What Is a Hip Replacement?
If your hip has been damaged, everyday activities such as walking, putting on your socks and shoes, or getting out of a chair can be painful and difficult. You may even feel uncomfortable at rest.
If medications, changes in your activity level, and using walking supports are not helpful, you may want to consider hip replacement surgery. By replacing your damaged hip joint with an artificial joint, hip replacement surgery can relieve your pain, increase motion, and help you get back to enjoying everyday activities.
Patients who undergo hip replacement are typically 60 to 75 years old. More than 90 percent of hip replacements last for 10 years or more.
Causes
The hip is one of your body’s largest weight-bearing joints. Usually, all parts of your hip work harmoniously, allowing you to move easily and without pain. Unfortunately, some people develop chronic hip pain. The most common cause of hip pain is arthritis, which results from lifelong wear and tear, previous injury, or mechanical abnormalities related to how the hip developed. Arthritis develops over years, and symptoms increase gradually over time. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
Some bone diseases may contribute to the development of hip arthritis. Patients with arthritis may also have brittle bones (osteoporosis).
Osteoarthritis usually occurs after age 50 and often in individuals with a family history of arthritis. It may be caused or accelerated by subtle irregularities in hip development. In this form of the disease, the articular cartilage cushioning the hip bones wears away. The bones then rub against each other, causing hip pain and stiffness.
Rheumatoid arthritis is an autoimmune disease in which the hip’s membrane becomes inflamed, produces too much 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. The articular cartilage becomes damaged, causing hip pain and stiffness over time.
Symptoms
Hip arthritis typically causes dull and aching pain. The pain may be constant or come and go. You may feel pain in the knee, groin, thigh, and buttocks. Walking, especially for longer distances, may cause a limp, and you may need a cane, crutch, or walker to help them get around. Activities such as climbing stairs and bending down to tie your shoes may also become difficult or impossible. The pain usually starts slowly and worsens with time and higher activity levels. You also may have pain when you rest, which may interfere with your sleep.
Diagnosis
If you are experiencing any of the above symptoms, please consult an orthopedic specialist. An evaluation consists of several components:
- A medical history to gather information about your general health, the extent of your hip pain, and your ability to function.
- A physical examination to assess your hip’s mobility, strength, and alignment.
- X-rays to determine the extent of damage and deformity in your hip.
- Occasionally, blood tests, a Magnetic Resonance Imaging (MRI), or a bone scan may be needed to determine the condition of your hip's bone and soft tissues.
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.
Treatment
You may benefit from hip replacement surgery if:
- Hip pain limits your everyday activities, such as walking or bending.
- Hip pain continues while resting, either day or night.
- Stiffness in your 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.
The first treatment your doctor may recommend is prescription or over-the-counter anti-inflammatory medications. These include ibuprofen (Motrin® or Advil® acetaminophen (Tylenol® or mild combination narcotics (Tylenol® with codeine). Some nutritional supplements may also provide some relief. These include glucosamine. Short-term physical therapy may help with strength and stiffness.
For more advanced arthritis, you may need to use a cane in the hand opposite the affected hip. It can improve walking ability. Using a walker may help patients who have more trouble walking. These measures usually improve pain and function. But arthritis is progressive. Even with treatment, it gets worse over time.
Whether to have hip replacement surgery should be a cooperative decision between you, your family, your primary care doctor, and your orthopedic surgeon. This decision typically begins with a referral by your doctor to an orthopedic surgeon for an initial evaluation. Your orthopedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery and those that can occur over time after your surgery.
Although many patients who undergo hip replacement surgery are aged 60 to 80, orthopedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability, and general health status, not solely on age.
Treatment Options
Surgical options include:
Arthroscopy: This minimally invasive outpatient procedure is relatively uncommon. The doctor may recommend it if the joint has evidence of torn cartilage or loose fragments of bone or cartilage.
Osteotomy: Candidates include younger patients with early arthritis, particularly those with abnormally shallow hip sockets (dysplasia). The procedure involves cutting and realigning the hip socket and/or thighbone bones to decrease joint pressure and create a more normal relationship between the ball and socket. In some cases, this may delay the need for replacement surgery for 10 to 20 years.
Minimal Incision Hip Replacement: The surgeon performs hip replacement through one or two smaller incisions. The artificial implants used for minimally invasive hip replacement procedures are the same as those used for traditional hip replacement. Compared with most people getting hip replacements, candidates for minimal incision procedures are typically thinner, younger, healthier, and more motivated to recover quickly. Reported benefits of less invasive hip replacement include:
- Less pain
- More cosmetic incisions
- Less muscle damage
- Faster rehabilitation
- Shorer hospital stays: Traditional hip replacements average a four-to-five-day hospital stay. With less invasive procedures, the hospital stay may be as short as one or two days, and some patients can go home on the day of surgery. Many patients will also need extensive rehabilitation afterward.
Total Hip Replacement: The doctor may recommend total hip replacement when all of the above measures have been considered or have been tried and failed. Traditional hip replacement surgery involves making an 8 to 12-inch incision on the side of the hip. The muscles are split or detached from the hip. The hip is dislocated. The ball of the femur is removed. The hip socket is prepared by removing any remaining cartilage and some of the surrounding bone. The cup implant is pressed into the bone of the socket. It may be secured with screws. A bearing surface is inserted into the socket. Next, the femur is prepared by removing some bone from the inside of the thigh bone. A metal stem is placed into the thigh bone to a depth of about 6 inches. The stem implant is either fixed with bone cement or is implanted without cement. Cementless implants have a rough, porous surface. It allows bone to adhere to the implant to hold it in place. A ball is then placed on the top of the stem. The ball-and-socket joint is recreated.
Research Continues
Extensive study and development are now underway to determine the long-term benefits of minimally invasive hip replacement. New technology for imaging and computer-assisted implant placement continues to be modified as experience with smaller incision surgery grows. This will allow more precise reconstruction of the hip with less direct visualization. In addition, new implant designs and materials are being developed to facilitate minimally invasive hip surgery and prolong the lifespan of replacements.
Reproduced with permission Fischer S., (interim ed): Your Orthopaedic Connection. Rosemont, Illinois. Copyright American Academy of Orthopaedic Surgeons.
