Hip replacement: Procedure, Benefits, Recovery

Choose the content to read

• What disease does hip replacement treat?
• Indications for hip replacement?
• How many types of hip replacement?
• What is the total hip replacement procedure?
• What is the recovery time for hip replacement?
• What are the benefits of hip replacement?

Hip replacement 

Hip replacement (hip arthroplasty) is a surgical procedure to treat severe hip degeneration involving removing degenerative hip joints and replacing them with a new artificial hip joint to treat severe hip pain, hip stiffness, or groin pain due to hip osteoarthritis, osteonecrosis of the femoral head, or femoral neck fracture. Hip replacement helps relieve hip pain, improves mobility for activities including getting up, sitting, standing, and walking, decreases dependency, and enables patients to resume their normal daily activities.

Why hip replacement?

Untreated hip osteoarthritis will progressively worsen, particularly when moving the body, whether standing, walking, or sitting. The hip joint will gradually stiffen, causing a stuck hip joint and decreased mobility. The hip joint and surrounding muscles will deteriorate and weaken, resulting in loss of ability to walk and step, poor balance, risk of stumbling and falling, fractures of the bones surrounding the hip joint, a hip deformity, and a risk of disability.

Hip replacement is one of the most effective treatments for hip osteoarthritis or severe injuries. The surgery helps relieve hip and groin pain, reduce hip stiffness, reduce the risk of stumbling and falling, improve hip mobility, and lower the risk of disability.

What disease does hip replacement treat?

Hip replacement can effectively treat the following diseases:

• Hip osteoarthritis is caused by age-related degenerative hip joint, wear and tear of the hip joint, degeneration of the synovial membrane, the joint surface, and the tendons surrounding the hip joint, or it may be caused by congenital hip deformity, a condition in which the femoral head and acetabulum do not fit together, the femoral head is not round and fits into the acetabulum (a ball-and-socket joint), resulting in abnormal hip movement, hip joint stiffness, cartilage degeneration, and severe hip pain.
• Osteonecrosis of the femoral head is caused by a lack of blood supply to the femoral head, resulting in the femoral head dying, a degenerated femoral head, decreased hip bone strength, and hip bone collapse, making it difficult to move the body normally and causing severe hip pain.
• Femoral neck fracture is caused by adults or the elderly with preexisting osteoporosis having an accident, stumbling and falling, or slipping on the hip, hitting the hip, resulting in a hip fracture and inability to move about the hip.
• Rheumatoid arthritis is caused by chronic inflammation of the hip labrum, a soft protective lining in the hip socket between the femoral head and the acetabulum, causing the hip joint to degenerate and damage, as well as chronic hip pain and pain at night or when waking. If left untreated, the hip joint will gradually deteriorate and be destroyed, causing the hip bone to deform and increasing the risk of disability.

Indications for hip replacement?

• Severe hip pain, chronic hip pain, pain around the hip joint
• Hip pain radiates down the thigh, leg, and knee
• Pain that’s felt at the base of the groin or upper thigh
• Hip pain at night or upon waking up in the morning
• Walking with pain; difficult to walk when pain is severe
• Chronic hip pain that interferes with daily life
• Pain when moving the hip joint, hip joint stiffness
• Unsteady walking, difficulty walking, inability to maintain balance
• Walking with a limp, slipping, or frequently falling
• Deformed hips, leg length discrepancy
• Elderly people with hip fractures
• Not responsive to medication, physical therapy, or injections

Hip Osteoarthritis

Preoperative hip replacement diagnosis

The orthopedist will diagnose degenerative hip joints by inquiring about hip pain, including the location of the pain when it occurs, how the pain occurs, whether the pain affects daily life, getting up, sitting, standing, walking, and hip movements, as well as obtaining a health history, accident history, and previous medical illnesses. Then, perform a physical examination and a radiological examination as follows:

• Physical examination: conduct a physical exam inspecting, palpating, moving, and measuring the hip range of motion; evaluating whether the hip structure and gait are normal; palpating for muscle tension to find abnormalities and tender loci; examining movement and stiffness as well as stretching and flexing of the hip joint; and measuring leg length, hip flexion angle, gait assessment, etc.
• Hip X-rays examine the entire hip joint structure, including the femoral head, acetabulum, and articular cartilage, to find the cause of pain, swelling, or hip pain. Checking if the hip joint is fractured, rheumatoid arthritis, or osteomyelitis changes.
• MRI is a 3D examination of hip structure to see the details of the entire hip joint with high clarity to discern abnormalities in case X-ray is uninformative, including osteonecrosis of the femoral head, fractures in some regions, trochanteric bursitis, or osteomyelitis.

How many types of hip replacement?

Hip replacement can be classified into 2 main types:

1. Partial hip replacement is surgery to replace only the femoral head and femoral neck without replacing the acetabulum (hip socket). It is usually determined in the case of a broken femoral neck. 
2. Total hip replacement is a surgery to replace the entire degenerated hip joint with a prosthetic hip joint, which consists of 3 components: acetabulum (hip socket), artificial femoral head, and artificial femoral stem.

What is the total hip replacement procedure?

The total hip replacement procedure at MedPark Hospital adopts the gold standard in surgery, prioritizing safety and treatment success outcomes to achieve the treatment goal of relieving hip pain, increasing hip joint function, and improving physical mobility to allow patients to resume their daily lives as soon as possible.

Preoperative hip replacement

• The orthopedist will advise you to do ankle dorsiflexion exercises before surgery to increase blood circulation and prevent complications.
• Stop or quit smoking, eat the 5 food groups, and drink plenty of water to avoid irregular bowel movements.
• 7 days before surgery, stop taking anticoagulants such as aspirin or warfarin, as well as some vitamins/supplements. Those taking underlying medications or having a history of drug allergies must inform the orthopedist in advance.

Intraoperative total hip replacement

• The anesthetist will perform a spinal block to numb the sensations before performing a hip replacement to remove the deteriorated or diseased femoral head, femoral neck, and articular cartilage from the acetabulum.
• The orthopedic surgeon will insert the artificial hip socket (acetabulum) and the inner part of the artificial hip socket made of plastic liner into the original hip socket, then insert the artificial metal femoral hip stem and metal-made or ceramic femoral head onto the upper end of the femur to replace the original femoral neck and femoral head, guided by bone reference landmarks obtained from radiographic imaging.
• The orthopedic surgeon inspects the position, leg length, and range of motion of the artificial hip joint to ensure the effectiveness of the new hip joints before stitching the incisions. Total hip replacement surgery typically takes 2 hours.

Postoperative hip replacement

• The orthopedic surgeon will transfer the patient to the inpatient room for close monitoring and care to prevent complications.
• The orthopedist will have the patient start physical therapy the day after surgery to practice hip and leg movement.
• Patients can begin walking from the first day after surgery with full weight bearing using a cane or walker to help walk.

What is the recovery time for hip replacement?

24 hours after hip replacement, patients can walk with a walking aid and will walk without it for 2-3 weeks after the surgery. They can drive and do some light activities within 4-6 weeks and will gradually recover fully after surgery in 6-8 weeks, depending on the patient's age, physical strength, walking training, muscle training before surgery, and postoperative physical therapy as advised by the orthopedist.

What are the complications of hip replacement?

Common complications from hip replacement include infection, blood clots in the leg, dislocation of the hip joint, fracture of the bone around the artificial hip joint, or stiffness. However, the incidence of these complications is very low. Typically, hip replacement, or hip arthroplasty, is regarded as a highly effective and safe surgery.

What is the success rate of hip replacement?

Hip replacement has a very high success rate. According to the study’s findings, 95% of postoperative patients report reduced hip pain; patients can move their bodies, use their hip joints, have a better quality of life, and engage in more activities. Regarding the survey results, 90–95% of surgery recipients can function their hip joint well even 10 years later, and 80–85% can still function their hip joint well 20 years later.

What are the benefits of hip replacement?

• Relieve pain: Hip replacement improves bodily movement while reducing and alleviating hip pain.
• High success rate: Hip replacement has a very high success rate of up to 95% and a very low complication rate.
• Improved mobility: Hip replacement improves getting up, sitting, standing, and walking without using a walking aid.
• Long-term results: Hip implants can function for up to 20 years to a lifetime without the need for repeated surgery.
• Enhanced quality of life: Hip replacement significantly improves body strength, reduces dependence, and enhances quality of life.

Hip replacement at MedPark Hospital

Orthopedic Center, MedPark Hospital, Bangkok, Thailand, led by a team of highly experienced orthopedic surgeons both domestically and internationally, is ready to diagnose and treat complex hip osteoarthritis, osteonecrosis of the femoral head, and hip fractures in the elderly with hip replacement using high quality, FDA-approved prostheses hip joint, state-of-the-art medical equipment with international standard operating rooms, combined with advanced surgical techniques, yielding in fast, accurate, and safe treatment, enabling the most treatment efficacy while providing postoperative follow-up care to minimize side effects, prevent complications, and allow patients to have a better quality of life, decrease dependency, and can perform various activities fully.