Hip replacement

Hip replacement is a surgical treatment that replaces a severely damaged hip joint with a prosthesis (an artificial body part). This type of surgery is often recommended to people with painful conditions of the hip that have not responded to more conservative nonsurgical treatments. Osteoarthritis, also known as wear-and-tear arthritis, is the most common reason for hip replacement surgery.

Other conditions successfully treated with hip replacement include rheumatoid arthritis, post-injury arthritis, broken hip, torn cartilage and ligaments and other rare, destructive joint diseases. All of these problems can lead to irreversible damage to the hip joint that can be repaired only with surgery. The American Academy of Orthopaedic Surgeons (AAOS) reports that more than 285,000 people undergo total hip replacement surgery (known as arthroplasty) each year.

Conditions treated

  • Osteoarthritis – The most common arthritis that affects the hip, osteoarthritis is caused by the slow and steady degeneration and thinning of the smooth articulate cartilage that covers the surfaces of the hip joint. Healthy cartilage makes it possible for hip joints to have a normal, pain-free range of motion and function that allows them to glide smoothly in their sockets. When osteoarthritis develops, it breaks down the cartilage and narrows the space in which the joints move, causing pain, inflammation and limited range of motion. Osteoarthritis can interfere with your ability to work, as well as limit your daily activities and quality of life. The hip and the knee are the joints most affected by osteoarthritis because they help carry our body weight. As a result, they are prime candidates for the slow and steady wear and tear of this potentially debilitating joint disease.
  • Rheumatoid arthritis – This type of arthritis is one of more than 100 rheumatic diseases (diseases that affect the joints and their connective tissues such as muscles, tendons and ligaments). It is a chronic autoimmune, systemic disease that can cause inflammation of multiple joints in your body. Autoimmune diseases occur when your body is attacked by its own immune system. Inflammation from rheumatoid arthritis can become so severe that the joints are swollen and deformed, making it difficult to move them.
  • Post-traumatic arthritis – This type of arthritis can develop years after a hip injury or fracture even though you received the proper treatment for the injury and fully recovered from it.
  • Avascular necrosis – A hip injury like a dislocation or fracture may limit the blood supply to the femoral head (the end of the thighbone that is part of the hip joint). This is called avascular necrosis. The lack of blood may cause the bone surface to collapse, resulting in arthritis. Some diseases also can cause avascular necrosis.
  • Childhood hip disease – Some infants and children have hip problems. Even though the problems may have been treated successfully at the time, they still may cause arthritis later in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

Surgery

In a total hip replacement surgery (also called total hip arthroplasty), your surgeon removes the damaged bone and cartilage and replaces them with prosthetic components:

  • Metal stem – The damaged head of the thighbone (femoral head) is removed and replaced with a metal stem that is inserted into the hollow center of the femur. Your surgeon may cement or "press fit" the femoral stem into the bone.
  • Metal or ceramic ball – This ball is placed on the upper part of the stem to replace the damaged femoral head that was removed.
  • Metal socket – Your surgeon removes the damaged cartilage surface of the hip socket (acetabulum) and replaces it with a metal socket.
  • Spacer – A plastic, ceramic or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

Animated video: Total hip replacement

Minimally invasive surgery

To perform traditional total hip replacement surgery, your surgeon makes a 10- to 12-inch incision on the side of the hip. For minimally invasive total hip replacement surgery, your surgeon makes two much smaller incisions: a two- to three-inch incision over the groin for placement of the socket and a one- to two-inch incision over the buttock for placement of the stem. The AAOS reports that the benefits of minimally invasive hip replacement surgery for the patient include:

  • Less pain
  • Cosmetically pleasing incisions
  • Less muscle damage
  • Faster rehabilitation
  • Shorter hospital stays

Animated video: Anterior hip replacement


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Recovery

According to the National Institutes of Health (NIH), full recovery from hip replacement surgery takes three to six months, depending on your overall health and the success of your rehabilitation. Many doctors recommend avoiding high-impact activities such as basketball, jogging and tennis. Recommended exercises are walking, stationary bicycling, swimming and cross-country skiing. These forms of exercise can increase muscle strength and cardiovascular fitness without injuring your new hip.

The multidisciplinary team of joint replacement experts at Northwell Health Orthopaedic Institute performs hip replacement surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the joints and connective tissues.

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Patient story - Anterior approach to hip surgery

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