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Total Hip Replacement

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A total hip replacement is a surgery that uses an artificial hip joint to swap out a natural hip joint that has worn out or been injured.

Written byDr. Saranya. P

Medically reviewed byDr. Anuj Gupta

Published At August 23, 2023
Reviewed AtOctober 11, 2023

What Is Total Hip Replacement?

Total hip replacement (THR) is a surgical treatment that replaces damaged bone and cartilage with prosthetic components. THR is one of the greatest economical and reliably successful orthopedic operations. The doctor performing the surgery will replace the head of the femur and the hip joint socket during a total hip replacement. Experts predict that the number of total hip replacements in the United States will nearly quadruple by 2040.

What Is the Anatomy of Hip Joint?

The hip is one of the body's largest joints. A ball-and-socket joint is used. The acetabulum, a part of the pelvis bone, forms the socket. The ball represents the femoral head (the thighbone's upper end). Articular cartilage, a soft tissue that cushions the ends of the bones and allows them to move quickly, coats the ball and socket bone surfaces. Ligaments (the hip capsule) are bands of tissue that attach the ball to the socket and offer support to the joint.

Who Requires a Total Hip Replacement?

Total hip replacements are most commonly used to treat advanced osteoarthritis. Hip replacements can also be used to address the following conditions:

  • Osteonecrosis of the hip.

  • Dysplasia of the hip.

  • Various kinds of arthritis.

Individuals who benefit from hip replacement surgery include:

  • Hip discomfort that impairs daily activities such as walking.

  • Hip stiffness that limits leg mobility.

  • Poor pain relief despite physiotherapy, walking aids, and anti-inflammatory medicines.

  • Hip discomfort remains even when resting down.

What Are the Hip Replacement Components?

The whole hip joint is replaced with a total hip replacement. The replacement consists of four parts:

  • Cup or Socket: A cup-shaped prosthetic element replaces the hip socket (acetabulum).

  • Cup Lining: A liner decreases friction between the hip's ball and socket.

  • Femoral Head: The circular head at the apex of the femur is replaced by a ball.

  • Femoral Stem: The ball and thigh bone are connected by a stem.

What Are the Choices for Total Hip Replacement?

Hip replacement implants come in a variety of materials. The ideal option depends on several factors, including age, cost, and how active one is. Surgeons' perspectives on the best material differ.

Metal-On-Polyethylene: The implant's ball is made of metal, while the socket is constructed of or lined with polyethylene, a form of plastic. Up until the middle of the 1990s, these implants were the most common. They are still widely used and suit a wide range of people. However, according to some studies, other varieties may be more appropriate for youthful, energetic people.

Ceramic-On-Polyethylene: The implant's ball is ceramic, and the socket is plastic or polyethylene-lined. It is still preferred because of its strong wear resistance and low corrosion risk.

Ceramic-On-Metal: The implant's ball is made of ceramic and the metal socket. Due to more significant than anticipated quantities of metal ions in the blood, researchers in a 2015 study concluded that they would not suggest ceramic-on-metal.

How Is a Total Hip Replacement Performed?

The THA technique can be approached in a variety of ways. The three most popular ways are as follows:

Posterior Approach:

The most common surgical technique for THR is posterior (PA). A surgical incision along the exterior of the hip is done while the patient is lying on their side. Avoiding the hip abductors is a significant benefit of this strategy.

Direct Anterior:

This surgical approach has been more popular in the last decade. During the direct anterior procedure, a surgical incision is made at the front of the hip. The surgeon moves the muscle and tendons aside to gain access to the joint. The direct anterior approach has several possible benefits. The two most notable are a low risk of dislocation and early postoperative healing.

Direct Lateral:

The surgeon will make an incision on the side of the hip during this procedure. To gain access to the joint capsule, they will remove the tendons of the gluteus Medius muscle. The benefit includes having a flexible incision that can be utilized to repair abnormalities and install specialized implants while having reduced dislocation rates after surgery than posterior methods.

How Long Does It Take To Recuperate From a Total Hip Replacement?

Following the surgeon's recovery guidelines can increase the likelihood of a quick recovery. Most people can resume modest activity between three and six weeks after surgery. The surgeon may advise:

What Are the Complications of Total Hip Replacement?

THR complications can be split into systemic and procedure-specific consequences. Complication rates have decreased over time as surgical and anesthetic procedures, and the diagnosis and management of these issues have improved.

Deep vein thrombosis is the most prevalent systemic consequence. The most severe complication is infection. A common source of patient disappointment is a difference in leg length. Other issues to consider are:

  • Aseptic loosening is thought to be the most common reason for revision surgery.

  • Fracture types include periprosthetic fracture, cement fracture, and stem fracture.

  • Femoral head dislocation out of the cup.

  • Stem dislocation.

  • Formation of heterotopic bone.

  • Metal reactions include metal-on-metal pseudotumor and metallosis.

  • Tears in the abductor muscles or tendons.

  • Stress protection.

  • Bursitis of the trochanteric artery.

  • Total hip arthroplasty revision.

  • Problems of general orthopedic surgery, such as hemorrhage, wound problems, pulmonary embolism, vascular injury, neurological disability, and mortality.

What Are the Contraindications of Total Hip Replacement?

THR is not recommended in the following medical situations:

  • Septic (infectious) local arthritis.

  • Active, continuous infection or bacteremia at a distant location.

  • Cases of severe peripheral vascular disease.

Conclusion

A total hip replacement is a surgical operation in which the ball and socket of the hip are replaced with implants. It is a frequent treatment for late-stage osteoarthritis and other hip pain disorders. A doctor can advise individuals on whether they are an appropriate candidate for a hip replacement. Total hip replacement surgery can be approached in a variety of ways. They each have advantages and disadvantages, and neither is superior.

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Frequently Asked Questions

Blood clots are one of the most common and significant medical consequences following joint replacement surgery. Deep vein thrombosis (DVT) is a type of blood clot that occurs in the leg. Infection, nerve injury, dislocation, and bleeding are the other potential risks.

Hip replacement recovery time ranges from two to four weeks on average, although each individual is different. Recovery after hip replacement is determined by several factors, including the level of activity before surgery, age, diet and nutrition, previous medical history, as well as additional health and lifestyle considerations.

Regular exercise to improve hip strength and mobility, as well as a gradual return to daily activities, are essential for full recovery following total hip replacement. Walking properly is the most effective technique for hip recovery. Some post-operative activities include ankle pumps, bed-supported knee bends, buttock contractions, abduction exercises, and standing exercises.

With generally outstanding results, total hip replacement surgery is one of the most popular and effective surgical procedures. Hip replacement implants might last 10 to 20 or 30 years. However, some could survive even longer, whereas some may need revision surgery sooner.

Following hip replacement surgery, standard precautions to take are to avoid bending down to tie shoes, sitting in a low chair, or engaging in any other activity that demands bending at the waist, as well as crossing the operated leg over the non-operated leg.

Hip replacement surgery is a painful procedure. Most patients typically start to feel better after 14 days of total hip replacement surgery. After a hip replacement, people often see a significant improvement within two to six weeks. A full recovery can take up to a year, but most patients feel much better after two to three months.

It is expected that the patient will be on a regular diet as they return home following hip surgery. The doctor may suggest taking iron and vitamin tablets. Fried and fatty foods, carbonated beverages, alcoholic beverages, and caffeine drinks must be avoided after hip replacement surgery.

Following total hip replacement surgery, the schedule of follow-up appointments with the surgeon may vary based on the patient's recovery progress and any special concerns. The first follow-up visit normally takes place within six to eight weeks. The second follow-up visit is often scheduled for three to six months after the initial postoperative phase. Following that, follow-up visits may be scheduled annually or as needed based on the patient's specific circumstances.

Physical therapy is often suggested after total hip replacement surgery to assist patients achieve hip joint strength, mobility, and function. Physical therapy is an important part of the recovery process and can enhance the overall success after surgery.

After receiving general or regional anesthesia, individuals will undergo total hip replacement surgery in the operating room. The surgeon performing the surgery will decide the surgical approach, which is commonly only one incision along the back, lateral, or anterior (front) part of the hip. The person is lying on their side, and the surgical incision is made directly down the exterior of the hip.

Gait relates to the way people walk. Normal walking is supposed to be painless, effortless, and constant. Recovery from a joint replacement surgery can result in a change in gait pattern that will improve with training.

Several muscles surrounding the hip joint may be affected after total hip replacement surgery, either directly or indirectly, as a result of alterations. It consists of gluteus muscles, quadriceps muscles, hip flexor muscles, and hamstrings.

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Dr. Anuj Gupta from iCliniq
Dr. Anuj Gupta

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