Who is a candidate for hip replacement surgery ?

Osteoarthritis of the hip most commonly affects people who are middle-aged and older. Symptoms range from mild discomfort to severe pain and immobility. Treatment for osteoarthritis of the hip focuses on decreasing pain and improving joint movement. When conservative methods of treatment fail to provide adequate relief, total hip replacement may be considered.

An orthopaedic surgeon, who specializes in treating problems of the bones and joints, will evaluate if you are a candidate for a hip replacement. The surgeon will discuss your medical history, measure the range of motion and muscle strength of your hips, and observe how you sit, bend, and move. In addition, x-rays will be taken to determine the extent of damage to your hip joints. If the x-ray shows severe joint damage and no other means of treatment has provided relief, the orthopaedic surgeon may suggest hip replacement surgery.

Total hip replacement has evolved to be one of the most predictable and reliable medical procedures available. Total joint replacement has transformed the lives of many patients by providing them the opportunity to once again be active and experience less pain.

To replace a hip joint that has been  damaged, usually by arthritis. The hip joint is a ball and socket joint. The ball is formed by the head of the thigh bone (femur) and fits snugly into the socket (acetabulum). This is depicted in the diagram to the left entitled "Normal Hip".

The surfaces of these bones are coated by a smooth substance known as articular cartilage. Arthritis occurs when the articular cartilage wears, exposing the underlying  bone. This is depicted in the diagram to the right entitled "Arthritic Hip". Arthritis causes pain, deformity, and loss of mobility.

In a total hip replacement operation, the surgeon replaces the worn head of the thigh bone with a metal or ceramic ball mounted on a stem, while the socket is resurfaced with a polyethylene (plastic) or polyethylene lined metal cup. The prosthesis may be cemented in place with a filler or grout similar to dental cement, or securely pressed into place using no cement. The results of a total hip replacement operation are depicted in the diagram below.

When the orthopaedic surgeon performs a total hip replacement, he or she has four basic goals:

• Relief of pain
• Restoration of mobility
• Correction of deformity, restoration of leg length, and correction of limp
• Good long-term results

Post-operative hip joint with prosthesis in place

Before a total hip replacement operation, a patient may undergo many tests such as x- rays, blood tests and possibly an ECG (electrocardiogram of the heart). The patient may be admitted to the hospital the day prior to the operation for anesthetic assessment and preoperative preparation. Fasting is necessary as the operation is performed under an anesthetic, either general or spinal, depending on the patient/surgeon preference.

Length of hospitalization varies, but can range from 3 to 10 days. After discharge, visits to a physical therapist and exercises to be performed daily will be required. Physiotherapy exercises are important following total hip replacement, and a smooth recovery usually depends upon the patient following the established post-operative exercise routine. Typically the patient will initially require crutches or a walking frame, progressing to the use of a walking cane for some months after.

During the post-operative period, techniques are taught for walking, negotiating stairs, getting in and out of chairs and motor vehicles, as well as getting on and off toilet seats.

Pre-operative and post-operative treatments vary due to many factors. Talk to your surgeon about the treatment and exercise schedule which is right for you.

All surgery carries risks and the Hip replacement is no different. These risks have to be fully understood by patients and relatives before surgery takes place. Complications specific to Hip replacement surgery include:

• Urinary problems and the need for urinary catheters.
• Chest infections
• Ileus (intestines cease to function for a few days)
• Constipation
• Stomach/duodenal ulcers
• Confusion and even psychosis
• Nausea and vomiting
• Inadequate pain relief
• Delayed wound healing

Major but rare complications of Joint Replacement Surgery:

• Deep venous thrombosis and Pulmonary embolus (blood clots on the leg and lung).
• Heart Attacks/strokes
• Infection in the joint following surgery
• Nerve damage and blood vessel damage.
• Fracture (break) of bones
• Failure to cure symptoms or even worsening of knee pain.

• Before your operation
• After your operation