Q: What is hip arthritis?
Hip arthritis is a condition with which the cushion between the two bones in the hip (cartilage) has worn out and deteriorated. This is most often the result of slow gradual wear and tear but can also be caused by broken bones, vascular problems, and infection.
Q: What is total hip arthroplasty?
The hip is a ball-and-socket joint. With total hip replacement, the socket (acetabulum) is replaced with a metal “cup” lined with an advanced plastic-bearing surface. The ball portion (femoral head) of the hip is replaced with a high-strength metal or ceramic ball that is mounted on a stem placed in the thigh bone (femur) to fix it rigidly in place. In this way, the damaged surfaces are replaced while leaving the majority of the bone around the hip intact.
Q: When is it time to have a hip replacement?
Most of the time, hip replacement is an entirely elective procedure. The patient can choose to delay it for months or even years with no increased difficulty for the patient or surgeon. A person considering hip replacement should not let anyone tell him or her that hip replacement is needed because, for the most part, hip arthritis is not a life-threatening condition. The reasons to undergo hip replacement are to decrease pain and to improve function.
Hip replacement is very successful at relieving the pain and disability associated with hip deterioration. If the following are present in addition to arthritis and groin pain, it might be time to consider hip replacement: 1) pain that disallows sleep, 2) progression to walking with a cane, or 3) other substantial disability related to the hip.
Q: Do you use minimally invasive surgery?
Yes, I was specifically trained in minimally invasive techniques. Fifteen years ago, hip replacement included a large incision and a week-long hospital stay. Currently, hip replacement can be performed through smaller incisions and patients achieve more rapid recovery. However, my main focus is on building a durable reconstruction that will last for years, and we use a surgical incision length that allows us to place the hip implants in optimal positions.
Q: Do you use a direct anterior hip approach?
Yes, we use a direct anterior hip approach for the majority of patients undergoing first-time hip replacement. I like the direct anterior approach because it allows more accurate installation of the hip replacement parts and patients recover slightly more rapidly than with other approaches. No specific hip precautions are necessary after a direct anterior hip replacement.
Not everyone’s hip is suitable for direct anterior hip replacement. It might not be the best option for those who have had extensive previous hip surgery, extensive bone deformity, or a high ratio of weight to height (body mass index).
Q: Where does the surgery happen?
All surgery is performed at the University of Maryland Hospital in operating rooms specially designed for joint replacement. A surgical procedure to replace the hip is performed with the patient under anesthesia. Regional anesthesia, which provides excellent pain relief both during and after surgery, usually is used. The surgery takes approximately an hour and a half. Patients usually are transferred from the operating room to the recovery room and then, later in the afternoon, to their hospital rooms.
Q: How long do I stay in the hospital?
Patients usually stay in the hospital for 2 to 4 days after hip replacement. During that time, we monitor vital signs and laboratory values. Most importantly, the physical therapists teach the patients how to get around with a new hip.
Q: What is physical therapy like after hip replacement?
After hip replacement, the physical therapists initiate an intense schedule to maximize mobility. Patients usually are out of bed the day after surgery (or, in some cases, the same day) and begin walking with a walker 1 to 2 days after surgery. Physical therapists are integral in teaching the patient to walk, dress, use the toilet, and bathe with a new hip while making sure walking is done safely.
Q: Will I be in pain after hip replacement?
Most patients experience some amount of pain after hip replacement. A dedicated team of pain physicians sees the patient during the hospital stay to make sure pain is well controlled. Most patients receive either a nerve block anesthetic or epidural anesthetic for 1 or 2 days after the operation. Patients are then transitioned to narcotic pain pills. Most of the time, patients are free of narcotic pain pills by 4 to 6 weeks after surgery.
Often, patients are mostly pain free by 8 to 12 weeks after surgery. Although some patients might continue to experience some amount of pain, the vast majority are extremely happy with the improvement in pain compared with before surgery.
Q: Will my legs be the same length after surgery?
The vast majority of patients have the same leg length after the operation as before. We use several checks in the operating room to make sure this is the case. In rare cases, it is necessary to slightly lengthen the leg with the hip replacement to render the hip more stable. However, this is very uncommon. Many people with severe hip arthritis feel that the leg with the arthritis is shorter than the other leg. We can correct this to a certain extent, and it should be discussed before surgery.
Q: How do you prevent blood clots after surgery?
We use several strategies to minimize the chance of a blood clot forming after surgery, including nerve blocks, calf compression devices, and early mobilization. In addition, patients who have undergone hip replacement receive a blood thinner for 6 weeks after surgery. The blood thinner usually is aspirin unless the patient has a history of blood clots, in which case Coumadin is administered.
Q: Should I donate blood before my hip replacement?
I generally discourage patients from donating their own blood before undergoing hip replacement because it does not reliably decrease the need for blood from the blood bank (allogeneic blood).
Q: Do you use the problem hip implants that I see on TV?
Several hip implants have been recalled and noted in television commercials. Those implants use an all-metal ball that rubs on an all-metal socket and are controversial. Some surgeons believe them to be better, and some surgeons believe them to be worse than other options. I do not use those implants and prefer more traditional hip replacement components (a high-strength metal or ceramic ball and a metal socket lined with an advanced plastic-bearing surface) that have a demonstrated track record of durability.
Q: How long does a hip replacement last?
Twenty years after surgery, 80% of hip replacements are still functioning well. Several factors determine how long a hip replacement lasts, including patient age and activity level, the type of implant used, and the reason the hip was replaced. Hip replacement materials continue to improve, and we are optimistic that current components will last longer than those used 20 years ago.
Q: How do I prepare for home after hip replacement?
Please see the sections “Discharge Instructions for Total Hip Replacement” and “Recovery at Home.” The information provided in those sections will help the patient transition from the hospital to home. After reviewing that information, let us know if you have any other questions.