What is hip replacement?
 
Hip replacement, also called arthroplasty, is a surgical procedure to replace a damaged hip with a prosthesis (an artificial joint).  This surgery may be considered following a hip fracture (breaking of the bone) or for someone who has severe arthritis. It is a metal and plastic covering for raw, arthritic bone ends. It replaces cartilage that has worn away over the years. Hip replacement can eliminate pain and allow you to move easily with less discomfort.

More than 234,000 artificial hip replacement surgeries are performed yearly. Hip replacement may become necessary if activities such as walking, sitting, or even resting become painful.

The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged and to relieve hip pain that cannot be controlled by other treatments.

Who should have a hip replacement?
 
The most common condition that results in the need for hip replacement surgery is arthritis. Osteoarthritis, a degenerative, joint disease that affects mostly middle-aged and older adults, causes the breakdown of joint cartilage and adjacent bone in the hips. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, can cause damage to the articular cartilage of the hip.

Persons with severe degenerative joint disease may be unable to do normal activities that involve bending at the hip, such as walking or sitting, because they are painful.

Also, hip replacement is one method of treating a hip fracture. A fracture is a traumatic event that may result from a fall. Pain from a fracture is severe and walking or even moving the leg is difficult.

Other conditions that may cause hip joint degeneration and require hip replacement include infections and hip deformities.

The decision to replace the painful hip with an artificial one is a decision made by the patient and physician. Other alternative treatments may first be used, including: 

• anti-inflammatory medications
• pain medications
• limiting painful activities
• assistive devices for walking (such as a cane)
• physical therapy

Is there an alternative to hip replacement?
 
Hip replacement is only recommended after careful diagnosis of your joint problem. It is not likely that anti-inflammatory drugs or cortisone injections will give you the same long-term relief that hip replacement will.

Should my hip replacement be cemented?
 
Hip replacements are successfully performed with all cemented components as well as with a combination of uncemented and cemented components. Your surgeon will discuss which technique is best for you.

What happens after surgery?

Hip replacement surgeries usually require an in-hospital stay of several days. While in the hospital, the patient generally begins physical therapy exercises to regain range of motion and strength in the hip. Physical therapy will continue at home. Pain medication also will be administered to keep the patient comfortable.

The incision will have stitches or staples that will be removed after a few weeks.

Making certain modifications to your home may help you during your recovery. These modifications include the following:

• proper handrails along all stairs
• safety handrails in the shower or bath
• shower bench or chair
• raised toilet seat
• stable chair with firm seat
• cushion and firm back with two arms, which will allow your knees to be positioned lower than your hips
• long-handled sponge and shower hose
• dressing stick
• sock aid
• long-handled shoe horn
• reaching stick to grab objects
• firm pillows to raise the hips above the knees when sitting
• removing loose carpets and electrical cords that may cause you to trip

The average hospital stay for a hip replacement patient is around 3-5 days. In some cases, fixing one hip reduces the stress on the other hip, thus giving another two or three years if the arthritis is not too advanced. Each individual case is different.

How long is recuperation?
 
Recovery varies with each person. You will use a walker for approximately 4 weeks after the operation. You can drive a car in 2-4 weeks. Most people gradually increase their activities and may play golf, doubles tennis, shuffleboard, or bowl in 12 weeks. More active sports, such as singles tennis and jogging are not recommended.
 
After discharge, there is usually no need for a nursing home. Some patients who live alone may require a short stay at a rehab center for a few days after they leave the hospital. This will depend on how you progress in the hospital, and keep in mind that healing and recovery times vary with each person.

Will I need a blood transfusion?
 
The need for blood transfusions after hip replacement surgery depends greatly on very individualized factors. The majority of hip replacement patients do not require a transfusion after surgery. Some patients may want to donate their own blood prior to surgery for use after surgery. Your surgeon will be happy to discuss these issues with you.