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Learning About Total Hip Replacement Surgery

Normal hip and total hip replacement

What is total hip replacement surgery?

During total hip replacement surgery, your doctor replaces the worn parts of your hip joint with artificial parts made of metal, ceramic, or plastic.

You may want this surgery if you have hip pain and trouble moving that you can't treat in other ways. Osteoarthritis or rheumatoid arthritis can cause these types of problems. Another cause is bone loss due to a poor blood supply.

Hip replacement is sometimes done after a hip fracture.

How is this surgery done?

In traditional hip replacement surgery, your doctor makes a 15- to 25-centimetre cut (incision) on the side or the back of your hip. Some muscles and other soft tissues, such as ligaments, are cut so the doctor can get to the hip joint.

Hip replacement can also be done with one or two smaller cuts. This is called minimally invasive surgery. It may cause less blood loss and a smaller scar. But it can also mean a longer time in surgery, because the surgery is harder to do. And if the new hip can't be fitted properly through the smaller cut, the doctor may have to make a larger opening.

A newer type of surgery is done through a small incision in the front (anterior) of the hip. Anterior surgery causes less damage to muscles and other soft tissues than getting to the hip joint from the side or the back. It may help you heal faster and get back to activity sooner.

Anterior surgery and minimally invasive surgery require special training and equipment. Your doctor can explain your options and help you understand the risks and benefits of each type of surgery.

You will get medicine to make you sleep during the surgery. After making the incision, your doctor will:

  • Remove the worn bone tissue and cartilage from the hip joint.
  • Replace the ball at the upper end of your thigh bone (femur).
  • Replace your hip socket with a shell and liner.
  • Fit the ball into the shell and liner to make a new hip joint.

Surgery may take 1 to 3 hours.

There are two kinds of replacement joints.

  • Cemented joints. The cement fits between the new joint and the bone.
  • Uncemented joints. These have a metal coating with many small openings. The bone is shaped to fit the new joint almost perfectly. But there are some small spaces. Over time, the bone grows to fill these small openings.

Sometimes, a doctor will use a cemented ball and an uncemented socket.

Your doctor can tell you which type of new hip joint is best for you.

What can you expect after a total hip replacement?

Your doctor will let you know if you will stay in the hospital or if you can go home the day of surgery. The physiotherapist will show you how to move safely before you leave the hospital. You will also learn exercises to help you get stronger.

You may need physiotherapy for several weeks after you leave the hospital. At home you'll keep doing the exercises you learned.

You will be able to move around with crutches or a walker. But for a while you will need someone who can help you day and night. If you need more extensive rehab, you may go to a specialized rehab centre for more treatment.

Your doctor will give you information about what to expect after surgery. How long it takes to recover will depend in part on the type of surgery you have.

After traditional surgery, you will slowly return to most of your activities.

  • You will need to use crutches or a walker for the first few weeks after surgery.
  • Your doctor will tell you when you can drive again.
  • You may be able to go back to work in 4 weeks to 4 months. It depends on your job.
  • Your doctor will tell you when you can do activities like swim, dance, golf, or bicycle.
  • You may need to avoid some strenuous activities. These may include running, horseback riding, tennis, and any type of skiing.
  • For most people it is safe to have sex about 4 to 6 weeks after the surgery.

It usually takes 3 to 6 months to get back to full activity after traditional surgery. You may recover faster if you have minimally invasive or anterior surgery.

After you recover from surgery, you may have much less pain than before and a better quality of life.

Most artificial hip joints last for 10 to 20 years or longer. It depends on your age, how much stress you put on the joint, and how well your new joint and bones mend. Your weight can make a difference. Every extra kilogram of body weight adds 3 kilograms of stress to your new hip joint. Controlling your weight can help your new hip joint last longer. It should also last longer if you avoid hard physical work and sports that stress the joint.

Your doctor may want to see you about once a year to see how you and your new hip are doing.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

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