Hip

Replacement of the hip joint has become a common operation due to the advances in surgery and the quality of artificial joints. About 15,000 hip replacements procedures are performed in Australian and New Zealand every year.

The hip joint is a ball and socket joint that connects the top of the thigh bone (femur) to the pelvic bone (acetabulum). It is held together by muscles, tendons and ligaments. The inside of the joint has a smooth protective covering of cartilage that assists smooth movement. When the joint is diseased or damaged, this cartilage cushion can wear away, allowing the bone of the head of the femur to rub directly against the acetabulum. This leads to pain, stiffness, limping and muscle weakness.

How is the diagnosis made?

A complete history and physical examination allows the physician to determine any correlation between symptoms of pain with past history and demands that have been placed upon the hip. The physician will enquire about experiencing episodes of trauma or instability, and examine the ligaments and hip alignment. X-rays are used to determine the extent of degeneration to the cartilage or bone and may suggest a cause for the degeneration of the hip joint. Blood tests and joint aspiration (removing a small amount of fluid from the affected hip joint) may be required to rule out systemic arthritis (such as Rheumatoid Arthritis) or infection in the hip if there is reason to believe that other conditions are contributing to the degenerative process.

How do I prepare for a hip replacement?

Preparing for a total hip replacement often begins several weeks prior to the actual surgery. Emphasis is placed upon the individual maintaining good physical health before the operation. Upper body strength becomes important for the ability to use a walker or crutches after the operation.

How is the procedure done?

During surgery, once the hip joint is exposed, the head and neck of the femur are removed. The shaft of the femur is then reamed to accept the metal component consisting of the head, neck, and stem. The acetabulum is then reamed to accept a plastic cup. The ball and socket are then replaced into normal position. Both of these implants can be fastened into the bone with or without special cement.

This type surgery is technically more sensitive, requiring a more exact fit of the metal component to the femur. In this procedure, the surface of the metal is prepared with a small porous roughened coat, which attracts bone in growth. This process is called porous ingrowth or osteointegration.

In general, the artificial joint implants used in the non-cemented procedure are larger than those used with cement but are still proportional to the size of the individual bone. Since their introduction, many different devices using cementless fixation have been used with the hope that these implants will maintain their attachment to bone for a longer period of time.

Other types of hip replacement procedures

There are other types of hip replacement procedures:

What are the risks and complications?

As with all major surgical procedures, complications can occur. Some of the most common complications following hip replacement are:

What you can expect after a hip replacement

New technology involving the implants for artificial hip replacement and advances in surgical techniques has improved the immediate and long-term outcome of the surgery. Generally today's artificial hips can last a lifetime. However, if the person is very young, the plastic can wear out. Fortunately, with the new socket implants for the pelvis, the socket can be changed without removing the other portions of the hip joint. The person with a hip replacement may be able to take part in physical activities that were impossible before surgery.

Most individuals following hip replacement surgery are able to return to work within a month or two of surgery. Yet, some individuals that are exposed to work requiring a great deal of repetitive climbing or crawling, may find it necessary to change jobs. Overall, many find that the activities that were once painful such as climbing up and down stairs, sitting for extended periods of time, and getting in and out of cars can now be performed with less pain.

* Source: Your Medical Source; Hip Diagrams: Australian Orthopaedic Association

Please remember that medical information provided by Brisbane Orthopaedic and Sports Medicine Centre, in the absence of a visit with a physician, must be considered as an educational service only. The information contained in this web site should not be relied upon as a medical consultation. This web site is not designed to replace a physician's independent judgement about the appropriateness or risks of a procedure for a given patient.