Total Hip Replacement (THR)
Synonyms: Hip Replacement, Total Hip Arthroplasty
What is a Total Hip Replacement?
Total Hip Replacement, or Total Hip Arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts called the prosthesis.
Where can I get a Total Hip Replacement?
Cost of procedure performed in the US: $40,000.
All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.
What does the procedure for Total Hip Replacement involve?
The hip joint is located where the upper end of the femur meets the acetabulum. The femur, or thigh bone, looks like a long stem with a ball on the end. The acetabulum is a socket or cup-like structure in the pelvis, or hip bone. This 'ball and socket' arrangement allows a wide range of motion, including sitting, standing, walking, and other daily activities. During Total Hip Replacement, the surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural, gliding motion of the joint. Total Hip Replacement surgery usually lasts 2 to 3 hours. Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a 'cemented' procedure. In an un-cemented procedure, the artificial parts are made of porous material that allows the patient's own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a 'hybrid' hip replacement, which consists of a cemented femur part and an un-cemented acetabular part.
What can be expected in the recovery period following Total Hip Replacement?
You will be allowed only limited movement immediately after Total Hip Replacement surgery. During the recovery period when in bed, the hip usually is braced with pillows or a special device that holds the hip in the correct position. You may receive fluids through an intravenous tube to replace fluids lost during Total Hip Replacement surgery. There also may be a tube located near the incision to drain fluid and a tube (catheter) may be used to drain urine until you are able to use the bathroom. Your doctor will prescribe you medicine for pain or discomfort.
How long is the recovery and rehabilitation period after Total Hip Replacement?
On the day after or sometimes on the day of Total Hip Replacement surgery, therapists will teach you exercises that will improve recovery. A respiratory therapist may ask you to breathe deeply, cough, or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after Total Hip Replacement surgery. A physical therapist may teach you exercise, such as contracting and relaxing certain muscles that can strengthen the hip. Because the new, artificial hip has a more limited range of movement than an un-diseased hip, the physical therapist also will teach you proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to the new hip. As early as 1 to 2 days after Total Hip Replacement surgery, you may be able to sit on the edge of the bed, stand, and even walk with assistance. Usually, hospital stay does not exceed more than 10 days after Total Hip Replacement surgery. Full recovery from Total Hip Replacement surgery takes about 3 to 6 months, depending on the type of surgery performed, your overall health and the success of rehabilitation.
B . R . A . N . D . of Total Hip Replacement
Benefits of Total Hip Replacement
- There will be immediate and substantial improvement in your pain, functional status, and overall health-related quality of life following Total Hip Replacement. Promising clinical evidence suggests that these immediate improvements persist in the long term. Over the last two decades, complications associated with Total Hip Replacement have declined significantly. Prophylactic antibiotic therapy has helped to prevent infection. Use of anticoagulants in the peri-operative period has reduced the incidences of deep venous thrombosis and pulmonary emboli.
Risks of Total Hip Replacement
The risks of complications following Total Hip Replacement surgery are a rare occurrence and include:
- Formation of blood clots in leg veins - These clots can form either as a result of decreased movement of your leg after Total Hip Replacement surgery or from injury to the veins during surgery. To prevent this from happening, your doctor usually prescribes blood-thinning medications after your surgery. Compression devices, such as elastic stockings, and exercise to increase blood flow through the veins in your legs can also reduce your risk.
- Infection - Infections can occur at the site of incision and in the deeper tissue near your new hip joint. Most of these infections can be treated with antibiotics. However, if the pocket of infection is close to your prosthesis, then a surgery may be required to replace the prosthesis or remove it completely.
- Dislocation of hip joint - Certain positions at the hip joint can cause the ball of your prosthesis to become dislocated. To avoid this, refrain from bending more than 90 degrees at the hip or from allowing your leg to cross the midline of your body.
- Loosening and stiffening of your hip joint - Over time your new joint may loosen or the soft tissues around your joint may harden as a result of a process of ‘ossification’. This may cause pain and stiffness in your hip and may make it difficult to move.
- Breakage of the prosthesis - This occurs rarely. Your artificial hip can break several years after surgery. In that case, another Total Hip Replacement surgery would be required to replace the broken joint.
- Change in length of your leg - Your surgeon takes special precautions during the Total Hip Replacement surgery to avoid this problem, but occasionally your new hip may make your leg longer or shorter than the other one. This may result from weakness in the muscles surrounding your hip. This problem can be resolved by strengthening those muscles.
Alternatives to Total Hip Replacement
- Arthroscopy - Arthroscopy of the hip is a minimally invasive, outpatient procedure. It is relatively uncommon however, it may be recommended if the hip joint has evidence of torn cartilage or loose fragments of bone or cartilage.
- Osteotomy - This procedure is usually recommended for younger patients with early arthritis in a hip joint that has an abnormally shallow hip socket (dysplasia). The procedure involves cutting and realigning the bones of the hip socket and/or thighbone thus making the socket deeper. It decreases pressure in the joint. In some cases, this may delay the need for Total Hip Replacement surgery for 10 to 20 years.
- Hip Resurfacing procedure has been promoted as an alternative to total hip replacement and is commonly indicated in patients younger than 55 years of age.
Now or Never
- The goals of Total Hip Replacement surgery are to improve mobility by relieving pain and improve function of the hip joint. Without surgery pain may get worse with time and higher activity level. Using a walker or a cane may help patients who have more trouble walking. These measures usually improve pain and function. However, arthritis is progressive. Even with treatment, it gets worse over time. Timely surgical intervention by Total Hip Replacement may reduce your unnecessary pain and suffering. There is clinical evidence that people who undergo minimally invasive hip replacement have an easier and less painful recovery, spend less time in the hospital and have fewer post surgical complications.
Decision to have Total Hip Replacement
- The decision to have the Total Hip Replacement is not made by the doctor. It is made by you, for it is you who must accept the risks and complications. The doctor may recommend the operation; however, your decision must be based upon weighing the benefits of the Total Hip Replacement surgery against the risks. You may wish to discuss the surgery with your own doctor or even get a second opinion. All your questions should be answered before you decide to have the operation. Please feel free to ask any questions that you may have in order to make your decision easier.
Your Questions Answered on Total Hip Replacement
B.R.A.N.D. of Total Hip Replacement
Orthopedic Surgery References