HIP

Anatomy of the Hip

On the upper side of the pelvis (hip) bone is the acetabulum, or socket, of the ball-in-socket joint. The surface of the acetabulum is the only part of the pelvis replaced in either hip replacement or resurfacing.

The femur, or thigh bone, is the longest bone in the body. The femoral head is the ball in the ball-in-socket joint, and fits into the acetabulum. It sits on top of the femoral neck. In hip replacement surgery, the femoral neck is cut and the head is completely removed. At the base of the neck is the greater trochanter, which marks the widest point of the hip area in the skeleton.

Cartilage is a tough, elastic, gel-like layer that lines the hip joint. It is the natural bearing surface in all joints. Cartilage absorbs the shock of impact and walking, and reduces the friction in the joint to allow smooth, pain-free movement. Once injured, cartilage in adults does not heal. With enough injury, progressive deterioration can result in a worn out (arthritic) joint. It can sometimes tear, leading to joint instability and pain.

The labrum is a ring of fibrocartilage that circles the rim of the acetabulum, deepening the socket. It adds strength to the joint, but limits the range of motion.

Synovial fluid is a transparent fluid that lubricates the hip joint, much like grease in mechanical, non-living joints.

The hip capsule is made up of multiple ligaments that completely enclose the hip joint, adding to its stability.

Life with an Artificial Hip

Living with your new artificial hip

Medical advances have made living with an artificial hip a remarkably pain-free and effective solution to hip joint problems for most.

How long will the artificial hip last?

In most cases, the hip replacement should outlast your lifespan. The 15-to-20-year data on the longevity of hip replacement components is excellent, with more than 90 percent of the implants still functioning well in many studies. But, this is neither a guarantee nor assurance, for the simple reason that life is unpredictable.

Many factors affect the future of a hip replacement or resurfacing, such as accidents, fractures, late infections, and deterioration in your overall health. How well you take care of yourself down the road is something the surgeon cannot control.

The longevity of a hip replacement thus depends on many factors, including the following:

Surgeon skill in implanting the components
Known history or track record of the implants
How well you take care of yourself and your health
Understanding and respecting the limitations of a prosthetic lifestyle
Your activity level and body weight
Avoiding high-impact or extreme sports

How do I know if I have a metal allergy to the hip part?

Orthopaedic implants are made of alloys of cobalt-chrome and titanium that have been implanted in millions of patients over the past several decades. Most instances of a persistently painful hip after replacement have to do with a problem related to the surgery, or possibly an infection. A true metal allergy is extremely rare, and seldom encountered in clinical medicine.

What will weather changes feel like in the hip?

Some patients report increased pain and stiffness, or can feel changes in the weather after hip surgery. These sensations are not common though, and usually will disappear over 1 to 2 years after surgery. For the first couple years, the bone adapts and grows around the metal prosthesis, and this bone activity probably leads to sensitivity to weather and pressure changes.

How about future dental work and other surgery?

Because you have an artificial hip joint in place, you must take care to protect it from infection. The same applies to any artificial implant in your body. Before having dental work (teeth cleaning, fillings, extraction or root canals) or certain medical procedures (colonoscopy, biopsy, endoscopies, etc.), you must take an antibiotic.

The antibiotic will help prevent bacteria from getting into the blood stream and thus into your hip. The odds of this happening are very rare, but the antibiotic can reduce this already small risk.

For routine dental prophylaxis following hip replacement surgery, antibiotics are recommended for your lifetime after the surgery.

In what other situations will I need antibiotics after the hip replacement?

Antibiotics given for other medical procedures may vary. Contact your physician for advice if there is any doubt. Antibiotics are needed if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.

If you have a cut anywhere that develops an infection, conditions like a tooth abscess or ingrown toenail developing, seek medical attention urgently. Ignoring a festering sore means that there is a risk the bacteria could migrate to the hip, resulting in a serious deep infection, even though it happens rarely.

Will the new hip set off a metal detector at the airport?

Most likely, it will. Tell airport personnel that you have an artificial joint prior to entering the metal detector. Metal detection sensitivity at airports is highly variable, and it is impossible to say if a certain detector will set off the equipment. Your surgeon will supply you with an implant identification card that you can carry to prove that you have metal hip replacement parts.

Can I have a MRI scan after hip replacement?

Yes. MRI scans of other parts of your body are safe after hip replacement. Although some old MRI scanning equipment may not be compatible with your prosthesis, the majority of MRI scanning equipment today is safe and compatible with hip replacement parts. You may also have a CT scan of any part of your body after a hip replacement.

How will I know if my hip implants are recalled?

In the extremely unlikely event of a recalled implant, you will be contacted by the company who made the device. All implants have lot numbers registered with the implant maker. This information is kept in your medical record. If you want a copy of your X-ray or exact implant type and model for your records, please let your medical team know.

Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.

Is there a long-term risk of failure of hip implants?

Implants are engineered to withstand your body weight and activity level, but the moving parts of a hip replacement do wear over a period of several decades. A properly aligned hip replacement done by a competent, experienced surgeon will usually last the lifetime of most patients.

Subtle component mal-positioning and suboptimal orientation can however compromise the lifespan of the implant. This is why the skill and expertise with which the hip is implanted in your body is a critical determinant of durability.

After Hip Surgery

Recovering from Hip Surgery

What happens after hip surgery? Here are answers to commonly asked questions.

What can I expect during the hospital stay?

You can expect to see several people who will help with your recovery. A physical therapist will assist with hip exercises and walking. An occupational therapist will assist you with learning everyday activities, such as dressing and bathing, while your hip is healing. Your surgeon, his associates, medical doctors, and nursing staff will see you daily. A nursing assistant will help with bathing and activities that you are unable to do yourself.

The first night or two may be hard considering that you will have an unfamiliar bed, diet, and medications. Ask for a sleeping pill or anti-anxiety medication if that will help. Anticipate several weeks before your normal sleeping, eating, and resting patterns are restored.

How long will I stay in the hospital?

The average hospital stay after hip replacement is one or two days. The day after your surgery, you will be helped into a chair and you may be able to walk limited distances. Your activity will increase with each day that follows.

Recovery time varies from one patient to another. Much depends on other existing medical conditions. For example, arthritic disease in other major joints, heart disease, diabetes, obesity, depression, and other related conditions will affect recovery.

Most people return to their own place of residence after a hip replacement. Some elderly or debilitated patients may need to go to a nursing home to recuperate.

Preventing blood clots

What measures are taken to reduce the risk of blood clots?

For routine hip surgery, it’s common to use a blood-thinning medicine for about 4 weeks after surgery. In addition to a blood thinner, doctors also use early mobility, spinal anesthesia, leg exercises, foot pumps, and efficient surgery as adjunctive measures to minimize the risk of blood clots.

Why is a blood thinner needed after surgery?

This is to reduce the risk of a blood clot. Hip surgery is associated with a risk of blood clots developing in the calf, thigh, or pelvic veins. These clots often do not have any obvious symptoms or signs. Clots can cause chronic swelling of the legs, pain, and circulation and skin problems. In rare instances, a clot can break off and travel to the lungs, which can sometimes be fatal. This is why blood clots and blood-thinning medications are taken so seriously.

The risk of clots greatly decreases when the blood is thinned after surgery. Therefore, we use a blood thinner in every patient following hip surgery.

If you have ever had a blood clot before, or have ever had an adverse reaction to a blood thinner, please let your physician know so that he or she can plan an accordingly.

Common sensations

What sensations can I expect right after surgery?

Typically, patients have little to no pain, but nausea is more common. This nausea can come from the anesthetic drugs or from pain medicines and we can help control it by changing pain medicines and prescribing anti-nausea agents if necessary. If you have pain, nausea, or any other disagreeable sensation, let the nursing staff know. They are very knowledgeable in controlling such symptoms. Usually, an adjustment of medications is all that it takes to address any disagreeable sensations.

Why do I have a popping sensation in the new hip?

This can happen from a tendon, called the psoas tendon, rubbing against the new hip. With exercise and time, this sensation will disappear, assuming that it ever manifests in the first place. Usually this popping sensation occurs while the hip is healing, and while turning the leg side to side.

Why is the outside of my thigh numb?

This is normal after most anterior approaches to hip replacement or hip resurfacing. The incision cuts small nerve fibers that run from inside to outside of the hip, so the skin to the outside of the cut always feels numb after hip surgery. Usually, this sensation will resolve over time and is not a major problem for patients. Most patients will not notice that the outside of the scar feels numb.

Is it normal for the muscles to spasm and tighten after surgery?

Yes. Sometimes unexpected spasms of the leg muscles occur after surgery, usually as the person is healing from the operation. These spasms will go away. If they are particularly troublesome, your doctor can prescribe a muscle relaxant medicine, which can help.

Why are my appetite, mood, food-taste, and sleep different after surgery?

Altered appetite, bowel habits, depression, and mood swings are common after hip replacement. This is very important to know, understand, and anticipate. In some cases, medications might be necessary to control such symptoms.

All surgery elicits powerful psycho-social and physiological responses, which vary from one person to another. These responses are normal,; your medical team will help you get through them. It takes time for the body, mind, and soul to recover from any invasive operation.

Caring for your incision

Should I keep the incision covered?

Yes. Covering daily with a gauze dressing is best. You can shower with the dressing on, protecting it as much as possible, and then changing with a new dressing after the daily shower. Avoid touching the incision; the skin around the scar should be kept clean with soap and water. No antibiotic ointments are necessary.

Alternatively, you can remove the dressing, wash around the incision with soap and water, pat dry, and cover with a new dressing. Showering is safe at any time after surgery, but immersing the incision in a bathtub should wait until the stitches/staples are removed.

Can I put any lotion on the scar?

While stitches or staples are still in, avoid applying anything to the incision; simply keep it clean and dry. Once stitches or staples are out, you can use Vitamin E cream to massage and loosen the scar. Massaging the thigh area with an anti-inflammatory or cortisone cream can reduce skin inflammation and tenderness; many such ointments are available over the counter.

What if I am allergic to the adhesive used in the dressing?

If your skin cannot handle the adhesive or tape, or if there is drainage from the incision, a useful tip is to use feminine hygiene pads as a dressing. These are self-adhesive, comfortable, very gentle on the skin, and very absorbent.

Who will remove stitches and when?

Usually the home health nurse will remove stitches or staples, no earlier than 21 days after surgery. In some cases, the stitches may be left in longer, depending on the rate of healing. Home health nurses should take a digital photo of the incision if there is a concern and send it to your physician via e-mail.

When can I shower, take a bath, or swim?

Shower anytime after the surgery, if you can sit or stand safely with help. The incision can be covered with a plastic wrap. A new, dry dressing should be used to cover the incision after the shower.

Tub baths and immersion into water, such as a swimming pool, should be delayed until the stitches or staples are out and the skin has sealed completely. This takes at least a couple of weeks after surgery.

Swelling

How long will I have swelling and warmth in the surgical site?

Swelling and warmth around the scar are common after a hip replacement or hip resurfacing operation. The ankle may also swell on the operated leg. This represents the normal process of healing and can last for several weeks to months, depending on factors such as circulation, body weight, diabetes, and other variables.

Obesity, diabetes, poor circulation, poor muscles, varicose veins, high activity, heart disease, and swelling before surgery will usually result in a longer period of swelling and heat in the operated leg. Elevating your leg at night and wearing compression stockings during the day will help.

Deep aches and swelling in the hip can persist for a long time because bone, a living tissue, continues to re-model and adapt around the metal implants. This increased metabolic activity can lead to lingering soreness and swelling after heavy activity, all of which will disappear with time.

When can I stop wearing the compression stockings after hip replacement?

Compression stockings may be applied to both legs after surgery to control swelling, and many patients inquire when these can be discontinued. The answer is that if swelling is not a concern, you can stop wearing the stockings at any time.

These stockings are prescribed to control one of the most common nuisances after any hip operation, namely, swelling in the leg and ankle. The stockings have nothing to do with preventing blood clots; for that problem, it’s common to use a blood thinner and other strategies discussed here.

Preventing infection

How do you prevent infections during hip replacement?

Some of the key factors in reducing the risk of infection involve scrubbing of the skin with an antiseptic, antibiotics given before surgery, surgeon experience, a team-approach designed to promote efficiency, and standardized protocols. It is impossible to completely eliminate this risk, but it’s possible to get the risk down to nearly zero. It is very rare to have an infection after routine hip replacement. .

Is there a long-term risk of infection in an artificial hip?

Yes, there is a lifetime risk of infection with any artificial implant in your body, whether a hip joint, heart valve, or other synthetic component. As long as you maintain good health and appropriate body weight, avoid smoking, maintain proper hygiene, keep diabetes under control, and promptly address even minor infections in your body, the risk of infecting an otherwise well-functioning hip implant is essentially zero.

What if an infection does develop?

An early infection shows up as redness and pain around the healing incision. This can generally be treated with oral antibiotics alone, usually taken for 5 to 10 days. Very rarely, the hip joint has to be opened and washed out to clean the tissues and effectively treat an early infection.

A late infection that happens months or years after surgery is more serious, and will require additional surgery. Such infections occur because the immune system can be weakened by age, infirmity, tobacco use, heavy alcohol use, cancer, and other conditions.

In these cases, the infected prosthesis is removed and a temporary antibiotic-loaded hip is implanted. After three or more months, a new hip joint is implanted. Six weeks of antibiotics and these two operations will effectively treat an established deep infection in the hip. Fortunately, such cases are very rare, and late deep infections usually occur in immune-compromised patients with other serious medical problems.

Leaving the hospital

How will I manage at home?

If help from an adult family member or friend is not possible, it may be necessary to stay at an inpatient rehabilitation facility. You will not be able to drive for the first couple of weeks after surgery. If you go home, a home health agency will check on you at home, about three times a week or more, to help with walking, exercise, incision checks, medications, and communication with the doctor.

The home health agency will send a nurse to do blood draws and follow-up care, a physical therapist to continue therapy, and possibly an occupational therapist. The nurse also communicates with your physician to keep them updated on your progress.

How is my hospital discharge handled?

Typically, a social worker will visit with you after surgery and work with the therapists and nurses to formulate a discharge plan. The social worker will assist in coordinating discharge to your home, a skilled nursing facility, in-patient rehabilitation facility, or nursing home.

What determines when I can go home after hip replacement?

You can go home when you can ambulate safely with a walker, go up and down stairs, and get to the bathroom. Typically, you will have had a bowel movement before discharge, and will be able to take a shower. Your doctor is the one making the ultimate decision about the safety and timing of your discharge. You will need someone to drive you home from the hospital.

When must I come back for a visit after hip surgery?

You will return for a visit about one month after surgery; call or e-mail if you have questions before that time. This guide and your home health nurse can be helpful resources. Long-distance patients may use email, sending digital photos of their incisions and digital X-rays; this works very well and saves time and travel expense.

When should seek medical help?

Contact your doctor if you have any of the following:

persistent drainage from your incision;
excessive redness around the incision;
increase in the incision pain;
increased leg swelling;
pain and swelling in the calf of the leg;
temperature above 101 degrees;
numbness or tingling down the back of the operative leg;
chest tightness;
new cough;
difficulty breathing;
or any related concern.

Your family doctor is a good resource if you develop a cold, flu, nausea, vomiting, diarrhea, or constipation. If you are unsure, please contact your surgeon. If unable to reach a doctor, and you feel there is a problem, please go to the local emergency room.

Getting moving

Can I place full weight on the operated leg after surgery?

Yes. But, use some form of assistive device for at least a month after surgery, to avoid a sudden twist and fall. Hip implants are loaded in torsion (a rotational stress is placed on the implant each time you get up, turn in bed, or go up or down stairs), as well as loaded in compression (your weight pressing down). Putting full weight on your hip right after surgery is never a problem.

About a month after surgery, if you feel confident and balanced, you can walk without a cane, but if there is any question, stay with a cane until you feel safe.

In complex, repeat hip implant surgery, these instructions will be more specific to each unique situation. In almost all cases, however, at 12 weeks after such surgery, patients can resume all activities.

Can I kneel down after hip replacement surgery?

Yes. As soon as you’re comfortable, kneeling is safe, as is crossing our legs and lifting weights by bending the knees or back. It is not possible to damage the implants.

How soon can I drive after surgery?

With a left hip replacement, an automatic transmission, and a healthy right leg, you can drive any time after surgery that you are comfortable. Typically this time is about two weeks from surgery, but sometimes longer.

If the right leg is operated on, you can drive in 3 to 4 weeks after surgery. If you feel sleepy or sedated because of pain medications, then you should avoid driving until you are alert and can concentrate on driving.

How much therapy will I need?

You need approximately four weeks of therapy, usually at home, with a visiting home health nurse. Some patients need therapy after this four-week period, and others are already independent. If you need outpatient therapy, usually 4 to 6 weeks will suffice. Once you learn basic hip exercises, you will be able to do them at home.

How much movement can I expect in the new hip?

The amount of movement you achieve should be close to that of a normal hip. That said, existing scar tissue, contractures of the hip joint, severity of arthritis, pain tolerance, motivation for exercise, body size, and other variables profoundly affect how much mobility a person will get. For most patients, the amount of hip movement gained after replacement allows them to engage in all activities of daily life.

Should I exercise after hip replacement?

Yes. A regular program of light aerobic exercise is beneficial from many standpoints, and will optimize the outcome of your hip replacement. After your six- week post-operative appointment, recommended exercises include walking, swimming, golf, hiking, treadmill walking, stair climbers, light aerobics, weight training, and elliptical exercise equipment.

How active can a person be after a total hip replacement?

You can be as active as you want, and lift as much weight as you desire. Heavy impact exercises, such as basketball, football, soccer, and tennis are probably best avoided, since they contribute to increased prosthesis wear. Low-impact aerobics, bicycling, treadmills, swimming, and similar exercises are fine. Climbing, hiking, and other outdoor activities can be performed as tolerated.

Strength and endurance will build up over time. Modern total hip implants are very durable and designed to take repetitive impact loading for many decades, even in active and heavy patients.

When can I ride a lawn mower, tractor, horse, bicycle, or ATV?

Defer these things for one month after hip implant surgery. You may feel like you can handle such activities sooner, but there is no point in rushing things.

When can I go back to work after surgery?

It depends on the type of work. If you are in hard labor, it is best to wait for three months before swinging into full action. Prior to that time, you can return to some light duty work if this is possible.

For jobs that require some standing, sitting, and walking, it is possible to return earlier. It really depends a lot on the individual and the job. Typically, most people will give themselves at least 3 to 4 weeks after joint replacement before returning to work in some capacity, but some people have returned to work after just two weeks.

When can I drink alcohol after surgery?

Moderate, social alcohol use can be resumed anytime that you wish. Avoid alcohol while you are on any blood thinner or pain medication.

When can one resume sex after a hip replacement or resurfacing?

You can resume sex as soon as comfortable, and in any position that does not cause discomfort. With earlier hip replacement methods, certain restrictions and precautions applied, but these do not apply to modern hip replacements.

How soon can I travel?

As soon as you are comfortable with sitting down, you can travel by airplane or car; there is no specific time period. If you travel, be sure to exercise your calf muscles and ankles frequently. Also, get out of the car or walk the aisle of the airplane frequently to avoid the possibility of blood clots. Continue taking blood thinners while you travel during the first month after surgery.

How long does it take to feel normal after a hip replacement?

A great deal of the recovery takes place in the first two months, but complete return to normal takes longer. Bone around the metal parts keeps changing and remodeling for 1 to 2 years after surgery, which is why you can feel deep aches and can tell when the weather changes. After that time, the hip will feel normal.

Do you use a machine to move the hip after surgery?

No benefit has been shown from the use of continuous passive motion (CPM) machines in hip replacement. Some surgeons use such machines after knee replacement, but they are not needed following hip replacement.

How much can I lift after hip replacement?

You can lift as much weight as you can comfortably tolerate. Once tissues have healed, lifting, climbing ladders or stairs, getting up on roofs, and related activities are safe. Avoid these things for about three months after surgery, until we are sure that your bone has healed into the implants.

Mobility Tips

Tips on walking

The therapist will demonstrate proper and safe walking after a hip replacement, with the use of crutches or walker. The purpose of the walker or crutches is to avoid a fall or sudden twist. Weight-bearing is safe immediately after surgery. But until the implants have grown into the bone, a process that takes 4 to 6 weeks, a fall or other sudden twisting force on the leg can risk implant loosening or injury to the leg. Reflexes take time to return, and narcotic pain medications can further dull the senses. That is the reason for learning to use an assistive device as long as necessary after surgery.

The assistive device can be a walker, crutches, or a cane in either hand; as long as you feel confident and safe in balancing yourself and minimizing the risk of a fall. When using a walker, lean forward, and lead with either leg. When using crutches, avoid putting weight into the armpits; the proper technique is to load the arms as much as needed for a comfortable stride. When using a cane, the most bio-mechanical advantage comes from holding the cane on the side opposite the replaced hip.

Assistive devices can be discarded anywhere from 1 to 4 weeks after surgery, depending on a number of factors, such as narcotic use, return of strength, confidence in walking, return of reflexes, and patient preference. Patients recover differently from each other, and there is no harm in using an assistive device to help in walking for a longer or shorter duration. Because the hip replacement components are designed to heal directly to bone without use of bone cement, the skeletal stability of the implants is assured by 4 to 6 weeks, at the minimum. Around that time, the assistive devices can be discarded, in favor of normal walking in nearly all cases

Tips on stairs

The ability to go up and down stairs requires strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good and down with the bad.” In other words, going up stairs, lead with the good (non-surgery) leg, and coming down stairs, put the bad (surgery) leg down first.

You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity.

Do not try to climb steps higher than the standard height (seven inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Managing pain & discomfort

Should I apply ice or heat to the hip as it is healing?

After surgery, and for the first two weeks, ice is more effective in reducing swelling and pain. After complete healing of the skin has occurred, you can use a moist heat pack if it feels comfortable. Soaking in a hot tub at this point may also be helpful.

Whom should I call for pain pills?

Please call the doctor’s office for pain medicines. State regulations allow some medicines to be phoned in; others require a written prescription. Please plan ahead, since narcotic prescriptions on weekends or Friday afternoons can be difficult to call in, mail in, or otherwise get filled.

How long can I have pain medications refilled?

Most patients will taper off the use of narcotic pain medications very quickly. Be aware that some narcotics cannot be phoned into pharmacies. If you will need refills over a weekend or holiday, be sure to contact medical staff during regular office hours.

Some patients require pain medications for a longer time, while others do not need them at all. Your physician will individualize treatment for every person.

How long should I take pain pills?

Most patients use pain medication for anywhere from 1 to 3 months. After three months, you should taper off and begin anti-inflammatory medicines and other non-addictive medicines for pain.

When taken over a long period of time, narcotic drugs create a tolerance that makes them less effective. That is why it is preferable to taper off narcotic drugs quickly after surgery, unless there are compelling reasons to continue use.

What if I need narcotics three months after surgery or if I have been taking them before surgery?

In such cases, the doctor who was filling the prescriptions prior to surgery may resume dispensing the medication. Very rarely, referral to a pain specialist is necessary for patients who are dependent on long-term narcotics.

If you were taking narcotics regularly before surgery, pain control is usually more difficult and complicated since the body is desensitized to the pain control medicines we use after surgery. In such cases, let your doctor know what you are taking before surgery so that they can adjust pain medicines accordingly.

Life with an artificial hip

How long will the artificial hip last?

The longevity of a hip replacement thus depends on many factors, including the following:

Surgeon skill in implanting the components
Known history or track record of the implants
How well you take care of yourself and your health
Understanding and respecting the limitations of a prosthetic lifestyle
Your activity level and body weight
Avoiding high-impact or extreme sports

How do I know if I have a metal allergy to the hip part?

What will weather changes feel like in the hip?

How about future dental work and other surgery?

The antibiotic will help prevent bacteria from getting into the blood stream and thus into your hip. The odds of this happening are very rare, but the antibiotic can reduce this already small risk.

For routine dental prophylaxis following hip replacement surgery, antibiotics are recommended for your lifetime after the surgery.

In what other situations will I need antibiotics after the hip replacement?

Antibiotics given for other medical procedures may vary. Contact your medical professional for advice if there is any doubt. Antibiotics are needed if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.

Will the new hip set off a metal detector at the airport?

Most likely, it will. Tell airport personnel that you have an artificial joint prior to entering the metal detector. Metal detection sensitivity at airports is highly variable, and it is impossible to say if a certain detector will set off the equipment. You will be given an implant identification card that you can carry to prove that you have metal hip replacement parts.

Can I have a MRI scan after hip replacement?

How will I know if my hip implants are recalled?

Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.

Is there a long-term risk of failure of hip implants?

About Hip Replacement

Hip Replacement FAQ

Hip replacements should not be undertaken lightly; below are some of the most common questions patients have.

What is a total hip arthroplasty?

Surgeons use the word “arthroplasty” to mean replacement. The word “total” means that both the ball and socket part of the hip are replaced. “Total hip arthroplasty” means the same thing as total hip replacement.

Is there a partial hip replacement?

Yes. In some cases of hip fracture in elderly patients who have no arthritis in the joint, surgeons may elect to replace only the ball. This means a metal ball moves inside the patient’s own socket.

In low-demand patients, this is a reasonable option, although a total hip replacement is usually more durable and offers more predictable pain relief (see illustration).

When should hip replacement be considered?

The ideal time for surgery is when other measures, such as medicines, exercise, weight loss, and alternative therapies no longer work. If hip pain causes a limp, affects your lifestyle, interferes with work or recreation, and negatively impacts your body image, then surgery is a reasonable option.

Will a new hip joint be a perfect substitute for my own hip?

Metal and plastic cannot fully replicate the complexity, intricate engineering, and healing ability of the human body. Hip replacement components are products of modern science and engineering that come close but cannot duplicate the natural hip joint.

However, a prosthetic hip provides dramatic pain relief and improves movement, function, and lifestyle. Many patients experience complete resolution of their pre-surgery pain and discomfort.

How does the artificial hip joint get lubricated?

The replaced hip develops a lining around it, and the cells secrete synovial fluid (a biological lubricant) into the synthetic joint. This fluid provides lubrication so that the artificial bearing is never dry.

Synovial fluid is recycled by the cells. No external lubrication of the new hip joint is ever needed. Injections into an artificial hip joint are not beneficial and will increase the risk of infection.

About how long does a hip replacement take?

It varies – a common time is about half an hour. However, patient preparation for surgery, safe positioning, safety checks, and anesthesia add considerably to this time. Individual patient and anatomic variations may also alter surgical times. Each person is unique and surgery is never an assembly-line procedure.

Is it possible to replace both hip joints at the same time?

Yes. This has become routine when patients need both hips replaced and are in good health otherwise. Rehabilitation time is perhaps slightly longer than for one hip replacement, but not noticeably so.

Many surgeons use the “anterior” surgical approach to hip replacement, which means that the patient is on his or her back, and muscles are spread, rather than cut. This usually makes surgery on both sides much simpler, safer, and faster.

Ask your surgeon about their surgical approach; new procedures are always being developed and refined to improve recovery and minimize surgery needs.

What is the optimal age for hip replacement?

Hip replacement is usually done in patients in their 50s through their 80s, although the operation is also done in patients who are older or younger than this age range. With modern implants and bearings, young age is not a contraindication to successful surgery. In the past, hip replacement was reserved for the elderly, because the implants and synthetic bearings were not as durable as they are today.

Should I wait, or get my hip replaced now?

The availability of new technology, streamlined surgical methods, and improved implants should not rush your decision to have a hip replacement. Non-surgical methods of relieving pain should be tried first; sometimes they can help postpone surgery for many years. A reasonable period of waiting and careful decision-making is always wise.

Will waiting to get a hip replacement make things worse?

No. Waiting is safe. Even if the hip joint gets becomes more deformed, the surgery is just as easy. The only downside to waiting is that muscles might get weaker and more stiff, thereby making recovery a bit longer. This can be offset by maintaining a reasonable body weight and following a program of light exercise to keep your muscles in shape.

One exception applies to revision hip implant surgery. If your joint was replaced many years ago, and the wear particles are starting to dissolve bone, your physician may advise you to have surgery sooner rather than later.

Another exception applies to joints that have been replaced, and are suspected of having a deep infection of the prosthetic device. In those cases, corrective surgery is recommended early, so that the infection does not penetrate the bone.

How many joints can one have replaced?

It is possible to have multiple joints replaced safely. For patients with other serious health conditions, it may be best to get these done one at a time, starting with the worst one first.

Some patients do have more than a single hip or knee replacement; it is not unusual for people to have artificial joints in both hips, knees, shoulders, and more. The ability to replace painful joints is a remarkable advancement in medicine.

What if my previous hip replacement surgery did not work out?

Hip surgery can be complicated by deep infection, implant mal-positioning, nerve injury, leg length discrepancy, and other unhappy outcomes. A second opinion is worth exploring even if a surgeon tells you nothing can be done.

Many factors can compromise the results of hip replacement, even though the X-rays look fine. A step-by-step approach to identifying the reason for an unsatisfactory outcome, and addressing it, can help patients who have had a poor outcome.

Hips can be replaced more than once. Modern technology allows replacement of deficient bone, even if the entire femur bone is lost.

Where else can I learn about hip surgery?

To learn more about the anterior hip replacement technique specifically, visit newhipnews.com. Another useful source is bonesmart.org, which even has a patient dialogue forum. Manufacturers of hip implants have patient education websites as well.

Can arthritis occur in a hip after it is replaced?

Replacement surgery eliminates all diseased cartilage in the hip joint. It is not possible to have arthritis since the native cartilage is gone and will never grow back.

However, arthritis is a complex disease that affects tissues around the joint, such as nerves, muscles, ligaments, and the synovial lining of the hip. This is why some pain, stiffness, and internal swelling can persist for many months even after X-rays show complete healing following a hip replacement.

Muscles and tendons, weakened and stiff from years of disuse, can take 1 to 2 years to stretch and adapt after hip surgery.

Will hip replacement get rid of all my pain?

Yes, if all the pain is really coming from the hip joint. But an artificial hip cannot relieve pain coming from an arthritic spine, weak muscles, arthritic knees, hernias, poor circulation, fibromyalgia, rheumatoid arthritis, and other such conditions.

How long is recovery after hip replacement?

Most recovery is in the first 4 to 6 weeks. By then, bone grows into the metal components and most patients become mobile enough to walk without a cane.

During the first 4 to 6 weeks, be cautious and use a walker or cane while walking, and avoid sudden twists and falls. Eight weeks after surgery, most patients can resume light lifting and other daily activities.

Very heavy lifting, returning to strenuous jobs, and extended exercise should wait until three months. These timeframes are approximate; healing varies from patient to patient.

The bone around the metal implants continues to adapt and remodel for 1 to 2 years after surgery. During that time, expect some mild aches and pains, and discomfort with pressure and weather changes. Ultimately, all such sensations will resolve.

Is recovery from hip replacement faster for younger patients?

No, not necessarily. The recovery appears to be more or less the same for young and older patients with hip arthritis. The recovery from hip replacement also seems to be very similar between men and women, as well as between thinner and heavier patients.

Is recovery faster after hip replacement than knee replacement?

Yes, people recover faster after hip replacement, with less pain and less need for physical therapy, when compared to knee replacement. There could be several reasons for this.

The knee joint is more complex, and involves many different types of movement; the knee may have more nerves transmitting pain sensations; hips have a heavier protective layer of muscle and tissue compared to knees, and there may be other explanations why recovery from hip replacement is usually easier than a knee replacement.

Patient perception between a knee replacement and a hip replacement is also different. It can take a couple of years, or longer, for an artificial knee to feel natural and like the real thing. In contrast, a hip replacement feels natural, and more like the real thing after considerably less time.

What are the inherent risks of hip surgery?

Inherent risks are those complications that can occur, no matter where you have surgery done, or who performs it. You should know these in order to make an informed decision about surgery.

No hospital, physician, or surgical method can eliminate the inherent risks associated with hip surgery; beware of any hospital or surgeon who claims otherwise.

Complications after hip surgery are rare, typically occurring with a frequency of 1 percent to 2 percent of the cases. Each complication listed below is discussed in more detail, elsewhere on this website. If you prefer to discuss this in person, please ask your physician.

Possible adverse outcomes after hip surgery include, but are not limited to, blood clots, pneumonia, nerve injury, blood vessel injury, blood transfusion risks, anesthetic complications, heart attack/cardiac complications, stroke, failure of implants, dislocation of the components, superficial or deep infections, bone fracture, leg length inequality, and even death.

How much does a new hip joint cost?

Insurance contracts, hospital pricing, medical billing, and other variables related to cost are complex. In fact, specially trained personnel are required to do medical billing. If you want to know the costs involved, please contact your physician’s office; their billing team will give you an accurate answer.

Will Medicare or my insurance cover hip surgery and therapy?

Yes. However, insurance plans and related benefits vary; to be certain, it is best that you check with your insurance company. Talk to your medical team as well, since surgery and hospital stays must be pre-authorized with insurance companies.

Before Hip Surgery

Health Considerations Before Hip Surgery

This article will help you understand how to get ready for hip surgery. Hip surgery does come with possible complications.

What do I need to do to prepare for hip surgery?

Reading the information on this site, communicating with your surgical team, and paying close attention to any checklists provided will best help you prepare for knee replacement surgery. The importance of preparation and information to successful surgery cannot be overemphasized.

What health conditions must be considered before undergoing surgery?

Some patients have unusual problems, such as HIV infection, hemophilia, cancer, bleeding disorders, liver or kidney transplants, enzyme disorders, and other conditions that require specialty consultations before surgery. If these considerations apply to you, your medical team will work with you to obtain the necessary testing and treatment prior to surgery.

What medical testing is needed prior to hip replacement surgery?

Pre-surgical checks are essential for your safety and it is unwise to short-circuit them; they are comparable to pre-flight checks that every responsible pilot makes before taking off. Out-of-town patients, or those traveling long distances, can have local doctors perform these checks; your surgeon’s staff will work with your doctors to expedite this. Common pre-surgical checks are listed below.

Medical Check: Prior to your surgery, you should see an internal medicine specialist to identify and manage your health risks. Examples of increased risks are heart and lung disease, tooth and gum disease, infection, obesity, and diabetes. That is why patients should undergo testing and clearance by a medical doctor prior to hip replacement surgery.

Dental Check: A dental check-up is necessary to identify any hidden infection in your teeth or gums. Such infections must be treated before knee replacement to eliminate the risk that bacteria from decayed teeth enter the bloodstream and end up infecting the knee implants. If you are traveling from out of town, visit your dentist and forward the information to your surgeon.

Heart Check: If there is any reasonable suspicion of heart disease based on your history, it is best to find out ahead of time if your heart is healthy enough for knee replacement surgery. Heart disease is usually silent; patients do not have symptoms until the heart is stressed. If indicated, your surgeon will have you see a cardiologist before surgery for clearance.

What if I have bowel problems?

Pre-existing trouble with constipation usually leads to constipation and related problems after hip replacement. If you regularly take supplements to encourage bowel movements, let your doctor know so they can plan accordingly, since the medicines used during and after surgery can result in serious constipation.

You will be given a stool softener before surgery to avoid problems with constipation later. Even so, you can probably expect disturbance of bowel patterns and at least some degree of constipation after knee replacement surgery.

How does diabetes affect my surgery?

Blood glucose levels over 200 will lead to poor wound healing and increased risk of infection. Therefore, it is critical that your diabetes is under control prior to surgery. A medical consultation and lab data before surgery will ensure your diabetes is controlled and your surgical risk is minimized.

Does osteoporosis affect the success of a total knee replacement?

No. If bone has severe osteoporosis, it may not be possible to use an un-cemented prosthesis. However, the cemented version of total knees can be implanted in nearly every type of bone, including bone that has osteoporosis, and the outcomes are very successful.

What about alcohol and drug use?

Regular alcohol consumption should be disclosed to your anesthesiologist and surgeon ahead of time. Alcohol withdrawal can happen to anyone, regardless of economic or social background. When it happens, it can be life threatening and can complicate your recovery from surgery. If your medical team knows about alcohol consumption, they can take steps to avoid withdrawal. The same is true of recreational drugs. Be sure to talk about this with the anesthesia doctor.

What if I am a smoker?

Smoking increases the chance of lung complications during and after surgery, delays wound healing, increases the risk of complications after surgery, and increases the odds of residual knee pain even after successful hip replacement. Therefore, you should try to stop smoking, both for your general health, and to improve the odds of a successful result from knee replacement. Most hospitals are smoke-free, and you may not be able to smoke on the premises.

Does my body weight affect hip replacement?

Obesity will increase the risk of complications from surgery, such as blood clots and slower wound healing. Ideally, your weight should be within reasonable limits before knee replacement surgery. In some cases, for excessively heavy patients, knee replacement is not an option without drastic weight reduction, such as with gastric bypass surgery.

That said, many people are somewhat overweight and unable to lose weight while dealing with a painful arthritic knee. The knee components are designed to handle enormous loads, and are safe, even in very heavy people. There is no evidence to suggest that the components loosen up prematurely, or wear out prematurely in heavy people.

What about dieting and exercising before surgery?

Maintain a nutritionally sound diet including a variety of foods in preparation for surgery. Crash dieting is not necessary; rather, regular exercise will help control weight and improve overall health.

Exercise before surgery, done within reason, and within the capability of the patient, will improve the recovery from knee surgery. Therefore, a reasonable exercise program to strengthen your thigh and calf muscles before hip replacement surgery is the best thing you can do to speed up your recovery.

How can exercise before the surgery help my recovery after?

Exercising and strengthening the thigh and leg muscles before the operation will result in faster recovery and return to function, with less suffering, struggle, depression, and mood swings. Consultation with a physical therapist before surgery can be very useful.

The reason exercise helps is that the knee, even if worn out, is a living joint. Living tissues respond positively to physiologic stress, and exercise is known to improve self-perception, esteem, and outlook.

When do I first visit the hospital?

About a week or so before surgery, you will visit the pre-op department in the hospital. This visit is to read and sign consents for the surgery, for the anesthesia, and for blood products (if needed). You will have lab tests, possibly a chest X-ray, and an electrocardiogram. Please make a list of your medications and their dosages prior to this visit.

At this visit, you will be instructed on where to report on the morning of surgery. You will receive instructions on not eating or drinking after midnight the night before your surgery. This includes chewing gum and hard candy.

Keep in mind that surgery schedules change often; this is why the exact timing of the operation is not known until the day before. If you have a special preference, such as being the first in the day, or last, or in between, simply let the surgeon know and they’ll try to accommodate your request.

When will I be assigned a surgery time?

The hospital will contact you a day before the surgery to tell you what time to arrive at the hospital. Surgery schedules tend to change, which is why most hospitals will confirm the exact surgery time only a day or so before the operation. Please arrive early. The actual operation will usually be less than an hour in duration, but preparation takes much longer.

When do I see the anesthesiologist?

On the morning of your surgery, you will see an anesthesia doctor (anesthesiologist) who will have already reviewed your medical records. If your medical condition so requires, your surgical team will have consulted with the anesthesia doctor ahead of time. This doctor will inquire about your health and plan the anesthetic technique, including any regional nerve pain blocks. If you know of a particular anesthesiologist at the hospital whom you would prefer to provide this service, simply let them know ahead of time.

Should I donate my blood for surgery?

No. This is not necessary since not everyone needs a blood transfusion after knee replacement. If you have religious convictions against blood products, let your doctor know so they can arrange to recycle your own blood. Blood loss differs from patient to patient, and pre-existing conditions such as anemia and other diseases can affect the odds of needing blood after surgery.

As a general rule, major bone surgery is associated with blood loss, but it is impossible to say how much blood a particular patient will lose. If needed, blood transfusions today are very safe and effective.

Points for Successful Hip Surgery

Inform yourself about outcomes and risks of surgery.
Get recommended medical, dental, and other checks to ensure safety.
Exercise muscles before surgery, whether upper or lower body.
Understand and follow discharge instructions when you leave the hospital.
Communicate with your surgeon and primary doctor often, especially if you have questions.
Avoid smoking and excess alcohol use during recovery.
Maintain good hygiene and reasonable body weight.
Participate in scheduling, planning, discharge, and related processes.
Select a surgeon in whom you have confidence and trust.The decision to have elective surgery should be made after careful thought and deliberation.

Parts and Materials for Hip Replacement

How do the implants work in a hip replacement?

You have a natural socket (called the acetabulum) in the pelvis. The hip ball normally sits in this socket. By reaming away the damaged bone and cartilage, fresh bone is exposed, and a slightly oversized hemispherical socket made of a sturdy, inert titanium alloy is impacted into your bony socket. Usually this impaction does not require fixation with screws since the mechanical press-fit is snug enough. Into this titanium shell, a bearing surface of polyethylene, ceramic, or metal is then locked mechanically.

Next, the femur (thigh bone) is prepared by cutting off the arthritic femoral head (the ball of your hip joint). The cavity inside the femur bone is enlarged, and a slightly oversized femoral implant is securely impacted into the femur. The stem has a metal junction at its top end, designed to fit an artificial ball. This ball is made of a cobalt-chrome alloy, or ceramic, and matches the diameter of the bearing earlier fitted inside the artificial socket.

Once the ball is placed in the socket during surgery, the surgeon must adjust leg lengths, implant stability, muscle tension, and range of movement of the hip joint. This is where surgeon judgment and expertise are critical. The new artificial ball will rotate inside the synthetic shell just like a natural hip ball and socket would, except the artificial parts will not produce any pain.

What materials are used in a hip replacement or resurfacing?

The structural parts are made of titanium alloy. Structural means that the skeleton grows and bonds permanently to these parts. Alloy means that the metal is not pure titanium. It is a mixture of other metals to enhance the safety, performance, and avoid possible allergic reaction to any one metal.

Titanium alloys are used for this purpose because of durability, biocompatibility, several decades of experience, and the fact that titanium is less stiff than other metals and therefore better suited for skeletal reconstruction.

The bearings are mounted on the structural parts, using specially engineered tapers. Bearing surfaces in the hip are made of plastic, metal, or ceramic. The choice of bearing depends on the individual patient.

In engineering hip replacement components, the structural parts are optimized for their ability to bind to living bone and for long-term biocompatibility and durability, while the bearings are optimized for the lowest wear rates.

What do you do on the socket side of a hip replacement?

On the socket (pelvic) side of a hip replacement or resurfacing, a metal half-shell is fitted inside the patient’s own bony socket. Inside this shell, a locking mechanism fastens the bearing, which can be polyethylene, metal, or ceramic. Screws were once used to fix the socket to the pelvis bone, but with modern designs, screws are rarely necessary.

The bearing part can be changed even years down the road, without disturbing the metal cup that has grown into the pelvis.

What do you do on the femur side of a hip replacement?

On the femur (thigh bone) side, the inside cavity of the thighbone is enlarged, and a metal femoral stem is implanted in this cavity, where it will bind to the bone. On this stem, an artificial ball is attached using an engineering taper. The ball is made of either cobalt-chrome metal, or ceramic. The ball can be changed at any time in the future, if need be, without removing the stem from the femur.

What brand of hip implants do you use?

Brands such as Zimmer, OMNI, and Wright Medical Products have been popular in the past, but new ones are always being tested. Look for designs that have withstood the test of time, with excellent long-term results. Implant companies make several models and designs of implants, and the precise application depends on individual patient needs and anatomy.

The most common bearing surface used in hip replacements is a cobalt-chrome ball with a cross-linked polyethylene socket liner. This bearing is built upon decades of experience with standard (non cross-linked) polyethylene; the material offers more flexibility and options to make hip replacement safe and predictable.

If you have a strong preference for a certain type of joint prosthesis, or a certain type of material, discuss that with your surgeon.

There is very little difference between the implants offered by the major manufacturers. Be wary when companies pay doctors to promote or use any product.

What if I want a particular brand of hip replacement?

Simply let your surgeon know. You want to work with someone who embraces the latest technology, biomaterials, and surgical methods.

Be cautious about the unregulated marketing and promotion of hip and knee implants though. Orthopaedic companies and hospitals want business, and their advertisements rarely give the complete picture. Your surgeon should offer you unbiased opinion about different implants, while respecting whatever decision you make in this regard.

How much do the parts used in hip replacement weigh?

The parts weigh about 3 to 5 pounds. The bone removed during hip replacement weighs a little less. So, you may gain a few pounds of body weight as a result of hip replacement surgery. This is more than balanced by the fact that people tend to lose weight after surgery due to diminished appetite and the stress of an operation.

Why does an artificial hip wear?

Everything wears out over time. Artificial hip bearings are no exception. During everyday activity, our hips endure several million cycles a year. People who are athletic or walk more than usual will load their joints even more. Cyclic loading leads to wear, even though modern hip bearings are extremely wear-resistant. But, no bearing surface is completely wear-proof.

Realistically, for most patients, bearing wear in an artificial hip is not a practical concern. Assuming the surgery is done properly, most modern hip bearings will last longer than the patient’s lifespan.

Where do wear particles from the artificial hip go?

All hip bearings produce microscopic wear particles that collect in the soft tissue envelope around the artificial hip. This layer of tissue, called the hip capsule, forms around the prosthetic joint after surgery. Cells in this layer act like a “biological sink” by absorbing and storing the wear particles.

Some wear particles migrate into the body, and are spread by the circulating blood to remote organs such as the heart, liver, spleen, and lymph nodes. No study has shown any adverse impact of such wear particles from artificial hips that spread throughout the body, although this remains an area of investigation and research.

What is the advantage of ceramic bearings in hip replacement?

Ceramics are synthetic materials, used in industrial applications. When used in orthopaedic bearings, their wear rates are extremely low.

A disadvantage of ceramic bearings is that there are fewer options for the surgeon. This is related to engineering limitations. With future developments, ceramic bearing use may become more widespread. Today, for most patients, a cobalt-chrome ball and cross-linked polyethylene offers the best trade-offs between safety, longevity, flexibility, long-term wear, and sizing options.

Can ceramic parts be used in my hip replacement?

Yes, such as a ceramic ball and a plastic socket. Or we can use ceramics in both the ball and the socket. Either combination offers extreme wear resistance and durability.

Old-design ceramics were brittle, and the extreme hardness of ceramic materials limited their use in hip replacement. The newer ceramics are super tough alloys, especially engineered for the orthopaedic market. They are safer, and have excellent long-term outcomes, with almost zero wear.

Even newer ceramic materials made of silicon nitride are in development; silicon nitride offers even less wear, with extreme durability and strength.

When do you use cement to fix the hip components?

Cementing implants is reserved for the elderly and for cases in which the bone anatomy requires a cemented implant. The majority of hip replacements are done without bone cement.

In decades past, cement was used extensively to attach metal parts to bone. Cement is now rarely use cement in hip replacements thanks to developments in biomaterials and implant design.

How durable are cemented parts in hip replacement or resurfacing?

Data from hip replacements done many decades ago show that cemented total hip sockets usually loosened up after 10 to 15 years and that cemented femoral stems usually loosened up after 15 to 20 years. Today, cement is rarely used in hip replacements; in fact, if a previously cemented hip replacement has come loose, the parts used in repeat surgery are of a cementless design. Such components are designed to heal to native bone; this type of skeletal fixation has almost indefinite durability.

How do cementless hip implants attach to bone?

They attach by healing directly to bone. Metal surfaces are designed with a porous honeycomb metal structure, into which bone can grow. This biologic fixation is very strong and will not loosen over time.

While bone is growing into such parts, initial stability relies on a mechanical fit between metal and bone. This is achieved by physically impacting or hammering the parts into bone during surgery.

Once bone grows into the socket and femoral stem, the bond is permanent.

Can I get the same hip implant that a famous celebrity has?

Implant companies use celebrities to promote hip replacement, typically showing the youthful lifestyle and active involvement in skiing, golf, and other outdoor activities. Please view all marketing and promotional information with skepticism; such information is not always complete.

In reality, participation in sports such as golf and other activities is just as possible with one brand of hip components as the other. No brand in the market today is superior in terms of returning patients to activities faster or in giving patients an advantage in a specific sport, no matter which celebrity a company pays to tout its products.

Do I need a custom implant or instruments made from CT/MRI studies?

Hip components come in many sizes, configurations, models, and geometries. Off-shelf components give a precise fit in nearly all the patients. In some cases involving congenital abnormality, special-sized components can be ordered if necessary.

Technology keeps advancing, and in the future, custom-built hips that are designed precisely for one person to ensure perfect leg lengths, tissue tension, fit, and sizing will probably become a reality. Surgery advancements will probably mean that some patients may even be able to go home the day of surgery. These innovations reflect research and product development that professionals around the country are actively engaged in at the present time, to further improve on the already very successful operation of hip replacement.

Do you use human tissue or parts for hip replacement?

In routine total hip replacement, no such tissue is needed. Many years ago, we used allograft bone in some complicated cases to restore deficient bone. But with newer metal composites that can be shaped like bone, human tissue is no longer necessary for hip surgery.

In fact, metal augmentation techniques have advanced such that we can help patients who in the past were probably beyond help. The ability to rebuild hips that have had multiple operations previously, and to restore people to function, is a practical advantage of innovation and improvement in our health-care system.

Can patients develop an allergy to the artificial hip?

Such occurrences are exceedingly rare. Most commonly, what is often called an allergy is a missed, subtle infection. True metal allergies are usually well known to the patient ahead of time. In such unusual cases, it is possible to use components made of alternative metals, based on allergy testing, to which the patient is not sensitive.

Some patients did develop allergies and reactions to the metal-on-metal bearings; those designs have been recalled from the market.

During Hip Surgery

Here are answers to frequently asked questions about what happens during hip surgery and immediately afterward. Procedures vary somewhat at different hospitals and with different surgeons. Be sure to discuss this with your specific surgeon and medical team!

Who will be doing my hip surgery?

Hip surgery is complex, and requires judgment and experience. Although team members will assist, and resident physician or students may observe, you can expect that an experienced orthopaedic surgeon will perform the entire operation.

Where will the surgery be done?

There are many state-of-the-art, technologically advanced specialty orthopaedic hospital in the U.S. Such centers are specifically equipped for joint replacement surgery and national data show a lower risk of complications, such as infections, and better outcomes from hip and knee replacement surgery.

What type of anesthesia will I have?

Typically, a spinal anesthetic with sedation will be used. This type of anesthesia is safer than general anesthesia for hip replacement surgery. In addition, we used a combination of injections and pain relief modalities. If you have any preference for a certain kind of anesthetic, please let your medical team know. Modern anesthetic drugs ensure that you will probably remember very little, if anything, about the surgery.

What should I do the day of my surgery?

Do not eat or drink anything, including gum and candy. Unless advised differently, take your blood pressure and heart medications with a sip of water. Avoid make-up, nail polish on fingers or toes, perfume, or cologne. Remove all jewelry in anticipation of surgery.

Can I wear my contact lenses to surgery?

You will have to remove your contact lenses prior to going into the operating room. Bring glasses, if you have them, or bring solution and a holder for your contacts.

Where does family wait and who updates them?

Your family will be in a waiting room while you are in surgery. They will be informed when surgery is over and you are in the recovery room. You will remain in the recovery room for approximately 1 or 2 hours before going to your room. Your family can see you once you have arrived in your room.

How much will I hurt after surgery?

There is very little pain early on, since modern pain medications and anesthetic techniques are very effective. Recovery from surgery is far more comfortable today than it was just a few years ago.

The hip joint itself and the tissues around it are injected with local pain-killing drugs.

If you were taking narcotic drugs before surgery, pain control is more difficult since the body gets desensitized to the pain-killers. In such cases, doctors typically prescribe a higher dose of pain-killers, and sometimes use a combination of drugs.

Pain medicines can be given by mouth, intravenously, or by intramuscular injection. If you hurt, please let someone know; they want to minimize discomfort and customize the treatment for you.

By the time you leave the hospital, your pain will be properly controlled by an oral pain medication. Depending on the patient, such medications may be taken for several weeks.

What can I expect right after surgery?

You will be monitored in the recovery room for about an hour, and most patients are reasonably alert by this time.

You will notice a bulky dressing and an ice pack on your hip. The ice pack helps to control pain and swelling. You may also have a drain in the incision that looks like a plastic tube; this is removed within 24 to 48 hours. Expect a catheter in your bladder to keep urine drained; this is usually removed within 24 hours.

After an hour or so the nursing staff will take you to a private room. If your family plans to stay in the hospital room with you, please talk to your nurse so that arrangements can be made.

The nursing staff will coach you to take frequent deep breaths after surgery. You will have a breathing device to help with this. This is a plastic breathing exercise machine designed to prevent pneumonia and keep the lungs healthy.

You will have an overhead lift on your bed to assist you in moving independently. This allows you to use your arms to move your body. Feel free to position your body in any way you want after hip surgery. For the first night, we prefer the leg slightly bent, on a pillow, since this reduces bleeding in the hip. The head of the bed can be in any position that you like.

You will have elastic stockings on and some sort of pump device squeezing your feet or legs to reduce the chance of a blood clot. You should exercise your calf and ankles regularly after surgery while you are awake. This will cut down the risk of a blood clot.

Why are there pumps on my feet after surgery?

Mechanical foot pumps are used to squeeze the feet and ankles intermittently after surgery in order to decrease the risk of blood clots. These are useful while you will be in bed and resting; you will not need them at home.

When can I eat after surgery?

Right after surgery, avoid eating solid foods. It is better to start with liquids and make sure that you can handle these before you progress to a full diet. Nausea is a very common side effect of modern pain medications. So, go slowly right after surgery to make sure you can keep liquids down, without nausea, before you progress your diet.

Hip Surgery Techniques

How are hip surgeries performed?

Common approaches are covered here.

What is a surgical approach?

The anatomic pathway used to reach the bones of the hip joint is also referred to as the surgical approach. Each surgical approach is a different technique to gain access to the joint itself, and exposes the anatomy for a hip replacement or hip resurfacing.

The most common hip joint surgical approach used by U.S. surgeons is called the posterior (from the rear) approach. Patients who have had a posterior approach typically have a curved scar on the outside of the thigh with a top part of the scar curving into the buttock. This approach is very popular, easy to learn, predictable, and cuts through a limited amount of muscle and tendon, resulting in good recovery.

Even in the hands of very good surgeons, the posterior approach is associated with a small risk of the hip popping out after surgery. Newer techniques and implants have reduced this risk somewhat, but a small possibility of hip dislocation remains associated with the posterior approach.

Another common surgical approach to hip replacement is the lateral (from the side) approach. The lateral approach also involves a scar on the side of the thigh, but instead of being curved, the scar is usually a straight line. The advantage of this approach over the posterior approach described above is a lower risk of dislocation.

The lateral approach nearly eliminates the risk of dislocation, but the approach involves cutting through more muscle tissue on the way to the hip joint. As a result, patients will usually have a slight limp after surgery, which generally disappears 6 to 12 months following surgery.

Another popular approach is called the anterior (from the front) approach. This method is still new in the U.S., with more surgeons using it every year. Very few surgeons in the United States use this approach routinely for all hip replacements. This is a true muscle-sparing approach with a very quick recovery.

What are the advantages of the anterior approach?

One advantage of the anterior approach relates to easier and safer patient positioning for surgery. The patient is on the back, which is a more natural position than placing the patient on the side, which is required in the posterior and lateral approaches.

Another advantage is that leg length checks are easier when the patient is on his or her back. Both legs can be easily assessed relative to each other.

Finally, the anterior approach does not cut through any muscle. The muscles are separated along their natural planes, and the entire joint can be replaced through a much shorter incision, with true sparing of muscle.

Muscle-sparing is beneficial in another way. The risk of dislocation (the hip ball popping out of the socket unexpectedly) is nearly zero with the anterior approach. With other methods of hip replacement, patients must follow certain precautions for a lifetime.

For example, patients are usually advised to not bend too far, tie shoes, or cross the legs for fear of the hip popping out of socket. These precautions and worries do not apply to hips replaced using our anterior approach.

Around 2003, a “two-incision” hip surgical approach was developed by surgeons in Chicago as the first truly minimally invasive hip replacement. We adopted that technique, published our results in peer-reviewed literature, and refined the method to make it safe and predictable in our patients.

The present-day anterior approach is an evolution of that work; instead of two incisions, the anterior approach allows us to perform the entire hip replacement through one short skin incision placed toward the front of the thigh.

Patient recovery and function are better with the anterior approach, when compared to conventional techniques.

What are the disadvantages to the anterior approach?

This technique is still relatively new and not widely used in the United States, since it involves new learning and is difficult to master. Very few surgeons use it routinely in all patients, given the technical challenges in learning it and getting comfortable with the technique.

Another reason is that with the scar in the front there is the risk of skin numbness over the side and front of the thigh as the result of microscopic skin nerves that are cut in during surgery. These nerves will heal over time, and thigh sensation is restored a few months after surgery. The nerves do not affect any muscles; subjective numbness is the only symptom.

Thigh numbness is usually not a significant issue other than a transient symptom that resolves. It is generally agreed that the temporary numbness is more than balanced out by the substantially improved recovery, reduced pain, absence of a limp, faster return to function, and virtual elimination of the risk of hip dislocation.

What surgical approach is typical for a complex total hip replacement?

In very difficult hip reconstructions, such as those in which the hip has been replaced many times previously, or the pelvis has to be repaired with plates and screws before placing a metal socket, or where extensive repair of the femur needed, the surgical method that spares the muscles while permitting the best exposure is called a trochanteric osteotomy.

A trochanteric osteotomy involves cutting a piece of bone near the top of the femur. This bone is called the trochanter, and is the bump you can feel on the side of the thigh. The major hip muscles involved in walking all attach to the trochanter.

Cutting the trochanter with all the muscles still attached is the oldest of hip approaches. Once the trochanter is cut, it can be moved aside along with the attached muscles, thereby facilitating entry into the hip joint. The resulting view of the hip is excellent for any type of hip replacement, no matter how complicated or difficult.

Metal cables are used to reattach the trochanter to the femur. The trochanter can be attached farther down the femur if tightening of the muscles is desired. This method gives the surgeon the freedom and flexibility to adjust leg lengths and tissue tension, independent of each other.

For first-time hip replacements, and even many repeat hip replacements, a trochanteric osteotomy, despite its above advantages, is rarely needed. This method is dictated by complex, difficult, and unusual hip replacement cases.

Do surgeons use computer navigation during hip replacement surgery?

Precise alignment of the bones and components is essential to the long-term success of both hip replacement and hip resurfacing. Computer and robotic technology can help in alignment of bones and reduce the possibility of error.

However, so far there is no substitute for the skill, judgment, experience, hands, and eyes of a high-volume surgeon.

Future technology is aimed at building custom hip components for each patient, thereby ensuring a precise operation and optimal implant placement, with no need for robots or computers.

What is the role of computer guidance in hip replacement?

At present, computer-assisted technology is most effective for low-volume surgeons. It helps such surgeons reduce the likelihood of error in implantation of the hip components. For some surgeons and hospitals, the greatest advantage of this technology is in marketing.

In other words, computer and robotic technology, while sounding fancy, do not add much value to the hands of an experienced, high-volume surgeon.

What about that minimally invasive hip replacement that I read about?

Bear in mind that all surgery is invasive to the mind, body, and psyche. Surgery is a very different experience for the patient than it is the surgeon, hospital, or implant manufacturer. Hip surgery is much easier today when compared to the past, but complications, pain, discomfort, and recovery still apply. Each patient’s expectations and physical, emotional, personal, and spiritual attributes are different and affect recovery profoundly.

For example, some patients can leave the hospital the same day or the day after hip replacement. But this is not true of all patients. Unfortunately, some health-care professionals use words like minimally invasive surgery, computer-driven surgery, custom-built implants, and same-day operation as business-driving tools. This type of marketing can be misleading and can create unrealistic expectations.

How long will my scar be?

The scar is about 3 to 5 inches long, and placed in front of the thigh. The length of the scar can vary, and will depend upon patient body size, the severity of arthritis, the condition of the soft tissues, and the deformity of the joint.

While the length of the scar has little to do with how fast you heal, everyone prefers to have the shortest scar. Your surgeon will aim for the smallest possible incision that allows safe and efficient surgery, with accurate implant placement.

Independent of the scar length, hip replacement surgery with our anterior approach avoids muscle damage. By spreading muscles apart, the recovery is much faster and easier.

Are there newer surgical approaches being developed?

Yes, there are exciting innovations constantly being developed. One example is the “Super-PATH” technique with which we hope will improve recovery by minimizing surgery so much that same-day discharge may be possible for some patients. These efforts entail painstaking, detailed experimental work in the laboratory, extensive cadaver-surgery training, development of new instruments, and collaboration with experienced and gifted colleagues nationwide.

About Arthritis, An Underlying Cause of Joint Pain and Deterioration

For many people, it’s helpful to understand more about Arthritis, an underlying cause of joint paint and deterioration.

What is arthritis?

Arthritis is the number one cause of chronic disability in the United States. Affecting nearly 40 million Americans, it refers to more than 100 diseases that cause pain, stiffness and swelling from the inflammation of a joint or the area around joints.

Are there different types of arthritis?

Yes. Osteoarthritis, fibromyalgia, and rheumatoid arthritis are the most common.

What is Osteoarthritis?

Osteoarthritis is a noninflammatory degenerative joint disease characterized by the breakdown of the joint’s cartilage.

It affects an estimated 21 million people in the United States and is characterized by mild to debilitating pain in the hands and joints such as knees, hips, feet and back. According to the Arthritis Foundation, the disease is most prevalent among individuals 45 years of age and older. Women are more prone to the disease.

When the joint cartilage is broken down by the disease, it removes the buffer between bones. The resulting bone-against-bone friction causes pain and eventual loss of movement. Symptoms include joint pain or aching (often after exercise or extended periods of pressure on weight-bearing joints) and limited or eventual loss of range of motion.

How do you get Osteoarthritis?

The exact cause of osteoarthritis is unknown. There are a wide array of factors that are known to contribute to the development and progression of the disease, including aging, obesity, joint injuries (sports, work or accidents), and genetics.

How do patients find out if they have Osteoarthritis?

An individual must seek the diagnosis of a physician. After a physical examination and full detailing of symptoms have been discussed, the physician may also recommend X-rays to confirm presence of the disease.

What is Fibromyalgia?

Fibromyalgia is the second most common type of arthritis, affecting 3.7 million Americans, mostly women; 70 to 90 percent of people who develop this disease are women aged 20 to 50.

Fibromyalgia is a disease involving pain in muscles or joints with no clinical signs of infection. It is often misdiagnosed as chronic fatigue syndrome, and usually does not require surgery.

What is Rheumatoid Arthritis?

In some types of arthritis, such as rheumatoid arthritis, the synovium becomes inflamed. This inflammation causes chemicals to be released that thicken the synovium and damage the cartilage and bone of the affected joint. This leads to inflammation of the synovium , which then causes pain and swelling.

What causes arthritis?

The causes of the 100 types of arthritis are unknown. Because there are so many different forms of arthritis, the causes are likely to vary. Scientists are currently examining factors such as genetics and lifestyle affect the development of arthritis.

What changes occur in the cartilage of an arthritic hip?

In a healthy hip, cartilage cushions the area surrounding the hip ball and socket to allow easy movement without pain. In an unhealthy hip, the cartilage is damaged or worn away causing pain from bones rubbing and grinding together.

What changes occur in the cartilage of an arthritic knee?

In a healthy knee, cartilage protects and cushions bone surfaces that come together at the joint. This allows bones to move without friction. In an unhealthy knee, cartilage is damaged or worn away, causing pain from bones rubbing together.

What are some of the symptoms of arthritis?

Pain from arthritis can be continuous or intermittent. Pain may occur after activity or exercise but it may also happen even if you’ve been resting and still for a period of time. Pain may be concentrated in one spot or you may feel it all over your body. Joints may feel stiff and difficult to move. Daily chores such as climbing stairs and opening cans may become a challenge. You may notice that pain is more severe during certain times of the day or after performing certain tasks.

Some kinds of arthritis cause swelling or inflammation. The skin over the joint may appear swollen and red, and feel hot when touched. Arthritis may also cause fatigue.

How can I know if I have arthritis?

Early diagnosis and treatment tailored to your needs are crucial in slowing or preventing damage to joints. Only a physician can determine if you have arthritis and what type it is. Arthritis is diagnosed based on the overall pattern of symptoms, medical history, physical exam, X-rays and lab tests.

The websites of the Arthritis Foundation (www.arthritis.org) and American Academy of Orthopaedic Surgeons (www.aaos.org) contain many informative articles.