Total Hip Replacement
What is a Total Hip Replacement?
During a hip replacement, your surgeon removes the ball (femoral head), which is arthritic and worn out. The bone of the socket (acetabulum) is machined down to remove any remaining arthritis and cartilage. A porous metal cup is placed into the socket. Eventually, your bone will grow into the metal so that it becomes part of you, a process that typically takes 2-3 months. Until bone grows into the implants, the cup is held in position by friction and oftentimes screws that hold the cup to the bone. A plastic liner is then placed within the metal socket.
On the femoral side, the femoral canal (marrow canal) is machined so that a metal stem can be placed. This stem may be either cementless (meaning that your bone will grow into it) or cemented (held in place with bone cement). A metal or ceramic ball is placed onto the femoral stem. This ball then articulates with the plastic liner.
Surgical Approaches for Total Hip Replacement
A hip “approach” refers to the route a surgeon uses to access or expose the hip joint. This relates to the location of the incision, as well as the structures that are encountered and need to be addressed to get to the hip. While there are many variations regarding hip approach, these generally fall into three categories:
- Direct Anterior
A hip replacement can be successfully done through any of these approaches with good results. There are pros and cons to each approach.
Total Hip Replacement Complications
There are potential complications to any surgical procedure. Complications can include:
- Dislocation (or the hip coming out of place)
- Loosening of the parts
- Wear of the plastic
- Leg length discrepancy
- Nerve or blood vessel damage
- Fracture of the bone around the implants
Fortunately, complications are uncommon, but when they do occur, additional surgery may be required. Make sure to discuss these potential complications with your surgeon prior to surgery.
How Can I Minimize My Risk of Complications?
It is not possible to have any surgery without potential risks or complications. However, there are certain aspects of your health that can be optimized prior to hip replacement surgery, which have been shown to improve outcomes.
- Diabetes: Poorly controlled diabetes can increase the risk of complications such as wound healing problems or infection. Your surgeon may check a blood test called hemoglobin A1c, which determines how well your diabetes in controlled. If your A1c is too high, your surgery may be delayed until better blood sugar control can be accomplished.
- Smoking: Smoking tobacco is one of the biggest risk factors for wound complications and infection. Cutting back or quitting smoking would lessen your risk of infection around the time of surgery.
- Obesity: Patients who are overweight are more likely to have their joints wear out at a younger age. There is also an increased risk of infection and component failure, particularly for patients with a BMI of more than 40. BMI can be easily calculated online. In some patients, weight loss will be required prior to surgery to minimize surgical risk.
How Long Does it Takes to Recover from Hip Replacement?
Specific recovery protocols may vary from patient to patient, but we typically allow full weight bearing immediately following surgery. You will need to use a walker or crutches initially, but may wean off of them at your own rate. The hospital stay for hip replacements has become much shorter in recent years – most patients now go home either the day of (outpatient), or the day following surgery (one night in the hospital). Often times, patients are most concerned about pain management. Managing pain differs from patient to patient so it is important to communicate with your doctors about what is working and what isn’t. Most patients will not require formal physical therapy following a hip replacement surgery. The best form of exercise initially following surgery is simple walking. Though full recovery continues for a full year after surgery, patients can return to most activities by 6-10 weeks.
Outcomes After Total Hip Replacement
Overall, the outcomes of hip replacement are excellent. Patients can essentially return to any activity once recovered from surgery, though it is generally recommended that patients avoid repetitive high impact activities to prolong the lifespan of the hip replacement materials. These days, in the absence of complication, we expect hip replacements to last multiple decades.
Why should I choose ROC?
Your best chance at an excellent outcome is to get things done right the first time. At Reno Orthopedic Clinic, our Joint Replacement Surgeons are fellowship-trained subspecialists who focus solely on joint replacement. Because of this, we have the experience and expertise to treat the full spectrum of hip arthritis, from basic nonoperative treatment to complex revision surgery.
If you think you may need hip replacement surgery, contact us for a consultation.