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Total Hip Replacement

Last updated April 16, 2019

A Total Hip Replacement procedure is a surgical intervention technique that involves the complete removal and replacement of the hip joint.


Background Information:

What are the other Names for the Procedure?

  • Hip Replacement Surgery
  • Total Hip Arthroplasty

What is the Total Hip Replacement surgical procedure?

  • A Total Hip Replacement procedure is a surgical intervention technique that involves the complete removal and replacement of the hip joint
  • It is recommended for individuals who have a degenerative joint disorder, such as osteoarthritis, or an injury that affects the entire hip joint

What part of the Body does the Procedure involve?

A Total Hip Replacement procedure involves the hip joint, muscles, surrounding ligaments, bones and bursa, which shape the hip.

  • The hip is a ball-and-socket joint
  • The socket is formed by the acetabulum, which is a part of the pelvis bone. The ball is the femoral head, which is the upper end of the femur (thigh bone)
  • The bony surfaces of the ball and socket are covered with a smooth tissue, called articular cartilage that cushions the ends of the bones and enables them to move easily
  • The hip joint is surrounded by a thin tissue, called the synovial membrane, which produces a small amount of fluid that lubricates the cartilage and eliminates friction during hip movement
  • Ligaments (the hip capsule) are the bands or tissue that connects the ball to the socket and provide stability to the joint

Why is the Total Hip Replacement surgical procedure Performed?

A Total Hip Replacement surgery is performed for the following reasons:

  • When there is a degeneration of the hip joint
  • Due to an injury to the hip, which causes pain and reduced mobility, impairing an individual’s quality of life

What are some Alternative Choices for the Procedure?

  • Conservative therapy, such as pain medications, physical therapy, exercise, and use of a cane or walker, may be recommended initially
  • For patients with significant damage to hip joint, Total Hip Replacement procedure remains a gold standard approach

What are the Recent Advances in the Procedure?

Use of less invasive techniques has been the recent advances in the procedure.

What is the Cost of performing the Total Hip Replacement surgical procedure?

The cost of Total Hip Replacement procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Total Hip Replacement procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://www.brighamandwomens.org/patients_visitors/pcs/rehabilitationservices/physical%20therapy%20standards%20of%20care%20and%20protocols/hip%20-%20thr%20protocol.pdf

http://orthoinfo.aaos.org/topic.cfm?topic=a00377

Prior to Total Hip Replacement surgical procedure:

How is the Total Hip Replacement surgical procedure Performed?

The Total Hip Replacement surgery is performed as follows:

  • The damaged hip joint is removed and replaced with prosthetic components
  • The head of the thigh bone is removed and replaced with a metal stem that is placed into the hollow center of the femur
  • The stem may be secured in place, either with bone cement, or is "press fit" into the bone
  • A prosthetic (metal or ceramic) ball is placed on the upper part of the stem. This ball replaces the femoral head that was removed
  • The damaged acetabulum is removed and replaced with a metal socket
  • Screws or cement are used to hold the socket in place
  • A plastic, ceramic, or metal spacer is inserted between the new ball and the socket, to allow for a smooth gliding surface

There are two basic types of hip replacement procedure: Standard hip replacement, and minimally invasive approach.

Standard Total Hip Replacement surgery:

  • This involves a bigger incision in the affected hip
  • Some of the muscles are detached to expose the joint
  • The damaged bone and cartilage are removed and the artificial joint (prosthesis) inserted
  • The new socket attaches to the pelvic bone and the ball, to the top of the thigh bone

Minimally invasive surgery:

  • Hip replacement can now be performed using less invasive techniques, using smaller incisions
  • These techniques can be performed with regional anesthesia. Minimally invasive techniques comprise:
    • Anterior approach: Performed through an incision in the front of the hip
    • Posterior approach: Performed through an incision in the back of the hip
    • Anterolateral approach: Performed through an incision on the side of the hip  

Where is the Procedure Performed?

The Total Hip Replacement surgical procedure is performed in a hospital.

Who Performs the Procedure?

An orthopedic surgeon performs a Total Hip Replacement procedure.

How long will the Procedure take?

A Total Hip Replacement surgical procedure may take anywhere between 3 to 5 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged 
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Total Hip Replacement procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Total Hip Replacement surgical procedure?

Prior to a Total Hip Replacement procedure, the patient has to undergo certain tests, such as:

  • Routine blood and urine analysis
  • X-ray of the hip joint
  • Computerized tomography (CT scan)
  • Magnetic resonance imaging (MRI)
  • Joint aspiration

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Total Hip Replacement surgical procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • How many such procedures have you (the physician) performed?
  • What are the costs involved?

During the Total Hip Replacement surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Spinal anesthesia by injection, or a general anesthesia by injection and inhalation, is administered during this procedure.

How much Blood will you lose, during the Procedure?

  • Open surgical approach can sometimes involve significant blood loss. In such cases, the patients are transfused blood and blood products
  • The amount of blood loss is generally minimal, with less invasive techniques

What are the possible Risks and Complications during the Total Hip Replacement surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Infection around the surgical wound
  • Formation of blood clots
  • Anesthetic complications
  • Damage to the neighboring structures

What Post-Operative Care is needed at the Healthcare Facility after the Total Hip Replacement surgical procedure?

  • After the surgical procedure, the patient will be sent to an area of the hospital, called postoperative recovery area (PACU)
  • The patient’s blood pressure, heart rate, and respiration cycle, are closely monitored. Any additional pain associated with the procedure will also be treated
  • Individuals are usually discharged from the hospital within a week after the surgery is performed

After the Total Hip Replacement surgical procedure:

What are the possible Risks and Complications after the Total Hip Replacement surgical procedure?

Post Total Hip Replacement procedure, the following complications may arise:

  • Excessive bleeding
  • Infection of the surgical wound
  • Hip dislocation
  • Pneumonia
  • Loosening of the metal and plastic implants, in the hip joint
  • Blood clots in the leg that can travel to the lung (pulmonary embolism)
  • Loosening of the new joint
  • Stiffening of the new joint
  • Breakage of the prosthesis
  • Change in leg length

What is the Prognosis after the Surgery?

The prognosis for a Total Hip Replacement procedure is usually excellent; a complete recovery without any complication is observed.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling of the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • Signs of an infection
  • Headache
  • Fever
  • Dizziness
  • Muscle aches
  • Fever
  • Feeling sick
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Total Hip Replacement surgical procedure?

At home, the following post-operative care is recommended, after a Total Hip Replacement procedure:

  • Slowly resume regular/daily activities, as advised by the surgeon and physical therapist
  • Avoid any/all activities that are physically strenuous, such as tennis, skiing, or contact sports
  • Begin using a walker, followed by crutches, and then a cane, if needed
  • Individuals are advised to use assistive devices, such as a raised toilet seat, a bench for the bathtub, etc. to limit bending at the hip
  • Individuals are advised to use handrails to assist them, while walking up and down the stairs
  • Identify your maximum range of motion
  • Avoid lifting or pulling heavy objects
  • Resume driving, when advised by your physician
  • Gently wash the surgical wound everyday with plain soap and water
  • Elevate legs while resting, to prevent formation of blood clots and reduce the possibility of swelling
  • Complete the course of prescribed medication, as advised by your physician
  • Blood thinning medication may be prescribed by your physician, to help prevent the formation of blood clots
  • Take stool softeners to prevent constipation, under advice by the physician
  • Take antibiotic medication to help combat or prevent infections, as advised by the physician
  • Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if necessary
  • Have a well-balanced diet, per physician’s advice

How long does it normally take to fully recover, from the Procedure?

It is observed that most patients generally resume their normal activities, within 6 to 8 weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision.
  • Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Total Hip Replacement surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility, hospital or a physician’s office
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)
  • Orthopedic surgeon

The patient is advised to inquire and confirm the type of billing, before the Total Hip Replacement procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 29, 2013
Last updated: April 16, 2019