Total Hip Replacement
A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials.
What is a total hip replacement?
A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a “cup-shaped” component of the pelvis called the acetabulum. The ball is the head of the thighbone (femur). Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them with a metal (or ceramic) ball and stem inserted into the femur bone and an artificial plastic (or ceramic) cup socket. The metallic artificial ball and stem are referred to as the “femoral prosthesis” and the plastic cup socket is the “acetabular prosthesis.” Upon inserting the prosthesis into the central core of the femur, it is fixed with a bony cement called methylmethacrylate. Alternatively, a “cementless” prosthesis is used that has microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem. This “cementless” hip is felt to have a longer duration and is considered especially for younger patients. Total hip replacement is also referred to as total hip arthroplasty.
What will recovery be like for the patient after surgery?
A total hip joint replacement takes approximately two to four hours of surgical time. The preparation prior to surgery may take up additional time. After surgery, the patient is taken to a recovery room for immediate observation that generally lasts between one to four hours. The lower extremities will be closely observed for both adequate sensation and circulation. If unusual symptoms of numbness or tingling are noted by the patient, recovery room nurses are available and should be notified by the patient. Upon stabilization, the patient is transferred to a hospital room.
During the immediate recovery period, patients are given intravenous fluids. Intravenous fluids are important to maintain a patient’s electrolytes and replace any fluids lost during surgery. Using the same IV, antibiotics might be administered as well as pain medication. Patients also will notice tubes draining fluid from the surgical wound site. The amount and character of the drainage is important to the doctor and can be monitored closely by the nurse in attendance. A dressing is applied in the operating room and will remain in place for two to four days to be later changed by the attending surgeon and staff.
Pain-control medications are commonly given through a patient-controlled-analgesia (PCA) pump whereby patients can actually administer their own dose of medications on demand. Pain medications occasionally can cause nausea and vomiting. Antinausea medications may then be given.
Measures are taken to prevent blood clots in the lower extremities. Patients are placed in elastic hose (TEDs) after surgery. Compression stockings are often added, which help by forcing blood circulation in the legs. Patients are encouraged to actively exercise the lower extremities in order to mobilize venous blood in the lower extremities to prevent blood clots. Medications are often given to thin the blood in order to further prevent blood clots.
Patients may also experience difficulty with urination. This difficulty can be a side effect of medications given for pain. As a result, catheters are often placed into the bladder to allow normal passage of urine.
Immediately after surgery, patients are encouraged to frequently perform deep breathing and coughing in order to avoid lung congestion and the collapse of tiny airways in the lungs. Patients are also given a “blow bottle,” whereby active blowing against resistance maintains the opening of the breathing passages.
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