Total Hip Replacement

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Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Dennis Lee, MD

• What is a total hip replacement?
• Who is a candidate for total hip replacement?
• What are the risks of total hip replacement?
• What does the preoperative evaluation entail?
• What will it be like for the patient after surgery?
• What is involved in the rehabilitation process after total hip joint replacement?
• What other postoperative instructions are given to patients with total hip joint replacements?
• How can patients protect the total hip joint replacement in the long term?
• Total Hip Replacement At A Glance
• Patient Discussions: Total Hip Replacement - Describe Your Experience

Hip Fracture Prevention - Hip Protectors Medical Author: William C. Shiel Jr., MD, FACP, FACR Breaking the bones of the hip (hip fracture) is common in the elderly. This is a result of two major factors that affect older people: (1) an increased risk of falling because of poor stability (from a decrease in muscle, joint, and nerve function) and poor vision; and (2) weak bones that break easily because of osteoporosis. It has been estimated that 250,000 (a quarter of a million) people in the United States suffer hip fractures each year! A hip fracture is a terrible injury. It typically requires major surgery for repair. Operations involve either metal pinning with screws and/or plates or replacement of the hip joint with artificial parts. These operations can be complicated by infections, blood clotting, bleeding, and failure of the repair work. After such a surgical procedure, long and aggressive rehabilitation programs are necessary for optimal success. For the very frail, elderly person, ultimate recovery can be extremely difficult and long-term loss of independence, nursing-home placement, and even death can result. Prevention of hip fractures is a key part of caring for the health of the elderly. Elderly people can take measures to decrease their own risk for hip fractures. These measures include participating in regular, proper exercise, "clearing the runway" in homes for walking and transferring, undergoing regular general and eye-health checkups, and addressing osteoporosis (bone-density exams, calcium and vitamin D intake, and osteoporosis medications when indicated). Find out how hip protectors prevent hip fractures » Top Searched Hip Replacement Terms: rehabilitation, complications, recovery, prognosis, different types, risks, arthritis, osteoarthritis

What is a total hip replacement?

A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a "cup-shaped" bone of the pelvis called the acetabulum. The ball is the head of the thigh bone (femur). Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal ball and stem inserted into the femur bone and an artificial plastic cup socket. The metallic artificial ball and stem are referred to as the "prosthesis." Upon inserting the prosthesis into the central core of the femur, it is fixed with a bony cement called methylmethacrylate. Alternatively, a "cementless" prosthesis is used which has microscopic pores that allow bony ingrowth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is considered especially for younger patients.

Who is a candidate for total hip replacement?

Total hip replacements are performed most commonly because of progressively severe arthritis in the hip joint. The most common type of arthritis leading to total hip replacement is degenerative arthritis (osteoarthritis) of the hip joint. This type of arthritis is generally seen with aging, congenital abnormality of the hip joint, or prior trauma to the hip joint. Other conditions leading to total hip replacement include bony fractures of the hip joint, rheumatoid arthritis, and death (aseptic necrosis) of the hip bone. Hip bone necrosis can be caused by fracture of the hip, drugs (such as alcohol or prednisone and prednisolone), diseases (such as systemic lupus erythematosus), and conditions (such as kidney transplantation).

The progressively intense chronic pain together with impairment of daily function including walking, climbing stairs, and even arising from a sitting position, eventually become reasons to consider a total hip replacement. Because replaced hip joints can fail with time, whether and when to perform total hip replacement are not easy decisions, especially in younger patients. Replacement is generally considered after pain becomes so severe that it impedes normal function despite use of antiinflammatory and/or pain medications. A total hip joint replacement is an elective procedure, which means that it is an option selected among other alternatives. It is a decision which is made with an understanding of the potential risks and benefits. A thorough understanding of both the procedure and anticipated outcome is an important part of the decision-making process.

Total Hip Replacement - Describe Your Experience

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