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Total Hip Replacement Surgery

Your hips work hard throughout your life and during your daily routine. Arthritis of the hip can make it hard for you to perform everyday tasks, walk and enjoy recreational activities. If your arthritis is severe, you may begin experience pain when you are sitting down or trying to sleep.

In the total hip replacement procedure, the prosthesis is made up of two major parts. The femoral component is a metal stem with a ball on the end and replaces the top of the femur or thigh bone. The acetabular component replaces the socket side of the joint and is made of a metal cup and usually a plastic liner.

Before you are taken to the operating room you will be given medication to help you relax, and the anesthesiologist will talk with you about the medications he will be using. In the operating room, you will be placed under full anesthesia.

Once you are anesthetized, the surgeon will begin by making an incision to allow access to the hip joint. He will then expose the joint and place a cutting jig or template on the end of the femur, or thigh bone. This jig allows the surgeon to cut the bone precisely so that the prosthesis fits exactly. Once the femur is cut, the inside of the bone will be prepared so that it closely matches the shape of the femoral stem your surgeon has selected. Then the socket portion of the pelvis is prepared with cutting tools so that the metal cup will fit exactly.

Click below to view a movie of how the total hip implant components work together...

The implants are next placed. This usually begins with the acetabular component. This is most often put in a "press fit" method without use of cement. The femoral component is placed next. This is also placed by "press fit" but sometimes bone cement will be used. The cement is an acrylic cement called Polymethylmethacrylate (PMMA). This cement has been used successfully by orthopedists for over 25 years. It is a strong material, well-tolerated by the body and sets or cures within 15 minutes after it is mixed. Before curing, the cement is pressure-injected and the femoral stem is placed.

When the implants are able to be affixed to the bones without cement, special surgical instruments are used to precisely prepare the bones so as to enable a press fit. To supplement this joining, supportive screws or pegs are often used. Bone is a living and growing tissue. An implant can be coated with metallic beads to form a porous covering and when placed in very close contact to living bone, tissues can grow into the pores, further locking the implant in place. Porous-coated hip prostheses have been used for many years and have shown excellent results in many patients.

After implanting the prosthesis, both leg length and stability is evaluated. Finally, the incision is closed and a drain may be placed.

Click below to view an animation of the total hip replacement procedure...

Returning Home

Physical therapy will be performed to not only get you walking again but will show you exercises and precautions for your hip replacement. You will be discharged when you can get out of bed on your own and walk with a walker or crutches with little or no assistance. You may be discharged to home, inpatient rehabilitation or a skilled nursing facility.

After leaving the hospital, you will advance weight bearing as instructed and begin using a cane when instructed by your therapist or doctor. You will continue the hip precautions as instructed for a total of 3 months after the surgery. Showering and wound care should be done based on instructions given by your surgeon. Increased redness drainage or pain should be reported to your surgeon.

You will continue your home exercise program and maygo to outpatient physical therapy, where you will work on an advanced strengthening program and such programs as stationary cycling, walking, and aquatic therapy.

Your long-term rehabilitation goals are walking without any assistive devices, mild or no pain with walking or other functional activities, and independence in all activities of daily living.