Whether you have just begun exploring treatment options or have already decided with your orthopedic surgeon to undergo hip replacement surgery, this information will help you understand the benefits and limitations of this orthopedic treatment.
You will learn…
- How a normal hip works
- What causes hip pain
- What to expect from hip replacement surgery
- Which exercises / activities will help restore your mobility & strength
If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, which may make it difficult to put on your shoes and socks. You may even feel uncomfortable while resting.
If medications or the use of walking aids, such as a cane, are not helpful, you may want to consider hip replacement surgery. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can help relieve your pain, improve motion, and get back to enjoying everyday activities.
How the Normal Hip Works
The hip is one of your body's largest weight-bearing joints, consisting of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.
The bone surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.
A thin, smooth tissue called synovial membrane covers all remaining surfaces of the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint.
Normally, these parts of your hip work in harmony, allowing you to move easily and without pain.
Common Causes of Hip Pain and Loss of Hip Mobility
The most frequent cause of chronic hip pain and disability is arthritis, with the most common being Osteoarthritis, Rheumatoid, and Traumatic.
Osteoarthritis usually occurs after age 50 and often in an individual with a family history of arthritis. It may be caused or accelerated by subtle irregularities in how the hip developed. In this form of the disease, the articular cartilage cushioning the hip bones wears away, causing the bones to then rub against each other, resulting in hip pain and stiffness.
Rheumatoid Arthritis is an autoimmune disease in which the synovial membrane becomes inflamed, produces too much synovial fluid, and damages the articular cartilage, leading to pain and stiffness.
Traumatic Arthritis can follow a serious hip injury or fracture. A hip fracture can cause a condition known as avascular necrosis, where the articular cartilage becomes damaged and, over time, causes hip pain and stiffness.
Is Hip Replacement Surgery for You?
The decision of whether to have hip replacement surgery or not should be a cooperative one between you, your family, your primary care doctor, and your orthopedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopedic surgeon for an initial evaluation.
Although many patients who undergo hip replacement surgery are age 60 to 80, orthopedic surgeon evaluate patients individually. Recommendations for surgery are based on the extent of your pain, X-ray findings, disability, and general health status, not solely on age.
You may benefit from hip replacement surgery if:
- Hip pain limits your everyday activities such as walking or bending
- Hip pain continues while resting
- Stiffness in a hip limits your ability to move or lift your leg
- You have little pain relief from anti-inflammatory drugs or glucosamine sulfate
- You have harmful or unpleasant side effects from your hip medications
- Other treatments such as physical therapy or the use of a cane do not relieve hip pain
Direct Anterior Approach Hip Replacement
The direct anterior approach to hip replacement surgery, can be a less invasive alternative to traditional solution like the lateral approach (on the side of the hip ) or the posterior approach (back of the hip).
During the direct anterior approach surgery, the surgeon reaches the hip joint from the front. The incisions are relatively small -- even just inches -- and the hip can be replaced without disturbing surrounding muscles - instead, simply working between them. This approach often results in a quicker healing and recovery period with less pain.
Immediately following surgery, patients can often bend their hip freely and bear full weight when comfortable, resulting in a more rapid return to normal function. Other potential benefits include:
- Reduced pain
- Reduced tissue healing required
- Reduced risk of dislocation and other complications
- Shorter hospital stay
- Quicker return to the life you love
The Orthopedic Evaluation
Your orthopedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options such as medications, physical therapy, or other types of surgery may also be considered.
- A medical history, in which your orthopedic surgeon gathers information about your general health and asks questions about the extent of your hip pain and how it affects your ability to perform everyday activities.
- A physical examination to assess your hip's mobility, strength, and alignment.
- X-rays to determine the extent of damage or deformity in your hip.
- Occasionally, blood tests or other tests such as Magnetic Resonance Imaging (MRI) or a bone scan may be needed to determine the condition of the bone and soft tissues of your hip.
Your orthopedic surgeon will also explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
What to Expect From Hip Replacement Surgery
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and can't do.
Most people who undergo hip replacement surgery typically experience a dramatic reduction of hip pain and significant improvement in their ability to perform common activities of daily living. However, hip replacement surgery will not enable you to do more than you could before your hip problem developed.
Following surgery, you will be advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life. You may be asked to avoid specific positions of the joint that could lead to dislocation.
Even with normal use and activities, an artificial joint (prosthesis) develops some wear over time. If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.
Preparing for Surgery
Medical Evaluation. If you decide to have hip replacement surgery, you may be asked to have a complete physical by your primary care doctor before your surgery. This is needed to assess your health and find conditions that could interfere with your surgery or recovery.
Tests. Several tests such as blood samples, a cardiogram, chest X-rays, and urine samples may be needed to help plan your surgery.
Preparing Your Skin. Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopedic surgeon for a program to improve your skin before your surgery.
Medications. Tell your orthopedic surgeon about the medications you are taking. Your orthopedist or your primary care doctor will advise you which medications you should stop or can continue taking before surgery.
Weight Loss. If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip, and possibly decrease the risks of surgery.
Dental Evaluation. Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, you should consider getting treatment for significant dental diseases (including tooth extractions and periodontal work) before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.
Urinary Evaluation. Individuals with a history of recent or frequent urinary infections and older men with prostate disease should consider a urological evaluation before surgery.
Social Planning. Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry. If you live alone, your surgeon's office, a social worker, or a discharge planner at the hospital can help you plan (in advance) to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.
Adam Bevevino, MD
Kelly V. Fitzpatrick, DO
Gens Goodman, DO, FAAOS
Joseph Lanzi, MD