Patient education: Hip replacement (The Basics)

What is hip replacement? — 

This is surgery to replace part or all of the hip joint with artificial or "prosthetic" parts, sometimes also referred to as "implants."

The hip joint is a "ball-and-socket" joint. This is because the top of the thigh bone (femur) is ball shaped. It fits into a socket-shaped part of the pelvis bones (figure 1).

Different conditions can cause problems with the hip joint. The hip can be painful and stiff, and have trouble moving normally. Hip replacement is a treatment that can reduce hip pain and improve how the hip moves.

Doctors often do a hip replacement to treat:

●Osteoarthritis – This is a type of arthritis that often comes with age and usually happens from "wear and tear" of the joint. A hip replacement is an option when other treatments can't be used or have not improved symptoms.

●A hip fracture

Hip replacement is an "open" surgery. This means the doctor makes a cut (incision) in the skin so they can see directly inside the body. They make the incision toward the back, side, or front of the hip. They make the incision as small as possible to limit injury to the muscles and other tissues in the hip.

Are there different types of hip replacement? — 

Yes. The doctor can do a:

●Total hip replacement – They replace the ball at the top of the femur, and reline the socket of the pelvic bone.

●Partial hip replacement – They replace the "ball" at the top of the femur, but leave the socket alone. The part of the implant that replaces the ball can have 1 (unipolar) or 2 (bipolar) parts that let the hip move smoothly.

In some cases, the doctor will re-shape the bony surfaces and place an artificial cap on the ball and cup in the socket. This is called "hip resurfacing."

How do I prepare for a hip replacement? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests

●X-rays

●Electrocardiogram ("ECG") – This measures the electrical activity in the heart.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. Tell them if you are taking any anticoagulants. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you. You might have to stop certain medicines for a short time before surgery.

●Any allergies you have

●Any infections – If you have an infection anywhere in your body, it needs to be treated completely before surgery.

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

Before surgery, the doctor might want you to:

●Learn about exercises you can do before and after surgery.

●Learn to use crutches, a walker, or a cane.

●Quit smoking, if you smoke. It takes longer for bones to heal if you smoke. Smoking also increases the risk of problems such as infection and poor wound healing after surgery.

●Try to lose weight, if you have excess body weight. Excess body weight increases the risk of problems such as infection and poor wound healing after surgery.

You will also get information about:

●Eating and drinking before your procedure – You might need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●Lowering the risk of infection – The doctor might ask you to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during hip replacement? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. Common types include "spinal" and "epidural" blocks. For these, a doctor injects medicine to numb the nerves in or near your spine. They can also do a "nerve block" to numb your hip area. This can help control pain after surgery.

If you get regional anesthesia, you will usually also get medicines to make you relax and feel sleepy, called "sedatives."

•General – This makes you unconscious so you can't feel, see, or hear anything during the procedure. You will usually also get a breathing tube or other device to help you breathe.

●You will get medicines to help prevent infection and control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision along the back, side, or front of your hip. They will remove the damaged parts of your hip joint and replace them with prosthetic parts to improve the function of your hip. The parts can be made of plastic, metal, or ceramic (figure 2).

●They will close your incision and cover it with clean bandages.

●In some cases, the doctor will place a drain or use a suction dressing to remove excess fluid and help with healing.

What happens after hip replacement? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might go home within a few hours. Or you might spend 1 to 3 nights in the hospital or go to a "rehabilitation" ("rehab") facility.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You will get medicine if needed to help with pain.

●The staff will help you get out of bed. A physical therapist might help you stand and start to walk soon after.

●You might have a special wedge-shaped pillow between your legs to keep you from crossing your legs.

●You might have special boots or stockings to help prevent blood clots in your legs. You will get medicine to help prevent blood clots, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of hip replacement? — 

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Dislocation (when the hip joint pops out of place)

●Blood clot

●Joint infection

●Broken bone

●Nerve or blood vessel damage

●Bleeding

●1 leg being shorter than the other

●The prosthetic wearing out, loosening, or breaking

●Joint stiffness

●A reaction to the material in the prosthetic

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when you should call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

When you go home, you will get instructions about physical therapy and specific exercises to do. These will help build your muscle strength and flexibility. Physical therapy exercises are a very important part of the recovery process.

More on this topic

Patient education: Hip replacement – Discharge instructions (The Basics)
Patient education: Deciding to have a hip replacement (The Basics)
Patient education: Hip pain in adults (The Basics)
Patient education: Hip fracture (The Basics)
Patient education: Osteoarthritis (The Basics)
Patient education: Rheumatoid arthritis (The Basics)
Patient education: Deep vein thrombosis (blood clot in the leg) (The Basics)
Patient education: How to use crutches (The Basics)

Patient education: Total hip replacement (Beyond the Basics)
Patient education: Osteoarthritis treatment (Beyond the Basics)
Patient education: Rheumatoid arthritis treatment (Beyond the Basics)
Patient education: Joint infection (Beyond the Basics)
Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)