Hip Replacement Surgery

What to Expect Before, During, and After the Procedure

If hip pain is keeping you up at night and making it difficult for you to get up from chairs, stand, walk, or use stairs, a total hip replacement (THR) surgery may be a possible treatment option. The goal of a THR is to reduce hip pain and improve the motion in your hip. Here’s what to expect.

Before Surgery
In the weeks before you enter the hospital, your orthopaedic surgeon will order tests to make sure you are healthy enough for surgery.

• Blood tests measure your red blood cell count
• EKG measures your heart 
• Urine tests for infection and pregnancy
• X-rays check your lungs

Certain problems, like diabetes, may slow the healing process, so have your complete medical record available. Also, certain medications, like blood thinners and anti-inflammatory medications, may result in excessive bleeding and may need to be stopped at a determined time before surgery. It is common for your surgeon and your primary care provider to work together in this pre-operative medical evaluation.

Your choice of anesthesia is important. An anesthesiologist will be there to discuss your options, such as general anesthesia versus a regional or spinal anesthesia.

Surgery Techniques
Your surgeon has many good techniques to choose from. They include: 

• Traditional Hip Replacement: The typical hip replacement procedure uses one of two approaches performed through similar incisions located on the upper thigh and buttock. One is called a posterior-lateral approach (posterior means rear) and the other is the anterior-lateral approach (anterior means front).
  
• Minimally Invasive Techniques: The term refers to approaches using smaller incisions combined with traditional approaches, as well as, to alternate surgical approaches employing smaller incisions or sometimes two incisions.
• Single incision techniques for minimally invasive surgery include:
• The Anterior Approach. Anterior means front. So this technique uses one small incision on the front of the upper thigh. The technique is sometimes called the “true anterior approach” to distinguish it from the anterior-lateral approach discussed earlier and in the next sectino that accesses the hip nearer the side of the thigh rather than at the front. 
• The posterior-lateral and anterior-lateral approach. These are traditional approaches described above using smaller incisions and special instruments to facilitate the procedure through these incisions.
• Two-incision techniques use one opening nearer the front of the thigh to insert the socket part of the implant, and a separate small incision toward the back of the thigh to insert the stem of the implant.

As with any surgery, each of these techniques poses some risks. Recovery takes time and hard work. The life of a new joint depends on weight, activity level, age, and other factors. Each patient responds differently. The most common adverse events following hip arthroplasty include dislocation, leg length discrepancy, failure to improve all pain, bone fracture, change in component position, infection, loosening, and tissue reaction.

The Surgery
Your hip joint is made up of two parts: the socket, in your hip or pelvic bone, and the ball, at the top of your upper leg bone (femur).

Your surgeon perform the planned approach and will reshape the socket to fit the new cup implant that replaces your diseased socket. After the socket is reshaped, a new cup will be placed in the socket. The cup usually consists of a metal shell and a polyethylene or metal liner.

Your surgeon then prepares your femur for the femoral stem, which will hold the new ball part of your hip joint. The head of your femur is removed and the bone is prepared for the new femoral stem. Your surgeon will most likely use a trial implant to verify the correct fit.

After your permanent hip stem is implanted, the ball that sits at the top of the femoral stem will be put into place.

Once your surgeon is satisfied with the position and movement of your new hip joint, it will be flushed with cleansing fluid and closed.

After Surgery and in the Hospital
Following surgery, you will be sent to the recovery room where your health care team will monitor your heart rate, blood pressure, and respiration. You will be given pain medication, by various means depending on your surgeon's plan.

The goal of your inpatient hospital stay is to prepare you for discharge from the hospital. During this period, all the people involved in your care—your nurse, your therapists, your surgeon and your discharge planner—will meet to discuss your progress and where you should go after the hospital.

Leaving the Hospital
Your surgeon will help you decide whether you should return home after surgery or go to an inpatient rehabilitation center.

Next: Anterior Approach Surgery