement surgery?
If there are no complications, you will be discharged after 72 hours. And in a month, you can return to your regular work. Before discharge your pain must be manageable and you should be able to get out of the bed and use the bathroom by yourself.
What precautions must you take after hip replacement surgery?
  • Avoid bending the hip beyond 90 degrees for the fi¬rst 2 months.
  • Do not sit on furniture that will cause excessive flexing at the hip.
  • Do not bend over at the hip to reach the floor.
  • Do not cross the operated leg over the other.
  • The feet must be kept between 3 and 6 inches apart.
  • Do not turn the operated leg inwards.
How can patients protect the replaced hip joint in the long term?
Running and contact sports should be avoided as they are too strenuous. Swimming is encouraged as it increases muscle strength, and improves mobility and stamina.
Q. How long will the results last?
A. Most of the replaced hips lasts for 10 to 15 years. A second replacement may be required after that.
Q. Are there any risk associated with this surgery?
A. Infection and blood clots are the two main complications that may occur after surgery.  You will be prescribed antibiotics and blood thinning agents to prevent these complications.
Q. How long does the surgery take?
A. The surgery takes between 1 to 2 hours depending upon the case, and the surgeon. 
Q. Will I have scars after the surgery?
A. Yes. You will have a scar that is approximately 6 to 8 inches long along the side of your hip. But it will heal within 1 to 2 weeks.
Q. Will I need physical therapy after the surgery?
A. Yes. A good recovery requires that you undergo physical therapy for a few weeks after the surgery. 

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