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Dr. Stephen J. Incavo

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Total Hip Replacement

Normal Anatomy :: Total Hip Replacement THR
Revision Hip Replacement

Normal Anatomy of the Hip joint

How does the hip joint work?
Find out more in this web based movie.

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Total Hip Replacement

 

Introduction

Total hip replacement (THR) surgery may be indicated to treat an arthritic hip that has not responded well to conservative, nonsurgical treatment.  It is proving one of the most effective procedures to restore function and relieve pain in those suffering from degenerative joint conditions like arthritis, also known as osteoarthritis.

 

Arthritis

Arthritis is a general term covering numerous degenerative joint conditions causing the joint surface (cartilage) to wear out. The joint surface is covered by a smooth articular surface that allows smooth, pain free movement in the joint. This surface can wear out for a number of reasons, often the definite cause is not known. When the articular cartilage wears out, the bone ends rub on one another and cause pain. There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always, it affects people as they get older (Osteoarthritis).

Other causes include

  • Childhood disorders such as hip dysplasia, Perthe’s disease, slipped epiphysis 
  • Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
  • Trauma (fracture)
  • Increased stress such as overuse, excessive weight
  • Avascular necrosis (loss of blood supply)
  • Infection
  • Connective tissue disorders
  • Inactive lifestyle
  • Inflammation such as that which is caused by rheumatoid arthritis

In an Arthritic Hip

  • The cartilage lining is thinner than normal or completely absent
  • The degree of cartilage damage and inflammation varies with the type and stage of arthritis
  • The capsule of the arthritic hip is swollen
  • The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
  • Bone spurs or excessive bone may build up around the edges of the joint
  • The combination of these factors make the arthritic hip stiff and limit activities due to pain or fatigue

Diagnosis

The diagnosis of osteoarthritis is made after a thorough review of patient history, a physical examination and X-ray or other diagnostic imaging. 

 

Indications

THR is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatment.

THR may be indicated when:

  • Arthritis is confirmed on X-ray
  • Pain fails to respond to analgesics or anti-inflammatory medication
  • Daily living including leisure activities, sport or work become limited
  • Stiffness in the hip limits mobility difficult
 

Benefits

Prior to surgery patients may be required to try simple analgesics, weight loss, anti-inflammatory medications, activity modification, physiotherapy.

The decision to proceed with THR surgery is a cooperative one between patient, surgeon, family and primary care physician/family doctor. Benefits of surgery include:

  • Reduced hip pain
  • Increased mobility and movement
  • Correction of deformity
  • Equalization of leg length (not guaranteed)
  • Increased leg strength
  • Improved quality of life, ability to return to normal activities
  • Sleep/rest without pain
 

Pre-operation

  • Your surgeon will send you for routine blood tests and any other investigations required prior to your surgery
  • You will asked to undertake a general medical check-up with a physician
  • You should have any other medical, surgical or dental problems attended to prior to your surgery
  • Make arrangements around the house prior to surgery
  • Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
  • Cease any naturopathic or herbal medications 10 days before surgery
  • Stop smoking as long as possible prior to surgery
 

Day of your surgery

  • You will be admitted to hospital usually on the day of your surgery
  • Further tests may be required on admission
  • You will meet the nurses and answer some questions for the hospital records
  • You will meet your anesthesiologist
  • You will be given hospital clothes to change into and have a shower prior to surgery
  • The operation site will be shaved and cleaned
  • Approximately 30 minutes prior to surgery, you will be transferred to the operating room
 

Surgical Procedure

 

Activities Following Hip Replacement Surgery

 

Risks and complications

 

Specific complications 

 

Summary

Surgery can be intimidating, but for those suffering from arthritis it can mean the difference between leading a higher quality of life or living a limited one with a debilitating condition. Surgery can be part of an effective treatment plan, restoring function to damaged joints, relieving pain and enabling a more active, healthier lifestyle.

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