When the hip joint deteriorates — most commonly because of arthritis or injury — the resulting pain, stiffness and limitation of motion can be severe. The early and milder symptoms can often be controlled through medications, exercise and loss of excess weight. However, when symptoms — especially the pain — become so severe that they can no longer be fended off with medication and they interfere consistently with a person's quality of life and function, hip replacement surgery may be the best next step.
Although people in their late teens and in their nineties may have hip replacement surgery, the majority of those seeking hip replacement are in their sixties and seventies. This surgical procedure is most commonly offered after hip fracture or hip joint failure caused by osteoarthritis in older patients or rheumatoid arthritis in patients of any age. Osteoarthritis is thought to be caused by the wear and tear that comes from overuse or age, although there are genetic and perhaps nutritional contributions to this condition as well. When the cartilage that normally covers and cushions the ends of the bones wears thin, the hip bone rubs against the socket, causing pain and limitation in motion.
Rheumatoid arthritis is a chronic, autoimmune disease that causes inflammation of the joint lining (synovial membrane) and destruction and deformity of bone and cartilage. Other conditions that can severely damage a hip include avascular necrosis (an interruption in the blood supply to the hip, associated with corticosteroid medications, heavy alcohol use and trauma), traumatic arthritis, and any other condition associated with severe or chronic inflammation, such as psoriatic arthritis or a bacterial infection.
Also called hip arthroplasty, hip replacement surgery entails re-forming the hip joint. Usually, this means a total hip replacement, a procedure that is fairly straightforward. The hip is made up of a ball and socket joint. In total hip replacement, an orthopedic surgeon attaches a steel or ceramic ball to a stem that replaces the ball at the upper end to the femur, or thigh bone. The cup or socket of the pelvis is also replaced with a plastic-lined metal socket. Both implants can be fastened into the bone with a special cement. However, recently, the trend is to use an artificial joint (prosthesis) covered with a material that actually allows bone tissue to grow into the metal, forming a tight bond of scar tissue that anchors the metal to the bone. This is referred to as cementless total hip replacement.
Because total hip replacement is major surgery, there are risks involved. For one, because there are no ligaments to hold the components of the new hip together, a person must be careful the first few weeks after surgery to avoid positions that could dislocate the hip. However, with time, the body will make enough scar tissue to stabilize it. Also, there are the usual surgery-related risks: infection, blood clots in the leg veins or lungs, pneumonia, or anesthetic complications.
Even so, for most people, the results of such surgery are dramatic. Of the approximately 170,000 artificial hip joints implanted annually in the United States, the success rate for most experienced surgeons is well greater than 90 percent. Most patients are up and on their feet the day after surgery. The average stay in the hospital after surgery is four to five days, followed by an intensive inpatient or outpatient rehabilitation program for two to four weeks. Most people who undergo hip replacement surgery can expect to return to normal or near normal activities within six or eight weeks and without much pain.
Physical therapy may begin even before surgery to optimize strength and range of motion before surgery and to plan the rehabilitation program needed after surgery.
If your work requires a great deal of repetitive climbing or crawling, it may be necessary for you to modify your work activity or even change jobs. Competitive sports that stress the joint (such as running, basketball, singles tennis) are usually prohibited after total hip replacement. Otherwise, chances are that you will be able to return to work and other usual activities within a month or two of surgery. Not only can most people resume their normal lives, many can expect the quality of their lives to improve. You may find to your delight that activities that were once painful or prohibited — such as walking up and down stairs, sitting for any stretch of time, crossing your legs to tie your shoes, getting in and out of cars, or walking in the park with your grandchildren — can now be performed with little or no discomfort.
In most cases, today's artificial hips can last the life of the patient. The expectation with total hip replacement is that the replaced joint will last at least 10 to 15 years; in fact, experts estimate that 80 percent of replaced hips are still working well 20 years after surgery. However, if the patient is very young, revision arthroplasty, in which new components are implanted, may be necessary. Fortunately, with the new modular sockets, the socket can be changed without removing the other portions of the hip joint. If you have undergone arthroplasty, your doctor may want to evaluate you yearly to assess the condition of the joint.
In short, the new technology involving prosthetic devices for hip replacement, advances in surgical techniques and improved safety of anesthesia have diminished the risks associated with the operation and improved the immediate and long-term outcome of arthroplasty. Successful replacement of deteriorated, arthritic and severely injured hips can enhance mobility and comfort, promoting independent living for hundreds of thousands of people who would otherwise be substantially disabled.
