A hip replacement is a surgical procedure to remove and replace a damaged or injured hip joint with an artificial joint called a prosthetic. Hip replacement surgery is recommended for people with hip joint damage from arthritis or an injury.
Osteoarthritis of the hip -- the most common reason for a hip replacement -- is caused by the wear and tear of aging. The cartilage covering the joint surfaces wears out, resulting in pain and stiffness.
Benefits of Hip Replacement
Hip replacement can help relieve or minimize the pain felt in the hip joint and increase range of motion and joint function.
Symptoms that can lead to Hip Replacement
Below are some of the most common reasons people consider hip joint replacement surgery.
- Osteoarthritis of the hip
- Developmental abnormalities of the hip, such as hip dysplasia
- Loss of the blood supply to the head of the thighbone (osteonecrosis)
- Rheumatoid arthritis
- Persistent pain
- Pain when walking
- Difficulty going up and down stairs
- Pain when standing from a seated position
- Lack of sleep due to pain
Symptoms of Hip Arthritis
Patients with arthritis can have osteoporosis (brittle bones), but there's no direct relationship between bone density and the development of hip arthritis.
- Can be dull and aching with moments of stabbing pain
- Can be constant, or might come and go
- Can be felt in the groin, thigh, buttock, knee or an alternating combination of these
- Usually worsens with time and higher activity levels
- Can interfere with sleep
- Patients might need a cane, crutch or walker
- Walking, especially for longer distances, can cause a limp
- Climbing stairs and dressing (especially putting on socks and tying shoes) can be difficult or impossible
To diagnose hip arthritis, Dr. Van Ryn will inquire about your symptoms and perform a physical examination. X-rays can show loss of the cartilage space in the hip socket and reveal a “bone-on-bone” appearance. Bone spurs and bone cysts are common.
Traditional Hip Replacement
Traditional hip replacement surgery involves making a 10-inch to 12-inch incision on the side of the hip. The muscles are detached from the hip, allowing the femur head to be dislocated from the hip socket, exposing the joint surfaces.
Some of the surrounding bone is removed from the hip socket so that a cup-shaped implant can be pressed into the hip socket. A smooth, plastic bearing surface is then inserted into the cup-shaped implant so the joint can move freely.
Next, the femur, or thighbone, is prepared. The surgeon cuts the ball from the top of the femur, and a metal stem is inserted into the femur to a depth of about 6 inches. Depending on the situation, the stem implant can either be fixed with bone cement or implanted without cement. A metallic ball is affixed to the top of the metal stem, becoming the replacement femur head. The ball is then inserted into the replacement socket.
Minimally Invasive Hip Replacement
Minimally invasive hip replacement surgery is similar to traditional hip replacement surgery, except for a few important differences.
Minimally invasive hip replacement surgery allows the surgeon to operate through one or two small incisions instead of one 12-inch incision. (A minimally invasive hip incision might measure only 3 to 6 inches, depending on the size of the patient and the difficulty of the procedure.) Smaller incisions usually mean less pain for the patient, and rehabilitation is often faster.
The implants used for the minimally invasive hip replacement procedures are the same as those used for traditional hip replacement, but specially designed instruments are needed (because they’re inserted through smaller incisions) to prep the socket and femur, and place the implants properly.
The muscles and tendons are detached, but to a lesser extent than with the traditional hip replacement operation.
Candidates for minimal incision procedures are typically thinner and more motivated to have a quick recovery compared with patients who undergo the traditional surgery.
Accelerated Joint Rehabilitation Pathway
More than solely a surgical procedure, the Accelerated Joint Replacement Pathway (AJRP) refers to a complete strategy that includes intense physical therapy before and after the surgery to expedite healing, with a goal of returning the patient to full function within six weeks of surgery. The AJRP is usually an option for healthier, younger patients.
- Preoperative physical therapy
- Preoperative occupational therapy
- Long-acting spinal anesthesia
- Intravenous (IV) use of Toradol (a strong, aspirin-class medication)
- Minimal need for narcotic medication
- Acute postoperative cooling therapy
- Intense, focused postoperative rehabilitation
Regardless of the procedure used, hip replacements are technically demanding surgeries, and each requires the patient’s involvement and commitment to their rehabilitation for that patient to make a full recovery.
For more information on joint replacement, call Christian Hospital at 314.653.5000 or email us.