Total hip replacement (also known as total hip arthroplasty) is an effective treatment for end-stage arthritis of the hip.
With this procedure, the acetabulum (socket) is replaced with a metal “cup” lined with an advanced plastic-bearing surface.
The femoral head (ball portion) of the hip is replaced with a high-strength metal or ceramic ball that is mounted on a stem placed in the femur (thighbone) to fix it rigidly in place.
That way, the damaged surfaces are replaced while leaving the majority of the bone around the hip intact.
Minimally Invasive Hip Replacement Surgery
Many years ago, hip replacement included a large incision and a week-long hospital stay. Currently, it can be performed through smaller incisions and patients achieve more rapid recovery. However, our main focus is on building a durable reconstruction that will last for years and we use a surgical incision length that allows us to place the hip implants in optimal positions.
Hip Replacement Recovery and Physical Therapy
Patients usually stay in the hospital for 2 to 4 days after surgery. During that time, we monitor vital signs and laboratory values. Most importantly, physical therapists teach the patient how to get around with a new hip. The physical therapists initiate an intense schedule to maximize mobility.
Patients usually are out of bed the day after surgery (or, in some cases, the same day) and begin walking with a walker 1 to 2 days after surgery. Physical therapists are integral in teaching the patient to walk, dress, use the toilet and bathe with a new hip while making sure walking is safely accomplished.
Pain from Hip Replacement
Most patients experience some amount of pain after surgery. A dedicated team of physicians sees the patient during the hospital stay to make sure pain is well controlled. Most patients receive either a nerve block anesthetic or epidural anesthetic for 1 or 2 days after the operation.
Patients are then transitioned to narcotic pain pills. Most of the time, patients are free of narcotic pain pills by 4 to 6 weeks after surgery. Often, patients are mostly pain free by 8 to 12 weeks after surgery. Although some patients continue to experience some amount of pain, the vast majority are extremely happy with the improvement in pain compared with before surgery.
Preventing Blood Clots
We use several strategies to minimize the chance of a blood clot forming after surgery, including nerve blocks, calf compression devices and early mobilization. In addition, patients who have undergone a replacement receive a blood thinner for 6 weeks after surgery. The blood thinner is usually aspirin unless the patient has a history of blood clots, in which case warfarin is administered.
Leg Length after Surgery
The vast majority of patients have the same leg length after the operation as before. We use several checks in the operating room to make sure this is the case. In rare cases, it is necessary to slightly lengthen the leg with the replacement to render the hip more stable. However, this is very uncommon.
Many people with severe hip arthritis feel that the leg with the arthritis is shorter than the other leg. We can correct this to a certain extent during surgery, and it should be discussed before surgery.
Durability of a Hip Replacement
Twenty years after surgery, 80% are still functioning well. Several factors determine how long a hip replacement lasts, including patient age and activity level, the type of implant used and the reason the hip was replaced.
Materials used in surgery continue to improve, and we are optimistic that current components will last longer than those used 20 years ago.