About the ProcedureCare at Mediora

Overview

• Total hip arthroplasty (hip replacement) is a surgical procedure replacing damaged hip joint components with artificial prosthetic parts, restoring pain-free movement and function to severely arthritic or injured hips.
• The procedure involves removing diseased cartilage and bone from hip joint, replacing femoral head with metal or ceramic ball, inserting metal stem into femur, and placing artificial socket (acetabular component) in pelvis.
• Over 450,000 hip replacements performed annually in United States; considered one of most successful orthopedic surgeries with 95% of implants lasting 15-20 years, dramatically improving quality of life for patients with debilitating hip pain.

Why You Need Hip Replacement

• Osteoarthritis: Most common indication; progressive wear and tear causing cartilage deterioration, bone-on-bone friction, severe pain, stiffness, and loss of function despite conservative treatments including medications, injections, physical therapy.
• Rheumatoid Arthritis: Autoimmune inflammatory condition destroying joint cartilage and bone; causing pain, swelling, deformity; hip replacement indicated when disease activity controlled but irreversible joint damage limits function.
• Avascular Necrosis: Death of bone tissue from inadequate blood supply following hip fracture, steroid use, excessive alcohol consumption, or other causes; progresses to joint collapse requiring replacement before extensive bone loss occurs.
• Hip Fracture: Displaced femoral neck fractures in elderly patients often treated with hip replacement rather than fracture fixation due to high non-union rates, avascular necrosis risk, and desire for immediate weight-bearing.
• Severe Hip Dysplasia: Congenital hip abnormalities causing premature arthritis and instability; may require complex reconstruction with specialized implants addressing abnormal anatomy and bone deficiency.
• Failed Conservative Treatment: Persistent severe hip pain and disability despite 6-12 months of non-surgical management including anti-inflammatory medications, activity modification, weight loss, physical therapy, assistive devices, corticosteroid injections.

Key Advantages of Hip Replacement

• Pain Relief: Over 90% of patients experience dramatic reduction or complete elimination of hip pain; enabling comfortable walking, sleeping, sitting without chronic suffering that dominates daily life.
• Restored Mobility: Significant improvement in range of motion, walking distance, stair climbing ability; elimination of limp; ability to return to activities previously limited by pain including travel, recreational activities, social engagements.
• Enhanced Quality of Life: Dramatic improvements in physical function, emotional well-being, social interactions, independence; ability to resume work, hobbies, exercise without debilitating limitations.
• Proven Long-Term Success: Modern hip implants have 95% survival rate at 15 years, 90% at 20 years; most patients outlive their implants never requiring revision surgery.
• Rapid Recovery Protocols: Enhanced recovery pathways enable same-day or next-day discharge for appropriate candidates; walking within hours of surgery; return to normal activities within 6-12 weeks.
• Minimal Activity Restrictions: Modern implant designs and surgical techniques allow return to low-impact activities including walking, swimming, cycling, golf, dancing; many patients participate in tennis, hiking with surgeon approval.
• Prevention of Disability: Addresses progressive hip disease before severe muscle wasting, compensatory knee/back problems, cardiovascular deconditioning occur; maintaining independence and preventing need for assistive devices or wheelchairs.

Preparing for Hip Replacement

• Medical Optimization: Comprehensive pre-operative evaluation including blood tests, chest X-ray, ECG; optimization of chronic conditions including diabetes, hypertension, heart disease, lung conditions; dental evaluation treating any infections before surgery.
• Medication Management: Review of all medications with adjustments as needed; discontinue blood thinners, anti-inflammatory drugs, certain supplements per surgeon instructions; typically 5-10 days before surgery; continue essential cardiac, diabetes, thyroid medications.
• Pre-operative Education: Attendance at joint replacement class covering what to expect, pain management, physical therapy exercises, equipment needs, discharge planning; opportunity to ask questions and meet other patients undergoing procedure.
• Home Preparation: Arrange post-operative help for first 1-2 weeks; prepare home removing tripping hazards, installing grab bars, placing commonly used items at waist level; consider renting raised toilet seat, reacher/grabber tools, shower chair, long-handled shoe horn.
• Physical Conditioning: Pre-operative exercise program strengthening hip, knee, core muscles; improves post-operative recovery, reduces complications; weight loss if overweight; smoking cessation minimum 6 weeks before surgery.
• Pre-Admission Testing: Visit to hospital or outpatient center 1-2 weeks before surgery for final testing, nurse evaluation, anesthesia consultation; opportunity to address last-minute questions or concerns.
• Day Before Surgery: Take chlorhexidine shower removing bacteria from skin reducing infection risk; confirm nothing to eat or drink after midnight (except small sips of water with essential medications); arrive at hospital at designated time typically 2 hours before scheduled procedure.

How Hip Replacement is Performed

• Anesthesia: General anesthesia (asleep) or spinal/epidural anesthesia (awake but numb from waist down) plus sedation; choice based on patient preference, medical conditions, anesthesiologist recommendation; spinal anesthesia offers excellent post-operative pain control.
• Patient Positioning: Lying on back or side depending on surgical approach; careful padding protecting pressure points; positioning optimizes surgical access while preventing nerve injury or pressure injuries.
• Surgical Approach: Posterior (back of hip), anterior (front), or lateral approach depending on surgeon preference, patient anatomy, reason for surgery; each approach has advantages regarding muscle preservation, recovery speed, dislocation risk.
• Tissue Dissection: Careful layer-by-layer dissection through skin, subcutaneous tissue, fascia to reach hip joint; muscles either split, detached and repaired, or preserved between intervals depending on approach; meticulous hemostasis minimizing blood loss.
• Hip Dislocation: After exposing joint capsule, femoral head dislocated from acetabulum allowing full visualization of joint; damaged cartilage and diseased bone removed from acetabulum using specialized reamers achieving proper size and orientation.
• Acetabular Component Placement: Hemispherical metal shell press-fit into prepared acetabular bone; may be supplemented with screws for added stability; plastic or ceramic liner snapped into metal shell providing articulating surface.
• Femoral Preparation: Femoral head cut off with precision saw at predetermined level; femoral canal opened using broaches progressively increasing size until optimal fit achieved; trial components placed testing range of motion, stability, leg length.
• Femoral Component Implantation: Metal or ceramic femoral stem inserted into femur either press-fit relying on bone ingrowth or cemented using bone cement; femoral head (metal, ceramic, or oxidized zirconium) attached to stem recreating normal anatomy.
• Closure and Recovery: Joint reduced confirming stability and appropriate leg length; multilayer closure repairing muscles, fascia, subcutaneous tissue; skin closed with staples or sutures; sterile dressing applied; procedure typically lasts 1-2 hours.

What to Expect: Before, During, and After

• Day of Surgery: Arrive at hospital fasting; meet with surgical team and anesthesiologist; IV placement; pre-operative medications; family waits in designated area receiving periodic updates; surgery typically 1-2 hours; recovery room for 1-2 hours before transfer to room.
• Immediate Post-Operative: Awakening in recovery with surgical dressing, catheter (removed within 24 hours), compression devices on legs preventing blood clots; pain controlled with nerve blocks, IV medications, oral pain relievers; close monitoring of vital signs, blood counts, drain output.
• Same Day Mobilization: Physical therapy begins within 4-6 hours of surgery; assisted standing, walking few steps with walker; exercises taught to prevent stiffness, blood clots; progressive increase in walking distance and independence with each physical therapy session.
• Hospital Stay: Most patients hospitalized 1-2 days for enhanced recovery protocol; some may qualify for same-day discharge if meeting specific criteria including adequate pain control, independent mobility, strong support system at home.
• Pain Management: Multimodal approach using combination of medications including non-opioid analgesics (acetaminophen), anti-inflammatories, nerve pain medications, muscle relaxants, limited short-acting opioids; ice therapy; positioning; most patients report pain well-controlled with oral medications.
• First Week Home: Walking with walker or crutches; gradual increase in activity and independence; home health physical therapy or outpatient therapy begun; following hip precautions preventing dislocation; managing incision care, taking medications, performing exercises; most activities of daily living possible with adaptive equipment.
• Weeks 2-6: Progressive improvement in strength, endurance, range of motion; transition from walker to cane to independent ambulation; driving permitted typically 3-6 weeks based on pain control, narcotic use, reaction time; return to desk work possible 2-4 weeks; physical labor 8-12 weeks.
• Long-Term Recovery: Continued improvement up to one year post-surgery though majority of gains achieved within first 3 months; regular follow-up X-rays monitoring implant positioning; gradual return to desired activities; participation in low-impact exercise encouraged maintaining muscle strength and overall health.

Risks and Complications

• Infection: Occurs in 1-2% of cases; superficial wound infections treated with antibiotics; deep prosthetic joint infections often requiring surgical debridement, prolonged antibiotics, occasionally implant removal and staged revision; prevention includes prophylactic antibiotics, sterile technique, skin preparation protocols.
• Blood Clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE) occurring in 1-3% despite prophylaxis; prevention includes early mobilization, compression devices, anticoagulation medications; symptoms include leg swelling, chest pain, shortness of breath requiring immediate evaluation.
• Dislocation: Hip comes out of socket in 2-4% of cases particularly first 6-12 weeks post-surgery; risk factors include posterior approach, prior hip surgery, muscle weakness, non-compliance with precautions; usually treated with closed reduction under sedation though recurrent dislocation may require revision surgery.
• Leg Length Discrepancy: Operated leg slightly longer or shorter than opposite side occurring in 10-15% of cases; usually less than 1 cm well-tolerated; larger discrepancies causing limping or back pain managed with shoe lift; prevented with careful surgical technique, intra-operative measurements.
• Nerve Injury: Sciatic or femoral nerve stretch or direct injury occurring in less than 1% of cases; ranges from temporary numbness to permanent weakness; most cases resolve spontaneously over months though severe injuries may cause persistent deficits.
• Blood Loss and Transfusion: Average blood loss 200-500ml; transfusion needed in 5-15% of cases particularly in anemic patients; autologous blood donation or cell saver techniques reduce allogeneic transfusion; iron supplementation before and after surgery speeds recovery.
• Implant Wear and Loosening: Long-term complications developing after 15-20 years as implant components wear or bone-implant interface weakens; presents as progressive pain, clicking, instability; requires revision surgery replacing worn or loose components.
• Heterotopic Ossification: Abnormal bone formation around joint occurring in 5-10% of cases; usually asymptomatic though severe cases limit range of motion; prevention includes indomethacin or radiation therapy in high-risk patients.

Results and Outcomes

• Pain Relief: 90-95% of patients report excellent pain relief; residual mild discomfort during weather changes or with prolonged activity common though not limiting; vast majority completely satisfied with pain improvement.
• Function Restoration: Significant improvements in walking ability, stair climbing, putting on shoes/socks, getting in/out of car; hip range of motion typically 90-110 degrees flexion enabling most daily activities though extreme positions avoided.
• Quality of Life: Dramatic improvements across all quality of life measures including physical function, emotional well-being, social activities, work capacity, sexual function; patients report feeling "like new person" able to enjoy life again.
• Return to Activities: Walking, swimming, cycling, golf, dancing permitted and encouraged; tennis, skiing, hiking possible for experienced individuals after surgeon approval; high-impact activities like running, jumping discouraged due to accelerated implant wear.
• Implant Survival: Modern hip replacements have 95% survival at 15 years, 90% at 20 years, 85% at 25 years; younger, more active patients may require revision surgery during lifetime though improved implant materials extending longevity.
• Patient Satisfaction: 85-95% of patients report being satisfied or very satisfied with hip replacement outcome; high satisfaction correlates with appropriate patient selection, realistic expectations, successful rehabilitation, return to desired activities.
• Economic Impact: Most patients able to return to work; reduced medication costs; elimination of assistive devices; decreased healthcare utilization; hip replacement considered one of most cost-effective interventions in medicine improving quality-adjusted life years.