Total Hip Replacement
A total hip replacement is a procedure which removes the hip joint and replaces it with a ball and socket bearing. This is one of the most effective operations known and should give you many years of freedom from pain and return to an active lifestyle.
What conditions are treated with a Total Hip Replacement?
- Rheumatoid Arthritis
- Hip Fracture
- Avascular Necrosis
- Femoral Head Fracture
- Post Traumatic Osteoarthritis
- Hip Dysplasia
When should I have a total hip replacement?
THR is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatment.
You should consider a THR when you have:
- Arthritis confirmed on imaging and by Dr. Faucett
- Pain not responding to analgesics or anti-inflammatories
- Limitations of activities of daily living including your leisure activities, sport or work
- Pain keeping you awake at night
- Stiffness in the hip making mobility difficult
Prior to surgery you will usually have tried some simple treatments such as:
- Anti-inflammatory medications
- Modification of your activities
- Physical Therapy
- Walking sticks
- Weight loss
There is no age restriction or requirement to have a total hip replacement. Dr. Faucett has performed this procedure in 20-year old patients and even some patients in their 90s. Dr. Faucett does not recommend waiting it out if you have severe pain just to hit some predetermined age or trying to figure out the optimal time based on your life expectancy. If it is causing severe pain or limitations, you should consider it. If the pain or stiffness is mild or tolerable then you should consider non-surgical options.
The decision to proceed with THR surgery is a cooperative one between you, your surgeon, family and your local doctor.
- Reduced hip pain
- Increased mobility and movement
- Correction of deformity
- Equalization of leg length
- Increased leg strength
- Improved quality of life, ability to return to normal activities
- Enables you to sleep without pain
- An incision is made over the hip to expose the hip joint
- The muscles are spread apart rather than cut to access the hip joint.
- The capsule is opened to access the hip joint. This capsule is made of the ligaments of the hip and is repaired after the procedure.
- The acetabulum (socket) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented. A liner which can be made of plastic, metal or ceramic material is then placed inside the acetabular component.
- The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference.
- The replacement femoral head component is then placed on the femoral stem. Dr. Faucett uses a ceramic head.
- The hip is then reduced again and tested for stability.
- The muscles and soft tissues are then closed carefully.
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- You will wake up in the recovery room with a number of monitors to record your vitals. (blood pressure, pulse, oxygen saturation, temperature, etc.) You will have a dressing on your hip coming out of your wound.
- Once you are stable and awake you will be taken to either Phase II of the recovery location or if you are staying in the hospital to your hospital room.
- On the day of surgery, will usually be allowed to sit at the edge of your bed or get out of bed and walk depending on what time your surgery was.
- Pain is normal, but if you are in a lot of pain, inform your nurse. We will do everything we can to make you comfortable.
- You will be able to put all your weight on your hip and your physical therapist will help you with the post-op hip exercises.
- You will be discharged to go home either the same day or the next day depending on your pain, mobility and home layout.
- Sutures are dissolvable.
- Some equipment will be helpful at home:
- Grabbers are helpful as are shoe horns or slip on shoes
- Elevated toilet seat helpful or a 3 in 1 commode
- Shower chair
- A sterile dressing is applied in the operating room. It should stay in place and not be routinely changed. We will remove it in the office. However, if the dressing appears to be soiled, or collecting water then it should be removed immediately and redressed with a dry sterile dressing.
- You can shower with the dressing in place. It is waterproof and is designed for you to take a shower.
- A post-operative visit will be arranged prior to your discharge. Usually 2 weeks with Dr. Faucett’s team.
- You will be advised about how to walk with crutches and or a walker. You should use these walking aids until you feel comfortable to transition to a cane and then no aids as your balance and strength improve.
- You can apply Vitamin E or moisturizing cream into the wound once the wound has healed
- If you have increasing redness or swelling in the wound or temperatures over 100.5° you should call your doctor
- If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details
- Your hip replacement may go off in a metal detector at the airport
Risks and Complications
We have listed possible complications/problems, which have been reported with hip replacement surgery.
IN GENERAL, HIP REPLACEMENT THROUGH THE DIRECT ANTERIOR APPROACH IS EXTREMELY SAFE, HIGHLY SUCCESSFUL, AND HAS MINIMAL COMPLICATIONS ASSOCIATED WITH THE PROCEDURE.
Common Occurrences, These can happen but often resolve without consequence to the final outcome after surgery.
- Bruising: Some patients will note bruising around the hip. This is not a complication.
- Hip Flexor Tendonitis: Some patients may develop new symptoms or exaggerated current symptoms during their rehabilitation, hip flexor tendinitis is often the cause and is prevented with strict adherence to postoperative physical therapy protocols.
- Swelling: It is common and in fact expected to have swelling about your hip after surgery. Icing your hip is extremely helpful. Specific complications include Infection
- Ankle and Knee Pain: During the surgery the leg is rotated and twisted to allow Dr. Faucett to access the necessary parts of the hip. These rotations are done in a controlled manner but sometimes can cause pain and or injury to the knee or ankle. These usually are minor injuries and recover quickly. In rare instances a major injury to knee or ankle occurs.
- Infection can occur with any operation: In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
- Postoperative bleeding within the hip joint and around incisions: The bone often bleeds and is not possible to effectively stop the bleeding bone. In some instances, patients will need a transfusion after surgery if they lose too much blood during or after surgery.
- Postoperative infection: Superficial (skin) or deep (within the joint) infections can occur. The incidence is reported at 1 in 200 surgeries. A skin infection generally is treated with oral antibiotics. If you develop a deep infection, you would require re-admission to the hospital, return to the operating room to wash out the infection, and a variable period of intravenous antibiotics. In many cases the implants have to be removed for the body for a period of time until the infection is eradicated, and then new ones can be reimplanted.
- Phlebitis (blood clots): Deep vein thrombosis or blood clots can occur in hip replacement surgery. A blood clot may require re-admission to the hospital and a treatment with an injectable blood thinner and rivaroxaban (Xarelto ®) for several days followed by a 3-month period of oral anticoagulants.
- Pulmonary Embolus: When a blood clot becomes dislodged it may travel to the lungs resulting in acute shortness of breath, rapid heartbeat, and in rare situations result in sudden death.
- Nerve injury: The approach to the hip is near a nerve that provides sensation to the front of the thigh (Lateral Femoral Cutaneous Nerve). The approach avoids this nerve but rarely simple moving the nerve causes it to stop working and can cause burning, tingling or numbness in the thigh. This often recovers over a period of weeks to months. In studies the risk of this injury is 4 in 1050 surgeries (0.4%). The length of the leg will be made to be equal to your other leg. Rarely the lengthening of a leg can cause a pulling injury to the sciatic nerve and result in weakness at your ankle and numbness burning or tingling in the foot. This injury is extremely rare.
- Vessel injury: Rarely the major artery/vein in the lower extremity is injured. If this occurs it is generally quickly detected. In a major injury to these vessels, which course through the back of the knee, immediate vascular repair by a vascular surgeon is required with a subsequent hospitalization. Extremely rarely, vascular injuries have resulted in an amputation of the extremity.
- Dislocation: One of the reasons to perform a total hip replacement is to be able to use x-ray during surgery to ensure the best placement of the socket as possible. In some instances, despite adequate placement the hip can dislocate. The risk of hip dislocation after an anterior approach hip replacement is less than 1 in 100 surgeries
- Reflex sympathetic dystrophy: This rare entity is characterized by burning and hypersensitivity in the leg. If this occurred postoperatively it would require referral to a pain clinic, prolonged rehabilitation, and epidural spinal pain blocks. This could happen at the thigh, leg or just the ankle.
- Compartment syndrome: This rare complication occurs when fluid leaks out of the hip into the muscle compartments. Massive swelling could result in compromise of the neurovascular structures with a potential complication resulting. If this were suspected or detected, emergency surgical decompression of the muscular compartments is required.
- Implant failure: Joint replacement relies on using manufactured implants to replace natural joints. It is possible that these implants could fail due to wear, cracking, trauma, or dislocation. In some cases, these types of implant failure require a repeat surgery to remove and replace the problematic implants. Again, hip replacement surgery is a very effective and successful surgery.
- Fracture: When placing these components in your body they are held in place by the bone. In some cases, the pressure applied to insert the components can cause the bone to break. Often this is discovered in surgery and stabilized with plates screws and or wires. Rarely it will not be recognized and will require going back to surgery to fix the fracture.
- Ankle Injury: To move the leg, the foot is placed in a boot and traction and twisting are applied to the leg. It is a possibility, although rare, that the ankle joint or the nerves or vessels going across the ankle joint could be injured.
- Anesthesia Problems: You will meet with the anesthesiologist on the day of surgery. They will formulate an anesthetic plan with you and discuss the specific risks and benefits of each anesthetic option that is safe for your surgery.
- Medical Problems: Hip replacement surgery is a major surgery. It will stress your body. This stress can exacerbate underlying heart, lung, brain, kidney, and digestive conditions as well as uncover new conditions in your body. In rare instances patients have died suddenly due to the stress put on their body from the surgery and immediate recovery. In order to make surgery as safe as possible we ask that you meet with your primary care practitioner to have a full physical and make sure that all your health conditions are under control.
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan- it may help to restore function to your damaged hip and relieve your pain.