The hip is essentially a ball and socket joint, linking the "ball" at the head of the thigh bone (femur) with the cup-shaped "socket" in the pelvic bone. A total hip prosthesis is surgically implanted to replace the damaged bone within the hip joint.
The total hip prosthesis consists of three parts:
- A cup that replaces your hip socket. The cup is usually plastic, although some centers are trying other materials like ceramic and metal.
- A metal or ceramic ball that will replace the fractured head of the femur.
- A metal stem that is attached to the shaft of the bone to add stability to the prosthesis.
If the surgery is a "hemi-arthroplasty," the only bone replaced with a prosthetic device is the head of the femur.
You will receive an extensive pre-operative evaluation of your hip to determine if you are a candidate for a hip replacement procedure. Your health care provider will assess the degree of disability, impact on your lifestyle, and pre-existing medical conditions. The health care provider will also evaluate your heart and lung function.
The surgery will be performed using general or spinal anesthesia. The orthopedic surgeon makes an incision, often over the buttocks, to expose the hip joint. The head of the femur is cut out and removed. Then, the hip socket is cleaned out and a tool called a reamer removes all of the remaining cartilage and arthritic bone.
The new socket is implanted, after which the metal stem is inserted into the femur. The artificial components are fixed in place, sometimes with a special cement. The muscles and tendons are then replaced against the bones and the incision is closed.
You will return from surgery with a large dressing on the hip area. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area. Many surgeons also place a knee immobilizer or special pillow between the legs in the operating room to prevent the hip from dislocating.
You will experience moderate to severe pain after surgery. However, you may receive patient-controlled analgesia (PCA), intravenous (IV) analgesics, or epidural (via the spinal cord) analgesics to control your pain for the first 3 days after surgery.
The pain should gradually decrease, and by the third day after surgery, oral analgesic medications may be sufficient to control your pain. Try to schedule your pain medications about one half hour before walking or changing position.
You will also return from surgery with several IV lines in place to provide fluids and nutrition. The IV will remain in place until you are drinking adequate amounts of fluids.
If the procedure is elective (i.e., planned in advance rather than in response to an injury), you can donate blood several weeks prior to surgery to replace any blood lost during the procedure.
Sometimes, the blood that is drained from the wound during surgery is collected in a special sterile container to be re-infused through an IV after surgery.
You will also return from surgery wearing "anti-embolism" stockings or inflatable "pneumatic compression" stockings. These devices are used to reduce your risk of developing blood clots, which are more common after leg surgery.
Start moving and walking early after surgery. On the first day after surgery, you should get out of bed to a chair. When in bed, perform ankle exercises frequently to prevent development of blood clots.
You may be instructed on how to use a spirometer (a plastic device that indicates how much air is breathed in at one time) to gradually increase the depth of your respirations, and to perform deep breathing and cough procedures to prevent pneumonia.
A Foley catheter may be inserted during surgery to monitor the function of your kidneys and hydration level. This will be removed on the second or third day after surgery. You will be encouraged to try to walk to the bathroom with assistance.
