What to expect if you need a total hip replacement

The hip joint is made up of 2 parts: the femoral head and the acetabulum. When the hip is healthy, the cartilage covering the components is smooth, soft and allows movements without pain. On the other hand, when it is injured or diseased, the cartilage deteriorates and the patient begins to feel pain, stiffness and functional limitation, decreasing his quality of life.

There are different diseases that can produce this joint deterioration, the most frequent being osteoarthritis, necrosis of the femoral head, rheumatic diseases such as rheumatoid arthritis, ankylopoietic spondylitis, fractures of the femoral neck and sequelae of severe trauma in young people.

The total hip prosthesis operation consists of the replacement of the hip joint, which has suffered significant wear and tear, with a prosthesis.

Benefits of the total hip prosthesis

The placement of a hip prosthesis will allow to recover the normal functioning of the hip, eliminating the intense pain that these patients suffer both when walking and at rest. In this way the patient recovers the lost quality of life and can walk normally again.

Hip arthroplasty has not only become one of the procedures with the highest success rate and continues to improve day by day thanks to the contributions of numerous researchers, but also during the last decade new load-bearing materials, designs and hip surface arthroplasties have been applied.

The success of the surgery will require the patient to exercise, taking into account the recommended precautions for your hip, without forgetting to have a healthy lifestyle.

Types of hip prosthesis, which one will I need?

The total hip prosthetic replacement consists of the replacement of the 2 articular elements, the femoral head and the acetabulum, through the implantation of a femoral stem and an acetabular component.

There are currently a multitude of different models of hip prostheses, of different materials and designs. Thus, there are cemented and non-cemented components that will be indicated according to factors such as the morphology of the hip to be treated and the quality of its bone mineral density, the patient’s age, etc.

Each type of prosthesis is designed to fit the needs of a specific type of patient, and therefore the treatment of each patient must be individualized, implanting the prosthesis that best suits their needs.

The different types of hip prosthesis are:

  • “Conventional” total hip prosthesis: after resecting the arthritic femoral head, two components are implanted, one in the pelvis in the form of a dome and a stem in the femur. In the upper part of the femoral stem, a head of different sizes and materials allows articulation with the inner part of the acetabular dome.
  • Total hip prosthesis with resurfacing: its difference with the conventional prosthesis is that it is always metallic and does not require the femoral head to be resected, thus respecting more of the patient’s bone. This makes them suitable for young patients and athletes, although their implantation has recently decreased due to their “friction” between metals.
  • Total hip prosthesis with short stem (mini-hip): they are similar to the conventional ones but with a smaller femoral stem, which allows the friction material with the acetabulum to be metallic or preferably ceramic. In addition, they require a somewhat smaller femoral head resection than conventional ones. They are suitable for young and active patients, especially when metal friction is to be avoided.
  • Partial hip prosthesis: the partial hip prosthesis is one in which only part of the femur is replaced, with a stem and a large metal head that articulates directly with the pelvis. It is used in elderly patients with low functional requirements, for example in patients with subcapital hip fractures.
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How is the total hip prosthesis operation?

Total hip replacement is always performed in the operating room. The duration of the operation is usually one hour, although the patient may remain in the operating room and the awakening room for 3 to 5 hours and will remain hospitalized for 3 to 5 days.

The preoperative measures for hip surgery are as follows:

  • Prior assessment in consultation in which the specific aspects of the operation are explained to the patient, giving him/her the informed consent.
  • Complete preoperative study with clinical analysis, ECG and X-ray diagnosis and visit with the anesthesiologist to review the results and resolve doubts regarding the anesthetic procedure.
  • It is recommended to cut your toenails, because you will not be able to do it again until 12 weeks after the operation.
  • The patient should plan his or her convalescence at home after surgery: seek help from family, neighbors or social assistance to help with shopping, personal hygiene, cooking, etc.
  • Get stools and high chairs for the kitchen and bathroom, as well as a toilet seat, since your knees should not be higher than your hips.
  • You will not be able to drink alcohol or smoke 48 hours before surgery.
  • If the surgery is scheduled in the morning, you should come to the hospital fasting. If it is in the afternoon, you should not take solid food or liquids from 9 hours before the appointment.
  • You should not wear any metal objects during the operation (rings, bracelets, earrings, piercings, etc.).

Postoperative and recovery with hip prosthesis

These are the steps that the patient can expect after a total hip prosthesis operation:

  • An abduction cushion will be placed between the legs to prevent the patient from closing his legs to prevent potential dislocation of his hip, which can be maintained while in bed for the first 6 weeks.
  • Mobilization should be started from the first day, limiting the load up to 50% during the first 6 weeks until osseointegration begins in cementless arthroplasties, or will be complete in cemented arthroplasties. In any case, the surgeon specialist’s instructions should always be followed.
  • Antithrombotic drugs and antibiotics will be administered.
  • During the recovery the patient will need, first, a walker, and later English canes.
  • It is not recommended to flex the hip more than 90º or to adduct the hip (crossing the legs) during the first 6 weeks.

As in all joint operations, there is a percentage of complications that could lengthen the recovery process, in the best cases, and even force the hip prosthesis to be replaced.