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What is a total hip replacement?
Total hip replacement is a surgical procedure for replacing the hip socket (acetabulum) and the "ball" or head of the thigh bone (femur). The surgeon resurfaces the socket and ball where cartilage (cushioning tissue at the end of the bones) and bone have been lost. An artificial ball and socket are implanted into healthy bone. Most routine total hip replacement procedures take approximately 90 minutes to complete and can be done under regional anesthesia.
Who needs a total hip replacement?
Most people who receive total hip replacements have advanced changes in the hip joint caused by arthritis. A hip replacement is recommended after more conservative therapies of medication and exercise have failed to improve symptoms such as loss of mobility and pain.
Rarely, an individual will have minimal pain but a severe deformity that significantly limits his or her daily function. This loss of function can occur in patients with systemic (whole-body) forms of arthritis, such as juvenile rheumatoid arthritis, rheumatoid arthritis and psoriatic arthritis. Severe deformities also can occur after a major injury to the joint.
When should a person consider having a hip replacement?
Most patients decide to have a total hip replacement when the pain in the joint becomes unbearable or when a loss of function significantly compromises their ability to perform activities of daily living. In general, with rare exceptions, patients do not postpone total hip surgery. Both the physician and the patient must be totally committed to obtaining a good outcome. This commitment requires not only a well-executed surgical procedure but an extensive and carefully planned rehabilitation program.
How soon does the person recover?
Most patients receive physical therapy at the bedside on the first day after surgery, transfer to a bedside chair and can even begin exercising. By the second day after surgery, most patients begin walking with the aid of a walker or crutches and can apply 50 percent to 75 percent of their weight on the affected leg. Most younger patients are allowed to go home by the fourth day after surgery. Older individuals and patients who have significant health problems can be referred to an extended care facility for an additional 7 to 10 days.
All patients remain on either crutches or a walker for about 4 weeks after surgery. They are then allowed to place full weight on their extremity while using a cane for balance. The cane prevents the muscles from becoming fatigued. Generally, by 10 weeks after surgery, the cane can be discarded and the hip can support the person's full weight. Patients who have a weaker musculature may need to use the cane for a longer period.
Can the person participate in any activity he or she chooses?
Once you have been fully rehabilitated from the total hip replacement, you can engage in most activities. Patients can walk, ride bicycles, ski, play golf and perform other, similar activities. Activities that require repetitive impact loading (such as tennis and racquetball) should be avoided or practiced only occasionally.
How long does the new hip last?
The early total hip prosthetics had limitations in their design that could compromise their longevity. After nearly three decades of use, prosthetic design and materials have greatly improved. The stability of these "artificial" joints depends on existing muscles and ligaments (tissue that binds joints together) rather than on the design of the artificial joint itself.
There are two basic types of prostheses: one type is cemented in place, while the other has a porous coating that allows bone to grow into it. Porous-coated prostheses can provide more long-term fixation in younger patients and in patients who have good bone stock. In patients over the age of 65, the socket component is fixed using a porous material coated with bone in-growth and the femoral component is cemented in place ("hybrid" hip prosthesis). Long-term studies have demonstrated that this combination provides excellent longevity.
With current improvements in materials, prosthetic designs and surgical techniques, more than 95 percent of contemporary total joint replacement procedures should last more than 20 years. Routine follow-up after recovery from surgery should include X-rays after the first, third, fifth and seventh years. Thereafter, X-rays should be taken every two years to make sure that wear is not occurring.
Failure of the replaced joint can result in bone loss, which can make surgery on the joint more difficult. However, newer techniques with bone grafting, as well as newer prosthetic designs that specifically deal with failed total joint replacements offer the patient a second chance for good long-term results.