For a step-by-step animated view of hip replacement surgery, visit All About Arthritis and click "View Animation" for each part of the procedure. Animation courtesy of DePuy/Johnson & Johnson.

The hip joint is where the top of the femur (thigh bone) meets the acetabulum (the socket of the pelvic bone). The top of the femur is ball-shaped and fits snugly in the socket formed by the acetabulum.

Each bone end of the joint is covered with a layer of smooth, shiny cartilage that cushions and protects while allowing near frictionless movement. Cartilage, which contains no nerve endings or blood supply, receives nutrients from the fluid contained within the joint. Surrounding the hip joint is the synovial lining, which produces this moisturizing lubricant. Tough fibers, called ligaments, link the bones of the hip joint and hold them in place while adding strength and elasticity for movement. Muscles and tendons also play an important role in keeping the hip joint stable and mobile.

What Causes Hip Pain

The largest cause of hip pain is arthritis. Three common types of arthritis can result in joint damage: osteoarthritis, rheumatoid arthritis, and trauma-related arthritis. Osteoarthritis, most common in people over sixty, is a disease which affects the tissues that allow joints to move smoothly. The layers of cartilage and synovium become damaged and as they wear away and the bones are left unprotected to rub against each other. With rheumatoid arthritis, the body’s immune system produces a chemical which targets and then destroys the synovial lining, the cartilage, and joint surface also resulting in joint pain and loss of mobility.

This disease can affect any age group however females more often than males. In the third group, arthritis is developed in a joint which sustained trauma and also results in joint damage, pain, and loss of mobility.

Total Hip Replacement

When conservative treatments fail to provide adequate relief to hip pain, a total hip replacement is considered. This surgical procedure consists of using two artificial components to take the place of the joint. The femoral (thigh) component is made of metal and replaces the ball. The acetabular component replaces the socket and may be made of a medical plastic called polyethylene or a combination of plastic and metal. The acetabular component is then secured inside the natural pelvic socket.

During surgery, the natural ball portion of the femur (thigh bone) is removed and the inside of the femur (the hollow canal) is drilled and enlarged to fit the femoral component of the hip prosthesis. To make room for the new artificial socket component, the socket portion of the pelvis is also enlarged with a special surgical instrument. The femoral component is inserted down the enlarged shaft of the thigh bone. The acetabular component is inserted into the enlarged socket. The ball and socket are then fitted together and stabilized with the surrounding ligaments and muscles. Staples are used to close the incision and are removed two weeks following surgery.

Preparing for Surgery

It may be necessary for an additional medical evaluation by your own family physician depending on any preexisting health conditions. If you are a smoker, it is advisable for you to stop two weeks prior to surgery. This will help your hip to recover faster. Certain medications may also be stopped two weeks before surgery as advised by the surgeon. Patients in good health may be asked to donate two units of their blood to be used following surgery if necessary.

After midnight on the night prior to your surgery, you cannot eat or drink anything.

What To Expect After Surgery

A plastic drain will be coming through the surgical dressing to remove any blood that accumulates in the surgical area. The drain will probably be removed on the second day after surgery. The dressing will also be changed and a smaller one applied.

An IV may remain in your arm for two to three days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon. You may be given a “pain pump” or PCA-patient controlled anesthesia pump for the first 1 to 2 days after surgery (see Medication/Pain Control below).

After the acute pain has diminished, usually the day after surgery, a physical therapist will help you begin standing and walking again. If cement has been used, a walker or crutches will be required for three to four weeks followed by three to four weeks with a cane. If cement has not been used, a walker or crutches will be required for four to six weeks followed by four to six weeks with a cane.

Most patients can return home four to eight days following surgery.

Physical Therapy

Your hip rehabilitation program will begin the day after surgery and will be monitored by a physical therapist. Exercises will be demonstrated that need to be done each day.

Medication/Pain Control

It is normal for you to have some discomfort. You may be given a “pain pump” or PCA-patient controlled anesthesia pump for the first 1-2 days after surgery. This device delivers pain medicine into your IV when you want it. You push a button and the medicine is delivered (usually morphine or Demerol). Your surgeon orders the pump set so that you only receive the appropriate amount of medicine needed. The pump is usually set to deliver medicine up to every 8 minutes. Or if you don’t want to bother with pushing the button, the pump can be set to deliver medicine automatically on a set schedule determined by your doctor. As soon as you are eating well, your doctor will switch from IV medicine to pain pills that you take by mouth. This is usually done on the first or second day after surgery. You will receive a prescription for pain medication before leaving the hospital.

Going Home

Prior to your discharge instructions for what to do at home will be given. Adhere to all precautions until your follow-up visit ten to fourteen days following surgery.

If you see any of the following, contact your surgeon immediately: drainage and/or foul odor coming from the incision, fever of 101 degrees or higher for two days, or increased swelling, tenderness, redness, and/or pain.

Resuming Activities

Returning to a sedentary or office job may be possible as soon as three to six weeks following surgery. A job requiring prolonged walking, standing, or lifting may need a full three months of recovery first. Some types of work, such as construction, may not be advised with your new hip.

After three months, general walking, riding a bicycle, and swimming are encouraged physical activities. Dancing, golf, and bowling are also permitted. Vigorous sports such as any contact sports, running, racquet sports, and skiing are not recommended at any time because it puts too much stress on the new hip.

Driving is usually possible once full weight-bearing on the leg is achieved. Caution should be taken getting in and out of the car.

Special Instructions

Follow-up to remove staples will be scheduled for ten to fourteen days following surgery. Another follow-up to see progress will be scheduled four to six weeks following surgery. Other follow-ups which may continue for as long as a year after surgery, will be scheduled depending on progress.

Alert your dentist that you have a hip replacement before any surgical work. Because bacteria can enter the blood stream and cause an infection, antibiotics will need to be prescribed before the procedure.

Download: Antibiotic coverage for total joint replacements

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