If you have constant hip pain that limits your day-to-day activities, like climbing stairs, walking, performing household chores, or going to work, and you've tried other treatments to no avail, it may be time to consider full hip replacement surgery. Another sign that you may be ready for surgery is hip or groin pain so intense that it keeps you up at night.
Simply experiencing hip pain may not indicate the need for a hip replacement. If your hip pain does not limit your normal activities, or is only keeping you from performing intense physical activities like running and skiing, or if your hip pain comes and goes, you should first consider more conservative treatments. Medicine, physical therapy, and osteotomic surgery are all options worth considering before committing to full hip replacement.
Hip replacement surgery replaces the hip joint with an artificial joint in order to relieve severe hip pain caused by osteoarthritis, rheumatoid arthritis, or arthritis resulting from traumatic hip injuries. Although hip replacement surgery is usually safe and has a high rate of success, as with any surgery, complications may arise. You should consult with an orthopedic surgeon prior in order to make sure that surgery is the right course of action for you.
How to Discuss Hip Replacement With Your Doctor
The decision to undergo hip replacement surgery should be made with care and in close consultation with an orthopedic surgeon. When meeting with your surgeon, make sure to bring up your full medical history and bring a list of medications you currently take, including over-the-counter pills and supplements. Some medications may result in excessive bleeding and may need to be stopped prior to surgery.
Your surgeon may order blood tests, an EKG, urine tests for infection and pregnancy, x-rays, and/or an MRI. Your hip, particularly the range of motion in the joint and the strength of surrounding muscles, will also be examined. These tests, in conjunction with a review of your full medical history, are performed to ensure that you are in strong enough physical condition to guarantee a safe and successful surgical procedure. You may be asked to donate blood in case the need for a transfusion arises during surgery.
If you have any concerns about the procedure, be sure to bring them up. Prior to your operation make sure that you have a good idea of what rehabilitation will be like and that you have reasonable expectations for your end results. It is also worthwhile to consider that there are a number of techniques used in performing hip replacement surgery. for some patients, surgeons may suggest a minimally invasive techniques using smaller incisions. Your surgeon will recommend which technique will suit you best.
What Happens in the Surgery?
Your anesthesiologist and surgeon will also counsel you on whether to receive a general anesthesia, which will render you unconscious, or a regional anesthesia, which leaves you awake but unable to feel any pain in the area of the surgery.
The actual surgical process takes a few hours and involves the replacement of the hip joint with an artificial joint. Your hip joint is made up of two parts: the socket, in your hipbone, and the ball, which sits at the top of your upper leg bone (femur). After performing an incision and approach, the surgeon will remove diseased and damaged bone and cartilage from your hip, and begin to fit the artificial hip joint. Although there are many types of designs and materials used in artificial hip joints, there are usually four main components:
- A prosthetic metal socket is fitted into your hipbone.
- A liner is fitted on top of the metal socket. This will allow the hip to move smoothly.
- The femur is prepared for the attachment of the new femoral stem and ball. The head of the femur is removed and the bone is reformed so that the new metal femoral stem fits in cleanly. The metal femoral stem will add stability to the joint.
- At the top of the stem is the new ball, made of either metal or ceramic, which will replace the round head of your thighbone. The ball is attached to the socket, completing the artificial hip joint.
These new components will be fixed to the bone either by using bone cement or a "press fit" that allows your bone to grow into a fine mesh coating on the prosthesis.
What to Expect Afterwards
A typical hospital stay after hip replacement surgery is three to five days, during which a physical therapist will help you to develop and begin a rehabilitation plan. The therapist will begin to walk you through isometric exercises, ankle and other joint movement, and dressing, walking, and moving safely. Immediately after surgery, you'll be at a higher risk for blood clots in your legs; your physical therapist and surgeon will instruct you on what preventative measures to take.
Afterwards, some patients may spend time at a rehabilitation center prior to returning home while others will be able to go straight home. At home, recovering patients should continue to exercise daily. At first, you will need an assistive device to walk, and may want to consider making some helpful modifications to your home, such as getting a raised toilet seat. There are certain precautions that you should take to ensure a full recovery, such as avoiding falls, not crossing your legs, and not bending your hips more than a 90-degree angle. Although complications from hip replacement surgery are extremely rare, you should also watch for any changes around the surgical incision, and contact your surgeon immediately if any complications arise.
After about six weeks, you should be able to walk without any assistance and, following your surgeon's advice, return to regular activities like driving, household chores, and work activities. Full recovery may take anywhere from three to six months. At that point, you may be able to return to engaging in low-impact recreational activities such as swimming, biking, and doubles tennis. Nearly 200,000 people undergo hip replacement surgery a year in the United States, and their results are usually excellent, with surgery relieving most or all of arthritis-associated hip pain and allowing patients to return to normal day-to-day activities.