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?
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.