What is Hip Replacement Surgery?
What is Hip Replacement Surgery?Hip replacement surgery, also known as hip arthroplasty, is a procedure where the bones that form your hip joint are removed and replaced with implants. Hip replacement surgery helps reduce pain and improve function, especially if the pain interferes with daily activities and nonsurgical treatments are ineffective. The most common conditions that cause damage to the joint requiring hip replacement surgery are osteoarthritis, rheumatoid arthritis, and osteonecrosis.
Types of Hip Replacement Surgery
TypesNewYork-Presbyterian Columbia Orthopedics surgeons are experts at performing a less-invasive, muscle-sparing hip replacement surgery called the "anterior approach," and traditional hip replacement surgery, commonly referred to as the "posterior approach."
The anterior approach involves a small incision toward the front of the hip, while the posterior approach requires the surgeon to make an incision on the back of the hip. Both methods are highly effective, but recovery times may be shorter with the anterior approach.
The three major hip replacement surgeries are known as:
Total hip replacement surgery
Total hip replacement surgery (total hip arthroplasty) is the most common type of hip replacement. Worn-out or damaged sections of your hip are removed and replaced with artificial implants made of ceramic, durable plastic (highly cross-linked polyethylene), and metal (titanium). Most total hip replacements performed by Columbia Orthopedics surgeons are done through the anterior approach.
Partial hip replacement surgery
Partial hip replacement surgery (hip hemiarthroplasty) is mostly performed in patients with a fractured hip. This involves removing the broken femoral head, which doesn't heal reliably in certain hip fractures, and replacing it with metal while leaving the socket alone. Partial hip replacement can be done through the anterior or posterior approach, depending on surgeon’s training and experience or the patient’s medical needs.
Hip resurfacing surgery
Hip resurfacing surgery requires the replacement of the surfaces of the femoral head and socket with metal (cobalt chromium). It has largely fallen out of favor due to concerns about the release of metal debris from the surfaces. It is an option in selected younger and active (typically male) patients and can be done through the anterior or posterior approach depending on surgeon training and experience.
How is a Hip Replacement Surgery Performed?
ProcedureHip replacement surgery typically takes one to two hours to complete, whether posterior or anterior. Before your surgery, you will receive anesthesia to induce a pain-free, sleeplike state for your surgery. The two most common types of anesthesia utilized are:
- Regional anesthesia temporarily numbs the lower half of the body. Patients also receive sedation medication to sleep peacefully throughout the operation. Unlike general anesthesia, when sedation is discontinued, you will awaken almost immediately and without pain as the regional anesthesia (spinal or epidural) is still working.
- General anesthesia induces a sleeplike state followed by a gas anesthetic administered through a breathing device into your lungs. You are attached to monitors throughout the operation to display information on your heart rate, oxygen level, body temperature, and blood pressure.
The process your surgeon will use to replace the portion of the hip that contains the damaged surfaces includes:
- Making an incision over the hip
- Removing the diseased or damaged hip joint (bone and cartilage) while leaving the healthy components intac
- Inserting a metal hemispherical implant into the pelvic bone (acetabulum)
- Inserting a metal stem into the top of the thigh bone (femur)
- Attaching a new ball and socket (typically made of ceramic and plastic) to these metal pieces inside the joint capsule, which serves as the new hip joint surfaces
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Risks to Consider
RisksWhen considering hip replacement surgery, the following risks should be taken into consideration:
- Blood clots can form after surgery in the legs or lungs, which can sometimes be dangerous. Blood-thinning medications are generally prescribed to reduce this risk. Ways to prevent blood clots after surgery include moving early and taking blood-thinning medications as prescribed.
- Change in leg length can occur as a new one replaces the diseased hip joint. These changes are typically several millimeters, and the perception of these changes diminishes after surgery in most patients.
- Dislocation, where the ball and socket come apart, can occur, especially in the first few months after surgery with certain movements or positions. If recurrent, this may need to be corrected with additional surgery to stabilize it.
- Fractures of the healthy portions of the hip joint can occur during surgery. If the fractures are small enough, they will heal on their own. Larger fractures may require stabilization with wires, screws, metal plates, or bone grafts.
- Infection can occur at the incision or deep tissue near the new hip. In some cases, the infection can be treated with antibiotics. A major infection involving the artificial implants often requires surgery to revise the artificial hip.
- Loosening may occur over time as the new hip joint may not become solidly fixed to the hip bones. This is rare with newer implant technology but may require surgery to correct the problem if it persists or worsens.
- Nerve damage, although rare, can occur during surgery, causing some numbness, weakness, or pain in the hip joint or leg
Preparing for Surgery
PreparingPreparing for hip replacement surgery begins with a physical examination by one of our NewYork-Presbyterian Columbia Orthopedics surgeons. During this exam, your surgeon will ask questions about your medical history and medications and examine the range of motion and muscle strength surrounding the hip. They will also require blood tests, an X-ray, and in some cases, an MRI of the hip. Any outstanding dental work should be completed at least two weeks before surgery.
What to Expect After Hip Replacement Surgery
After the SurgeryAfter your hip replacement surgery, you will be moved to the recovery area for a few hours. Our specialists will help manage your pain and comfort while monitoring your blood pressure and pulse. While in recovery, our specialists will ask you to work on breathing deeply and frequently coughing to clear your lungs. Once you are alert, you will begin your healing. Many patients regain the ability to walk and can go home on the same day.
FAQs
FAQsHow long does a typical hip replacement surgery take?
Total hip replacement surgery typically takes approximately one to two hours. Many patients can go home the same day, while others remain in the hospital for one to two days.
How long after hip replacement can I tie my shoes?
This largely depends on the type of hip replacement surgery and the patient's overall health. It is best to consult your doctor or rehabilitation expert for advice on your recovery journey.
How long does a hip replacement last?
Hip replacement technology has improved markedly in the past 20 years. While older versions of hip prostheses typically lasted between 10 and 20 years, newer versions appear to have a much greater lifespan. Results vary depending on the type of implant and the patient's age and activity level.
What are the signs of needing a hip replacement?
If you are experiencing a combination of the following signs and symptoms, you may need a hip replacement:
- Persistent pain in and around the hip joint, most often the groin or inner thigh, even when resting
- Difficulty exercising with limited range of motion and pain during movement
- A limp when walking
- Limited range of motion or mobility while walking, putting on socks and shoes, or clipping toenails
Which method for hip replacement is the best?
Your surgeon will recommend the method that they are most comfortable with, to minimize the risk of any complications. Most high-volume hip replacement surgeons at NewYork-Presbyterian prefer the anterior approach for most patients. However, the best hip replacement type is determined by the medical diagnosis and other factors that your orthopedic surgeon will recommend, including what kind of implant should be used. The ideal hip replacement is the one that gets the patient back to normal activities, a normal range of motion, and pain-free living as soon as possible.
Hip Replacement Surgery at NewYork-Presbyterian
If you are experiencing persistent hip or groin pain that gets worse while walking and interferes with your sleep, affects your ability to walk or exercise, or results in difficulty completing normal activities of daily living, you may be a candidate for hip replacement surgery.
If you are experiencing any other orthopedic medical condition, including a sports medicine injury that may require treatment, contact one of the orthopedic specialists at NewYork-Presbyterian Columbia to set up an appointment at a location near you.