Total Hip Replacement

hip-joint-painWhat is a Total Hip Replacement?

A hip joint consists of two bones – the femoral head (the ball) and the acetabulum (the socket). Usually the joint is well lubricated and the one bone can slide against the other bone with minimal friction. However, with diseased hips, the cartilage covering the surface of the bone is worn away and we now have a situation in which the bones are rubbing against each other, causing pain and limiting movement.

Joints can be destroyed for a variety of reasons, but arthritis is the most common.

Total Hip Replacement is a surgical procedure which involves the removal of the diseased bone and the reconstruction of the anatomy with an artificial joint called a total hip prosthesis. The components of the prosthesis are designed to act like the normal joint. There is a femoral stem – a metal component that is placed into the thigh bone, and an acetabular cup- a plastic and metal component that is placed where the socket was.

There are two goals with Total Hip Replacement:

  1. Reduce or eliminate pain.
  2. To restore function by improving the movement of the joint.

Total Hip Replacement Surgery – What to Expect

Here you will find general information which would apply to most surgical procedures with Lakewood Orthopedic Surgery and Medical Group.

Blood Transfusion: Many patients who have a total hip replacement will require a blood transfusion. If you are donating blood for your surgery, you will be asked to donate one or two units of your own blood within 35 days prior to your surgery date. This will involve scheduling an appointment with the blood bank of the hospital, or if necessary, a blood donation facility recommended by your insurance carrier or one closer to where you live (for out­of­state patients). Only one unit of blood can be donated at a time, so you may need to come in for two visits. The blood is then stored until your operation. If you are unable to donate blood for whatever reason, donor blood will be used. Donor blood is carefully screened for communicable diseases, so you need not be concerned about the risk of disease transmission. The risk of hepatitis and HIV infection is extremely low. To our knowledge, disease transmission through use of donated blood has never occurred in any of our patients. However, there is no question that your own blood is the safest, so if you are able, we recommend that you donate blood for your surgery. If distance is a problem, arrangements can be made to have you give blood locally and transported here for your surgery. Please be assured that any unused blood that you give will be returned you.

Pre­-Admission Testing. Within two weeks before your surgery, you will be asked to undergo several laboratory tests and possibly an electrocardiogram and chest x-ray. Pre-­admission testing will indicate whether you have any conditions which might increase the risk of surgery. A regular physical examination, performed by your own medical doctor or hospital staff here, is also required.

Other “day of surgery” information: Your doctor may order x-­rays just prior to surgery. If not done previously, a physical examination will be done. If you have not already done so, you will be asked to sign an operative consent form to state that you understand what is being proposed and that you are in agreement that we may proceed with the operation. Just prior to surgery, an intravenous line will be started and you will be taken into the operating suite.

Anesthesia: You will see your anesthesiologist prior to surgery. He or she will ask you a few questions and will also answer any questions you might have. Most of our surgeries are performed under spinal anesthesia which is safer than general anesthesia and is much less disturbing to major body functions than general anesthesia. The anesthesiologist will administer medication which will make you sleepy and the spinal anesthesia will cause the surgical area to be totally numb during the surgery and for several hours after the surgery.

The Surgery: Your doctor will first remove all of the damaged bone and cartilage. The bone is next prepared for the prosthesis. Surgical tools are used to make precise cuts and to shape the bone so that the prosthesis will fit precisely. The artificial joint is then placed into the bone with or without bone cement (methylmetacrylate). With proper technique, this cement creates an immediate fixation of the prosthesis to the bone.

Your doctor may have chosen to use a fixation method called biologic fixation, wherein over time the bone and prosthesis grow together. Biologic fixation requires that the surface of the prosthesis next to the bone be porous.

Each method of fixation has both advantages and disadvantages which your doctor will have previously discussed with you. Your age, weight, activity level and other factors will factor into the decision.

Surgery Time Required: The actual surgery takes between two to three hours, depending on the complexity of the case.

Recovery Room: When your surgery is completed you will go to the recovery room where you will be closely monitored until the effects of the anesthesia and intraoperative medicines are decreased and you are relatively awake and comfortable.

Orthopaedic Unit: When you have completed your stay in the recovery room, you will be transferred to your hospital room in the orthopaedic nursing unit. You will be lying on your back in a comfortable position with a pillow between your legs so that you will not dislocate the hip replacement in this initial postoperative period. If your surgery is early in the morning, you may sit up on the edge of the bed that evening. In general, you will be out of bed within twenty­four hours and attending physical and occupational therapy. Your therapists will instruct and demonstrate to you how to use crutches and/or a walker and will also explain some important precautions necessary in the immediate post­operative period. Your physical therapist will of course be able to answer any of your questions and concerns.

Activity: As was discussed previous to your decision to have surgery, an artificial hip can never be as good as a normal hip. It will not tolerate the same kinds of physical stresses that the normal hip will tolerate and for that reason we strongly recommend against physical activity such as tennis, running, contact sports, or activities that might contribute to loosening of the hip through a physical process. One must be fully aware of the limitations of the hip prostheses before this surgery is elected.

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