Total Hip Arthroplasty (Total Hip Replacement)

Overview

Total hip arthroplasty typically replaces a damaged hip joint with artificial components that can include a socket (acetabular cup) and a femoral stem with a ball. The procedure may be considered when hip joint damage can often contribute to pain and limited function despite non-surgical care.

Indications

This procedure may be considered when:

• •Hip osteoarthritis may often lead to persistent pain and functional limitation that can prompt consideration of total hip arthroplasty
• •Inflammatory arthritis (such as rheumatoid arthritis) may generally contribute to hip joint damage that can limit walking, daily activities, or sleep
• •Avascular necrosis of the femoral head may typically cause collapse of the hip joint surface that can reduce joint function
• •Certain hip fractures in older adults may often be managed with arthroplasty when fixation may be less suitable
• •Hip deformity or dysplasia may generally lead to progressive joint degeneration that can contribute to pain and disability
• •Non-surgical treatments may often provide insufficient symptom control, and surgery may be considered as an option

How It Works

The procedure typically involves several coordinated steps:

• •Anesthesia can typically include general anesthesia or regional anesthesia, and monitoring can generally occur throughout the procedure
• •An incision can typically be made using a surgical approach (such as posterior, lateral, or anterior) that may vary by surgeon and patient factors
• •The damaged femoral head may typically be removed, and the acetabulum can generally be prepared to accept an artificial cup
• •An acetabular component can typically be implanted, and a liner may generally be placed to form the new socket surface
• •The femoral canal may typically be prepared, and a femoral stem can generally be implanted using cemented or uncemented fixation
• •A femoral head (ball) can typically be attached to the stem, and the joint may generally be reduced to restore hip alignment and stability
• •Soft tissues can typically be repaired as needed, and the incision may generally be closed with sutures or staples
• •Early postoperative mobilization may often occur with supervision, and imaging can typically be used to assess implant position

Risks

As with any surgical procedure, potential risks include:

• •Infection may occur and can sometimes require antibiotics or additional procedures
• •Blood clots (deep vein thrombosis or pulmonary embolism) may occur after hip surgery
• •Hip dislocation may occur, particularly in the early recovery period
• •Leg length difference may occur and can sometimes be noticeable
• •Periprosthetic fracture may occur during or after surgery
• •Nerve or blood vessel injury may occur, although it can be uncommon
• •Implant loosening, wear, or mechanical failure may occur over time and can sometimes lead to revision surgery
• •Ongoing pain, stiffness, or limited function may occur despite surgery
• •Complications related to anesthesia may occur and can vary by individual health factors

Recovery Expectations

Recovery follows a gradual progression:

• •Hospital stay may typically range from same-day discharge to a few days, and it can vary based on health status and surgical factors
• •Walking with assistance may often begin on the day of surgery or within the first days, and mobility aids may typically be used during early recovery
• •Physical therapy may typically focus on restoring walking, strength, and range of motion, and progression can generally occur over weeks
• •Pain, swelling, and bruising may often occur early and can generally lessen over several weeks
• •Many daily activities may typically become easier over the first 6 to 12 weeks, although recovery can generally continue beyond that timeframe
• •Driving and return to work may typically depend on pain control, mobility, and job demands, and timelines can vary
• •Implants can often function for many years, although longevity may generally vary by implant type, activity level, and individual factors

Alternatives

Depending on individual circumstances, alternatives may include:

• •Activity modification may often be used to reduce symptom-provoking movements
• •Physical therapy or exercise-based rehabilitation may typically improve strength and function for some conditions
• •Oral pain relievers or anti-inflammatory medications may often be used for symptom management when appropriate
• •Intra-articular injections (such as corticosteroids) may typically provide temporary symptom relief for some patients
• •Walking aids or assistive devices may often reduce joint load and improve mobility
• •Hip resurfacing may be considered in selected patients and can depend on anatomy and risk profile
• •Osteotomy or other joint-preserving surgery may typically be considered for selected deformities or earlier-stage disease
• •Continued non-surgical management may often remain an option when symptoms can generally be managed without surgery

Sources

• AAOS OrthoInfo: Total Hip Replacement
• MedlinePlus (NIH): Hip Joint Replacement
• Mayo Clinic: Hip replacement
• Cleveland Clinic: Hip Replacement Surgery
• Johns Hopkins Medicine: Hip Replacement Surgery