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A guide to total hip replacement

A total hip replacement may be recommended when hip pain from deformity, disease or injury gets in the way of normal life. The surgery consists of removing damaged bone and tissue and replacing it with an implant.

Total hip replacement is an operation to replace the hip joint with an artificial hip, or implant. The operation helps people who have hip pain that limits their ability to function normally and who cannot get relief from other treatments, such as medication or physical therapy. Hip pain may be the result of arthritis, rheumatism, a hip deformity or a hip fracture.

Before surgery

To help prevent infection, your doctor may prescribe antibiotics for you to take several days before the surgery. Shortly before the surgery, you'll be asked to shower or bathe.

Just before the surgery, your hip will be cleaned with an antiseptic fluid. You'll be given anesthesia to put you to sleep during the surgery, and the surgeon will position you so that he or she can best reach your hip.

During surgery

The surgeon makes an incision to expose your hip joint and separates the muscles covering the bones. The thighbone (femur) and hip bone (pelvis) are separated from each other, and any deformed or damaged bone and tissue are removed.

Once this is done, the surgeon is ready to begin putting the artificial hip in place. Artificial hips are designed to resemble the natural joint as much as possible. To mimic the original ball-and-socket joint, implants have three parts: a stem, or long rod, which is anchored inside the thighbone; a ball at the top of the stem; and a cup (which is placed inside the socket in the hip bone) in which the ball fits.

Some designs combine the stem and ball into a single piece, and others leave them separate to allow for a more customized fit. The components are made of a combination of metals, plastics or ceramics.

During surgery, the cup is placed in the hip socket first. The surgeon then hollows out the center of the thighbone to make room for the stem. The stem is secured into the thigh bone, and the ball is secured into the cup in the pelvis. Once the hip is set, muscles and tendons that were moved or cut are repaired or put back in place. The surgeon then stitches the incision closed. The surgery lasts one to two hours.

For decades, surgeons have used a specialized cement to secure the artificial hip components to the bones. But some components are now designed to be used without cement. The surface of these components is coated or textured to encourage the bone to grow on to the implant. Cemented and cementless implants each have benefits and risks. Your doctor can help you understand which type of implant is best for you.

After surgery

When you wake up after surgery, you may or may not feel pain. If you're uncomfortable, your doctor may give you pain-relief medicine.

Your new joint will be unstable for a time after your operation. Some surgeons recommend that people lie with their feet apart for a few days. Other doctors like people to be up and walking, perhaps as soon as the day of surgery.

Getting up and moving early reduces the risk of blood clots, which, according to the American Academy of Orthopaedic Surgeons, are the most common complication of hip replacement surgery. Other things your doctor may recommend to reduce the risk of blood clots include wearing support hose or leg coverings and taking blood-thinning medications.

Once you're able to get out of bed, you may have to use tools such as a cane, crutches or a walker until your hip becomes strong and mobile and your balance and strength improve. Your healthcare team will help you decide what tools you need, show you how to use them and let you know when you can quit using them.

Other precautions

When you get a hip replaced, it's important not to cross your legs or bend your hips more than 90 degrees. You should also avoid turning your feet too far inward or outward. Your doctor may suggest sleeping with a pillow between your legs for a time to lessen your risk of moving in a way that will dislodge your hip during sleep.

You must also take steps to prevent infections. Bacteria that enter your bloodstream during teeth cleanings or other dental procedures pose a special danger if they lodge near your hip. Therefore, your doctor may recommend that you start taking antibiotics before dental appointments.

Finally, realize that your new hip may activate metal detectors, such as those in airports.

Tell a security officer about your artificial hip if an alarm activates. You may want to ask your doctor for a card confirming you have an artificial hip and carry the card with you at all times.

Reviewed 11/30/2021

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