Alternative Names total hip replacement, THR, total hip arthroplasty
Definition Hip joint replacement is a surgical procedure to replace the hip joint. The new joint is artificial, and has two parts. The first part is the hip's socket, called the acetabulum. This is a cup-shaped bone in the pelvis. The second part is the "ball" or head of the femur, also called the thighbone.
These artificial parts together are called a prosthesis. The artificial socket is often made of high-density plastic. The artificial ball, which is attached to a stem, is usually made of a strong, stainless metal. The goal of the surgery is to relieve pain and improve mobility and function in the hip joint.
Who is a candidate for the procedure? This surgery is most commonly done for severe arthritis, which can wear down the hip joint. People with other conditions, such as injury, bone tumours, and a vascular necrosis, or a loss of bone caused by a lack of blood supply, may also need a hip joint replaced. An individual is usually advised to consider this surgery when:
The pain is severe enough to restrict not only work and recreation, but also the normal activities of daily living.
The pain is not relieved by arthritis medications.
The person is not helped by the use of a cane or walker.
There is significant stiffness of the hip that limits activities.
Joint x-rays show advanced arthritis, or other severe problems.
How is the procedure performed? The surgeon first removes the diseased bone and cartilage. Replacement pieces are implanted into healthy areas of the pelvis and thighbone. These pieces are then cemented in place.
One method does not require cement, and is called cementless hip joint replacement. This allows bone to grow into the prosthesis, and it may last longer than a cemented hip. This can be an important advantage for younger people.
The surgery is usually done under general anaesthesia, which means the person is put completely to sleep. The procedure usually takes two to three hours to perform.
What happens right after the procedure? After the surgery, the person is taken to the surgery recovery room. This allows a brief period of close observation. Vital signs, such as the blood pressure and pulse, are checked frequently. Close attention is paid to the circulation and sensation in the legs and feet. The hip is usually braced with pillows or a special device that holds the hip in the correct position. The person is given fluids through an intravenous tube, or IV, to replace fluids lost during surgery. A tube may have been placed near the incision to drain fluid. A urinary catheter is often used to drain urine from the bladder until the person is able to use the bathroom. Analgesia will be given as needed.
While in the hospital, the individual will begin Physiotherapy to strengthen the hip. He or she will also learn how to perform the activities of daily living in ways that can prevent injury to the new hip. For example, proper ways to bend and sit are taught. Most people are sent home from the hospital 5 to 7 days after the surgery.
What happens later at home? By the time the person leaves the hospital, he or she should be able to get around using crutches or a walker. physiotherapy may be continued after discharge. Some people need to go to a rehabilitation centre after leaving the hospital. This is done when a person needs extra time to gain enough independence to be able to get around at home. Complete recovery from this surgery usually takes three to six months.
What are the potential complications after the procedure? The most common complications of hip joint surgery are:
blood clot in the leg, or deep venous thrombosis. To prevent blood clots, medications called blood thinners may be given. The person is asked to move around shortly after surgery, and may need to wear support stockings.
wound infection. To prevent this complication, antibiotics may be given.
hip dislocation, which means the ball becomes dislodged from the socket. This may occur if the hip is placed in certain positions. The person is taught exercises before leaving the hospital to help prevent this. The individual will also learn what activities to avoid, such as crossing the legs, to prevent hip dislocation.
Author: Gail Hendrickson, RN, BS Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
