Hip Replacement Surgery (Hip Arthroplasty)

The hip is one of the largest weight-bearing joints in the body. When it's working properly, it lets you walk, sit, bend, and turn without pain. Hip arthroplasty is the replacement of all or part of the hip joint with an implant that is designed to function like the patient's own hip joint before the onset of osteoarthritis (also known as degenerative joint disease.)  Osteoarthritis of the hip is a condition where the smooth cartilage that covers the end of a healthy hip joint wears out causing the bones in the ball-and-socket joint to rub together becoming rough and pitted.  The painful and stiff hip that results often prevents the enjoyment of simple things like walking or getting up from a chair.

If your injury or arthritis is severe, you may begin to experience pain when you’re sitting down or trying to sleep. Sometimes hip replacement is the only option for reducing pain and restoring a normal activity level.

There are different types hip replacements:

• Hemi-arthroplasty: If hemi-arthroplasty is performed, either the femoral head or the hip socket (acetabulum) will be replaced with a prosthetic device. 
   
• Total hip replacement: In total hip replacement, both the femoral head and the hip socket is replaced by the prosthetic device.
   

• Resurfacing Arthroplasty: In resurfacing arthroplasty the arthritic femoral head  is reshaped and resurfaced with a mushroom-like cap instead of being totally replaced with a prosthesis. The socket is prepared in a similar fashion to a total hip replacement. Birmingham Hip

If you are considering hip surgery the following hip replacement information might help you understand the procedure and implants better.

Pre-operative Testing and Consultation
You and your orthopedic surgeon participate in an initial surgical consultation. This appointment may include preoperative X-rays, a complete medical and surgical history, physical examination, and comprehensive list of medications and allergies. During this visit, your orthopedic surgeon will review the procedure and answer any questions you may have.

Your orthopedic surgeon may require that you have a complete physical examination by your internist or family physician as you will need to be cleared medically by your physician before undergoing this procedure. And you may be instructed by your internist on whether you need to donate blood prior to surgery in the event that you will need a blood transfusion post-operatively.

Pre-operative Class
This class taught by the multidisciplinary total joint team provides detailed information regarding all phases of your joint replacement experience.  Members of the orthopaedic surgical, nursing, physical therapy, and discharge planning staff answer any questions that you might have regarding your joint replacement plan of care. It is highly recommended that you make plans to attend a preoperative class.  They are offered weekly and take place on the post operative orthopaedic surgical floor in the hospital so you will have a chance to become familiar with your post op surroundings.  You are encouraged to bring someone with you who will be assisting you after your surgery upon your return home.

Finally, maintaining good physical health prior to surgery will improve the recovery period and overall post-operative outcome. General strengthening exercises are often recommended prior to your joint replacement surgery.

Preparation for the Hospital
You should bring the following items to the hospital for your hip replacement surgery:

• Clothing: underwear, socks, t-shirts, exercise shorts for rehabilitation
• Footwear: walking or tennis shoes for rehab; slippers for hospital room
• Walking aids: walker, cane, wheelchair, or crutches if used prior to surgery
• Insurance information

You should follow your regular diet on the day before your surgery. Do not eat or drink after midnight.

Follow your doctor’s instructions regarding use of medication in the days leading to surgery.  Herbal & vitamin supplements should be discontinued 3 weeks before surgery. Glucophage should be discontinued 24 hours before surgery.

Day of Surgery
On the morning of the surgery, you will be admitted to the hospital and taken to the appropriate pre-surgical area. The nurse will spend a few minutes preparing you for surgery by taking your vital signs, starting IV fluids, and administering medications as needed. You will be asked to empty your bladder just prior to surgery, and to remove all jewelry, contacts, dentures, etc. You will change into a hospital gown, be placed on a stretcher, and transported to the operating room. The anesthesiologist will meet you and review the medications and procedures used during the surgical case.

The Procedure
Anesthesia will be either general or spinal. With a general anesthetic you are asleep and with a spinal your legs and hips are numb allowing you to have the operation without pain. Patients who receive spinal anesthesia are given intravenous medication during the procedure to allow them to remain comfortable and relaxed.

The surgeon begins by making an incision in your leg to allow access to the hip joint. He’ll then expose the joint and place a cutting jig or template on the end of the femur, or thigh bone. This jig allows the surgeon to cut the bone precisely so that the prosthesis fits exactly. Once the femur is cut, the inside of the bone will be prepared so that it closely matches the shape of the femoral shaft your surgeon has selected. Then the cup portion of the pelvis is prepared with cutting tools so that the metal cup will fit exactly.

Now it’s time to place the prostheses. This begins with the femoral prosthesis. For some patients, an acrylic cement called Polymethylmethacrylate (PMMA) will be used for the fixation. This cement has been used successfully by orthopedists for over 25 years. It is a strong material, well-tolerated by the body and sets or cures within 15 minutes after it is mixed. Before curing, the cement is pressure-injected and the implants are seated.

For other patients, the implants are able to be affixed to the bones without cement. Special surgical instruments are used to precisely prepare the bones so as to enable a press fit. To supplement this joining, supportive screws or pegs are often used. Bone is a living and growing tissue. If an implant coated with metallic beads to form a porous undersurface is placed in very close contact to living bone, tissues can grow into the pores, further locking the implant in place. Porous-coated hip prostheses have been used for many years and have shown excellent results in many patients.

Finally, the incision is closed, a drain is put in, and the post-operative bandaging is applied.

Recovery
After the surgical case is completed, you will be taken to the recovery room for a period of close observation. Your blood pressure, heart rate, respiration, and body temperature will be closely monitored by the recovery room staff. Special attention will be given to your circulation and sensation in the feet and legs. When you awaken and your condition is stabilized, you will be transferred to your room.

Although every patient experience is unique, you may awaken to some or all of the following:

• A large dressing applied to the surgical area.
   
• A hemovac suction container with tubes leading directly into the surgical area. This device allows the nurses to measure and record the amount of drainage being lost from the wound following surgery.
   
• An IV will continue post-operatively in order to provide adequate fluids. The IV may also be used for administration of antibiotics or other medications.
   
• Some patients have a catheter inserted into the bladder as the side effects of medication often make it difficult to urinate.
   
• An elastic hose may be applied to decrease the risk of deep vein thrombosis (DVT). Furthermore, a compression device may be applied to your feet to further prevent a DVT.