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(Hip Arthroplasty; Total Hip Replacement; Minimally Invasive Total Hip Replacement; Mini-incision Hip Replacement)
A total hip replacement is a surgery to replace a diseased or injured hip joint. An artificial ball-and-socket joint is inserted to make a new hip. It can be done by full open surgery or a minimally invasive technique. The minimally invasive technique only requires 1 or 2 tiny incisions and special instruments.
|Left Total Hip Replacement|
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Reasons for Procedure
This surgery is done when pain and stiffness limit your normal activities and rest, medication, and physical therapy are no longer working.
Other reasons for surgery may include a broken hip, severe rheumatoid arthritis, bone tumors, and loss of blood supply to the bones of the hip.
If you are planning to have a hip replacement, your doctor will review a list of possible complications, which may include:
- Hip dislocation —occurs when the ball portion of the prosthesis dislocates from its normal position in the hip
- Blood clots
- Swelling or bleeding
- Injury to nearby nerves or blood vessels
- Anesthesia-related problems, like pneumonia
- Noisy or squeaky hip after surgery
Factors that may increase the risk of complications include:
- Pre-existing medical condition, such as heart or lung problems
- Infection, such as urinary tract infection or gum disease —having an infection increases the risk of bacteria entering the bloodstream and infecting the joint
- Previous problems with blood clots
Be sure to discuss these risks with your doctor before the surgery.
What to Expect
Prior to Procedure
Your doctor will do a physical exam and may also do:
In the time leading up to the procedure:
- Try to lose weight if you are overweight. This will decrease the amount of stress on your new joint. Pool exercise may be a good option.
To enhance safety and recovery, make home modifications:
- Install safety bars, a raised toilet seat, a shower bench, and a hose. Install handrails on stairways and steps.
- Remove throw rugs. Check to make sure extension cords are in a safe place.
- Purchase a stable, firm-backed arm chair. When seated, your knees should remain lower than your hips.
- Buy items to make daily activities easier, such as reachers and dressing aids.
- Place items so that they are easy to reach. This way, you will be able to avoid bending.
- Talk to your doctor about your medications. You may be asked to stop taking some medicines up to 1 week before the procedure.
- Your doctor may suggest donating your own blood for the surgery. You will most likely lose some blood and fluid during this surgery. If you need a blood transfusion , the doctor can use your own blood.
- If you become sick or have a fever just before the surgery, tell your doctor right away.
- Arrange for a ride to and from the hospital. Also, arrange for help at home.
- If you smoke, try to smoke less or stop smoking . Smoking slows the body's ability to heal.
- Eat a light meal the night before the surgery. Do not eat or drink anything after midnight. If you have diabetes, ask your doctor if you will need to adjust your medication.
Description of the Procedure
Total Hip Replacement
An incision will be made along your joint. The muscles will be moved aside. The damaged bone and cartilage of the hip joint will be removed. The remaining bone will be prepared for the prosthesis. The new artificial joint will be placed in position. Depending on the type of prosthesis, bone cement may be used to hold one or both parts of the artificial hip firmly to your bone. Lastly, the incision will be closed with stitches or staples.
Minimally Invasive Total Hip Replacement
This surgery may be done with 1 or 2 small incisions, one over the groin and another over the buttock. Special tools are used that fit into these small incisions. In some cases, x-rays will be used to help guide the doctor.
For the one-incision surgery, an incision will be made over the outside of your hip. The muscles and tendons will be moved out of the way. Next, the damaged bone and cartilage of the hip joint will be removed. The remaining bone will be prepared for the prosthesis. The new artificial joint will then be placed in position. Depending on the type of prosthesis, bone cement may be used to hold the artificial hip in place. Lastly, the incision will be closed with staples or stitches.
How Long Will It Take?
- Total hip replacement: 1-1½ hours
- Minimally invasive total hip replacement: 1 or more hours
How Much Will It Hurt?
You will have pain after the surgery. Pain medication will be given to help with discomfort.
Average Hospital Stay
This procedure is done in a hospital setting. The usual length of stay is:
- 4-6 days for a total hip replacement
- 1-2 days for minimally invasive total hip replacement
Your doctor may choose to keep you longer, if complications occur. In some cases, you may need to stay in a rehabilitation unit. The focus will be on regaining function.
At the Hospital
While you are recovering at the hospital, you may need to:
- Walk using a walker on the day after surgery.
- Be cautious. A fall can damage or dislocate the new joint. Do not try to walk without help.
- Take medication to prevent blood clots.
- Wear compression boots or stockings.
- Begin physical therapy to regain mobility and strength.
- Breathe deeply and cough 10-20 times every hour—This will decrease the risk of fluid build-up in the lungs. The fluid can cause pneumonia .
When you return home, do the following to help ensure a smooth recovery:
- Work with the physical therapist. You will learn how to move your hip and maintain proper alignment. You should also talk to your doctor and physical therapist about ways to prevent dislocations. Depending on your surgery, you may need to avoid crossing your legs, flexing your hips more than 90 degrees, and turning your feet very far inward or outward.
- Maintain a healthy weight . Obesity can increase wear on your new joint.
- Avoid jogging and other high-impact sports. This can also increase wear on the joint, cause it to loosen, and cause pain.
- Be sure to follow your doctor’s instructions .
Antibiotics may be needed before certain dental procedures or surgeries now that you have an artificial joint. This will prevent possible infections from entering the bloodstream. Make sure to let the dentist or doctor know that you have an artificial joint.
Within 6 weeks, you should be able to resume normal, light activities. A replacement hip typically lasts 10-15 years.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge around incision site
- Pain and/or swelling in the feet, calves, or legs
- Cough, shortness of breath, chest pain
- Severe nausea or vomiting
- Hip pain that you cannot control with the medications you have been given or that becomes worse
- Numbness, tingling, or loss of feeling in your leg, knee, or foot
In case of an emergency, call for emergency medical services right away.
American Academy of Physical Medicine and Rehabilitation
National Institute of Arthritis and Musculoskeletal and Skin Diseases
The Arthritis Society
Canadian Orthopaedic Association
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Antibiotic prophylaxis prior to dental procedures. American Dental Association website. Available at: https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis. Published September 14, 2017. Accessed February 8, 2018.
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Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. Surgical technique. J Bone Joint Surg Am. 2009 Mar 1;91 Suppl 2 Pt 1:50-73.
Questions and answers about hip replacement. National Institute of Arthritis, Musculoskeletal, and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Hip%5FReplacement/default.asp. Accessed February 8, 2018.
6/14/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T566765/Elective-total-hip-arthroplasty : Wilson SH, Wolf BJ, Algendy AA, Sealy C, Demos HA, McSwain JR. Comparison of lumbar epidurals and lumbar plexus nerve blocks for analgesia following primary total hip arthroplasty: a retrospective analysis. J Arthroplasty. 2017;32(2):635-640.
- Reviewer: EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
- Review Date: 03/2018
- Update Date: 06/14/2017