What is hip replacement surgery?

Hip replacement is the removal and replacement of portions of the pelvis and femur (thigh bone) that form your hip joint. It is performed primarily to relieve hip pain and stiffness caused by hip arthritis.

This procedure is also sometimes used to treat injuries such as a broken or improperly growing hip, and for other conditions.

Conditions that require Hip Arthroplasty

Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary, include:

• Osteoarthritis. Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly.
• Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.
• Osteonecrosis. If there isn't enough blood supplied to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone might collapse and deform.

Hip replacement may be an option if hip pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from a seated position

Risks associated with hip replacement surgery can include:

• Blood clots. Clots can form in the leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. Blood-thinning medications can reduce this risk.
• Infection. Infections can occur at the site of the incision and in the deeper tissue near the new hip. Most infections are treated with antibiotics, but a major infection near the new hip might require surgery to remove and replace the artificial parts.
• Fracture. During surgery, healthy portions of the hip joint might fracture. Sometimes the fractures are small enough to heal on their own, but larger fractures might need to be stabilized with wires, screws, and possibly a metal plate or bone grafts.
• Dislocation. Certain positions can cause the ball of the new joint to come out of the socket, particularly in the first few months after surgery. If the hip dislocates, a brace can help keep the hip in the correct position. If the hip keeps dislocating, surgery may be needed to stabilize it.
• Change in leg length. Surgeons take steps to avoid the problem, but occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contracture of muscles around the hip. In these cases, progressively strengthening and stretching those muscles might help. Small differences in leg length usually aren't noticeable after a few months.
• Loosening. Although this complication is rare with newer implants, the new joint might not become solidly fixed to the bone or might loosen over time, causing pain in the hip. Surgery might be needed to fix the problem.
• Nerve damage. Rarely, nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.

Need for second hip replacement

The artificial hip parts might wear out eventually, especially for people who have hip replacement surgery when they're relatively young and active. If this happens, you might need a second hip replacement. However, new materials are making implants last longer.

For a smooth transition:

• Arrange to have a caregiver at home
• Place everyday items at waist level, so you won't have to bend down or reach up
• Consider getting a raised toilet seat and a shower chair for your recovery at home
• Put your phone, tissues, TV remote, medicine and books near the area where you'll be spending most of your time during recovery

Results

Full recovery from a hip replacement varies from person to person, but most people are doing well three months after the surgery. Improvements typically continue during the first year after surgery.

The new hip joint can reduce pain and increase the hip's range of motion. But don't expect to do everything you could do before the hip became painful.

High-impact activities, such as running or playing basketball, might be too stressful on the artificial joint. But in time, most people can participate in lower-impact activities � such as swimming, golfing and bicycle riding.

When hip replacement surgeries were first performed in the early 1970s, it was thought that the average artificial joint would last approximately 10 years. We now know that about 85% of the hip joint implants will last 20 years. Improvements in surgical technique and artificial joint materials should make these implants last even longer. If the joint does become damaged, surgery to repair it can be successful but is more complicated than the original procedure.