A total hip replacement procedure creates a new surface for the ball and socket mechanism of the hip. The top of the femur bone (the ball) and the acetabulum (the socket within the hip) are replaced with components constructed from metal alloys and polyethylene. The procedure is usually recommended for older patients that have advanced degenerative joint disease within the hip, resulting in severe pain and restricted mobility.
- A hip replacement is usually performed after other treatment options have begun to show diminished effectiveness in controlling the pain of the degenerated hip, either while walking or at rest.
- The typical candidate for a hip replacement is a patient over 55 years of age.
- The primary goal of a hip replacement procedure is to greatly reduce pain and stiffness in the joint. The replaced hip will generally last between 15 and 20 years.
- Surgery removes the damaged joint, and then replaces the contact or functional points of the hip and thighbone with metal alloy and polyethylene (plastic) implants.
Signs and Symptoms
- Severe osteoarthritis, degenerative joint disease, inflammatory arthritis or continual and progressive discomfort and pain throughout the hip
- Hip pain that can no longer be managed through other treatments; pain while using the leg in normal activities, particularly intense pain while climbing or descending stairs, or during movements that put increased pressure on the hip
- Discomfort or pain after sitting or keeping the leg and hip motionless for an extended period of time
- Stiffness, which increases after the hip has remained motionless.
- Pain at night
Contact the Doctor if …
- Patient has signs and symptoms of severe osteoarthritis, inflammatory arthritis or degenerative joint disease.
- Patient experiences increasing pain or weakness in the joint after treatment.
- Patient experiences unexplained symptoms, other types of pain or unexpected side effects of medication.
Causes of Injury
- Many conditions may result in degeneration of the hip joint; the most common is osteoarthritis.
- Some individuals are more prone to develop osteoarthritis than others. Causes for the condition are not yet known, although it is likely a process similar to other degenerative conditions which result from a combination of factors including: heredity, type and intensity of athletic activity and the extent of previous injury.
- Repetitive pounding or impact producing actions to the hip can cause damage to the cartilage over time.
- Cartilage can also be damaged from a traumatic event, such as a sudden twist or blow to the hip.
- A traumatic injury to the cartilage can accelerate the rate of the ongoing degenerative condition.
- Inflammatory arthritis (such as rheumatoid arthritis) destroys the cartilage of the hip.
Expectations of Recovery
- Hip replacement surgery usually requires a hospital stay of three to five days.
- Rehabilitation will usually require the use of crutches, cane or a walker for six weeks.
- After three months, the patient will likely be allowed to return to moderate athletic activity such as bicycling, golf and swimming.
- To help maintain the condition of the replaced hip, continued gentle use of the hip joint is encouraged. Running, pounding or impact producing activities should be kept to a minimum and undertaken with caution and common sense.
- The initial hip replacement should last 15 or more years. Should the implants become loose, a second surgery may be required to replace or revise the implants.
Medical Details
As the bones of the hip come in contact with each other, an insulating layer of cartilage helps distribute weight and reduce friction across the joint. Osteoarthritis, or other degenerative conditions that affect this cartilage erodes the smooth surface of the joint and begins to interfere with the efficient functioning of the hip. For older patients that have exhausted other treatment options and continue to experience pain, a hip replacement may be recommended to alleviate many of the problems caused by a degenerating joint.
The hip is the largest joint that utilizes a ball and socket construction. As with the shoulder, the ball and socket arrangement allows a large range of motion. The shape and position of the hip provide excellent stability, acting as a junction between the upper and lower body. Degeneration of the cartilage in the hip can be especially debilitating because of the critical role the joint plays during most day-to-day activities. Almost any routine activity of daily living, places tremendous stress across the hip joint.
Cartilage is found throughout the body, and depending upon its location, varies in its composition and structural qualities. In the ear or nose, cartilage provides a flexible construction that can easily bend without harm. In the hip, however, cartilage provides support and protection, while at the same time significantly improving the function of the entire joint. The softer and nearly frictionless cartilage allows the bones to mesh together and move with ease. Degeneration of the cartilage results in bones grating and rubbing against each other, a usually very painful condition.
Cartilage will begin to wear in older individuals and cannot be replaced or repaired by the body. The severity and rate of degeneration varies from person to person. The process of cartilage degeneration occurs in all individuals to the point that approximately 60% of all 60-year-olds will have some cartilage fraying or tearing.
Diagnosis
Both the patient’s previous treatment history and their ability to tolerate the pain associated with a degenerative hip are important factors when considering a hip replacement. A painful hip can greatly reduce the patient’s ability to lead an active life. After non-surgical therapies to treat the hip are no longer providing effective pain relief, a hip replacement may be considered.
The orthopedic surgeon will review previous treatments. Initial treatment plans may have included steroid injections, anti-inflammatories, activity modification, correction of any bio-mechanical or gait abnormalities and weight loss. A physical examination and x-rays will be used to determine the extent of the degeneration and if a replacement hip will be used in treating the condition.
Symptoms
- Severe osteoarthritis, degenerative joint disease or continual and progressive discomfort and pain throughout the hip
- Hip pain that can no longer be managed through other treatments; pain while using the leg in normal activities or particularly intense pain while climbing or descending stairs or during movements that put more pressure on the hip
- Discomfort or pain after sitting or keeping the leg and hip motionless for an extended period of time
- Stiffness, which increases after the hip has remained motionless