Hip joint replacement

Alternative names:

hip arthroplasty; total hip joint replacement

Definition:

Surgery to replace all or part of the hip joint with an artificial device to restore joint movement (a prosthesis).

Description:

The hip is made of a ball and a socket joint, linking the dome at the head of the thigh bone (femur) and the cup in the pelvic bone. A total hip prosthesis is surgically implanted to replace the damaged bone within the hip joint. The total hip prosthesis consists of three parts:

• a plastic cup that replaces your hip socket (acetabulum)
• a metal ball that will replace the fractured femoral head
• a metal stem that is attached to the shaft of the bone to add stability to the prosthesis

If a hemi-arthroplasty is performed, either the femoral head or the hip socket (acetabulum) will be replaced with a prosthetic device.

You will receive an extensive pre-operative evaluation of your hip to determine if you are a candidate for a hip replacement procedure. Evaluation will include assessment of the degree of disability and impact on your lifestyle, pre-existing medical conditions, and an evaluation of heart and lung function.

The surgery will be performed using general or spinal anesthesia. The orthopedic surgeon makes an incision along the affected hip joint, exposing the hip joint. The head of the femur and the cup are cut out and removed. Then a metal ball and the metal stem is inserted in the femur and a plastic socket is placed in the enlarged pelvis cup. The artificial components are fixed in place (sometimes a special cement is used). The muscles and tendons are then replaced against the bones and the incision is closed.

You will return from surgery with a large dressing to the hip area. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area.

You will experience moderate to severe pain after surgery. However, you may receive patient-controlled analgesia (PCA), intravenous (IV), or epidural analgesics to control your pain for the first 3 days after surgery. The pain should gradually decrease, and by the third day after surgery, oral analgesic medications may be sufficient to control your pain. Try to schedule your pain medications about one half hour before ambulation or position changes.

You will also return from surgery with several IV lines in place to provide hydration and nutrition. The IV will remain in place until you are taking adequate amounts of oral fluids. If the procedure is elective, you may be encourage to donate blood several weeks prior to surgery to use to replace any blood lost during the procedure. Sometimes, the blood that is drained from the wound during surgery is collected in a special sterile container to be re-infused through an IV after surgery (autotranfusion).

You will also return from surgery wearing anti-embolism stockings or an inflatable pneumatic compression stockings. These devices are used to reduce your risk of developing blood clots, which are more common after lower extremity surgery. Additionally, you will be encouraged to start moving and walking early after surgery. You will be encouraged to get out of bed to a chair on the first day after surgery. When in bed perform ankle exercises frequently to prevent development of blood clots.

You may be instructed on how to use an incentive spirometry device (a plastic device that indicates how much air is breathed in at one time) to gradually increase the depth of your respirations, as well as performing deep breathing and cough procedures in order to prevent pneumonia.

A foley catheter may be inserted during surgery to monitor the function of your kidneys and hydration level. This will be removed on the second or third day after surgery. You will be encouraged to try to walk to the bathroom with assistance. If you are unable to walk this far, a special smaller bedpan will be used to keep the hip in proper alignment.

Indications:

Hip joint replacement is mostly done in older people. The operation is usually not recommended for younger people because of the strain they can put on the artificial hip.

The indications for the replacement of the hip joint include:

• hip pain that has failed to respond to conservative therapy (NSAID medication for 6 months or more)
• hip osteoarthritis or arthritis confirmed by X-ray
• inability to work, sleep, or move because of hip pain
• loose hip prosthesis
• some hip fractures
• hip joint tumors

This surgery is not recommended for:

• current hip infection
• poor skin coverage around hip
• paralysis of the quadriceps muscles
• severe disease of the blood vessels of the leg and foot (peripheral vascular disease)
• nerve disease (neuropathy) affecting the hip
• severe limiting mental dysfunction
• serious physical disease (terminal disease, such metastatic disease)
• morbid obesity (over 300 lb.)