Hip Replacement Surgery
Considering a hip replacement?
If you are considering a hip replacement, chances are you have dealt with chronic pain for a while. The decision to have a total hip replacement is one you make after talking with your primary care doctor, your family, and Midwest Orthopedic and Musculoskeletal Alliance.
A hip replacement can give you a great deal of relief, but it is important to have the right expectations.
Why hip replacement?
The decision to get a hip replacement is primarily based on your quality of life. If your hip pain is getting in the way of your everyday activities, it may be time for surgery.
Many choose to have a hip replacement surgery due to:
- Hip pain that limits common activities, such as walking or bending
- Hip pain that continues while resting, either day or night
- Stiffness in a hip that limits the ability to move or lift the leg
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
How the Normal Hip Works
The hip is one of your body’s largest weight-bearing joints. It consists of two main parts:
- A ball (femoral head) at the top of your thighbone (femur) that fits into
- A rounded socket (acetabulum) in your pelvis.
Bands of tissue called ligaments connect the ball to the socket and provide stability to the joint.
The bony surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.
All remaining surfaces of the hip joint are covered by a thin, smooth tissue called synovial membrane. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint.
Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.
The most common cause of chronic hip pain and disability is arthritis, which can occur in several different forms, the most common of which is osteoarthritis. Osteoarthritis often occurs in an individual with a family history of arthritis. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.
What Is a Hip Replacement?
A total hip replacement is a procedure used to relieve pain and restore function in a hip that has been damaged by arthritis or other conditions.
During surgery, the worn-out ball-and-socket joint is replaced with smooth, artificial components. The damaged ball at the top of the femur bone is replaced with a ceramic or metal ball attached to a stem going down the femur. The worn socket is resurfaced with a titanium shell as well as a durable plastic liner that acts as your new cartilage and is fit into the shell. These new surfaces are designed to move smoothly together, reducing the painful bone-on-bone contact that causes stiffness and discomfort.
The goal of hip replacement is to help you return to everyday activities with less pain and better movement. Most patients notice significant pain relief soon after surgery, while strength and motion continue to improve over several months with physical therapy and home exercises. Although the artificial joint is very durable, it is important to follow your surgeon’s recommendations regarding rehabilitation and activity to protect your new hip and maximize its lifespan. Many patients are able to return to activities such as golfing, swimming, tennis, pickleball, skiing, gardening, and other recreational pursuits once they have fully recovered.
Ideal Candidate
Who May Benefit from a Total Hip Replacement?
A total hip replacement may be a good option if you have ongoing hip pain, stiffness, and loss of function that has not improved with treatments such as medications, injections, physical therapy, or activity changes. You may be a candidate if you have:
- Wear-and-tear arthritis (osteoarthritis) – The smooth cartilage in your hip has worn away over time, causing pain, stiffness, and grinding.
- Rheumatoid arthritis or other inflammatory arthritis – Arthritis caused by your immune system attacking the joints, leading to pain and joint damage.
- Arthritis after a previous injury – Damage from a previous fracture, dislocation, or other injury has led to arthritis over time.
- Loss of blood supply to the femoral head (avascular necrosis) – Part of the ball of the femur has been damaged because it did not receive enough blood flow.
- Arthritis after previous hip surgery – A prior hip procedure has resulted in pain, stiffness, or arthritis.
- Failure of a previous partial hip replacement – A previous partial hip replacement is no longer working well and needs to be converted to a full hip replacement.
- Long-term problems after a hip fracture – An old fracture has healed poorly or has caused arthritis and persistent pain.
- Less common causes of hip arthritis – Certain medical conditions can damage the hip joint and lead to severe arthritis.
The Best Candidates Usually Have:
- Significant hip pain that limits daily activities
- Pain that may interfere with sleep
- Stiffness and loss of hip motion
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
- X-rays showing advanced arthritis
- Symptoms that have not improved with non-surgical treatment
Not recommended:
When a Hip Replacement May Not Be the Right Choice
A hip replacement can provide excellent pain relief and improved function for many people. However, there are certain situations where surgery may not be safe or may not provide a good result. In some cases, these conditions can be treated first, making hip replacement possible at a later time.
You may not be a candidate for hip replacement if you have:
- An active infection – An infection anywhere in your body, especially in or around the hip, must be treated before a hip replacement can be safely performed.
- A severe hip infection in the past that has not been fully cleared – Persistent or recurrent infections increase the risk of infection after joint replacement.
- Poor overall health that makes surgery unsafe – Serious heart disease, lung disease, or other medical conditions may make the risks of surgery outweigh the benefits.
- Poorly controlled diabetes, morbid obesity, or other serious medical conditions – These conditions can increase the risk of infection and slow healing. Improving your health, and losing weight before surgery can reduce these risks.
- Severe nerve damage affecting the hip – If the nerves that control the hip muscles are not functioning properly, a replacement may not restore useful movement.
- Weak or non-functioning hip muscles – Hip replacements rely on healthy muscles to move the leg after surgery.
- Severe bone loss – If there is not enough healthy bone to support the implants, additional procedures or a different treatment may be necessary.
- An inability to participate in rehabilitation – Physical therapy and home exercises are essential for a successful recovery. Patients who cannot safely participate may not achieve a good result.
- Unrealistic expectations – Hip replacement is designed to relieve pain and improve function, but it does not restore a hip to “new.” Repetitive impact activities, heavy lifting, running, and other high-intensity activities may still be limited.
- Poor skin or soft tissue around the hip – Healthy skin and soft tissues are important for proper healing and to reduce the risk of infection.
Conditions That May Delay Surgery Until They Are Improved
Some conditions do not permanently prevent hip replacement but should be addressed before surgery, including:
- Active smoking or nicotine use
- Obesity that significantly increases surgical risk
- Poor nutrition
- Uncontrolled high blood sugar (diabetes)
- Untreated dental infections or other infections elsewhere in the body
- Certain medications that increase the risk of infection or bleeding
Every Patient Is Different
Having one of these conditions does not automatically mean you cannot have a hip replacement. Many of these issues can be treated or improved before surgery. Your orthopedic surgeon will carefully evaluate your overall health, hip condition, and personal goals to determine whether hip replacement is the safest and most effective treatment option for you.
How can I prepare for surgery?
Before surgery, you will want to prepare your home or environment so you can have a smooth transition coming home. This will allow for common activities like bathing, to still be done while you are recovering. You may want to set up items you often need in a central location, as it may be hard to move around immediately following a hip replacement.
You may need assistance at home for a short period following the surgery, as your range of motion may be limited. The surgery usually takes a couple of hours and you will likely need to be monitored for a short while following the procedure.
What happens during the procedure?
Both types of hip surgery last anywhere from one to three hours.
As you arrive for your procedure, you will be admitted to the surgery center. You will receive anesthesia, so you can feel comfortable and at ease during the hip replacement. There are several options for anesthesia based on your preference.
The procedure typically takes one to two hours and follows these stages:
How a Standard Total Hip Replacement Is Performed
- Anesthesia – You’ll receive either general anesthesia, which puts you fully to sleep, or an epidural that numbs the lower body while you remain awake.
- Accessing the joint – The surgeon makes an incision over the front (anterior) or side (posterior) of the hip. Depending on the approach, the surgeon gently moves the surrounding muscles (anterior) or cuts the external rotator muscles (posterior) to expose the hip capsule, which is then incised to expose the arthritic ball-and-socket joint.
- Removing the damaged ball – The worn femoral head is removed with a precise cut, ensuring the new artificial ball will sit correctly once in place.
- Preparing the socket – Remaining cartilage and labral tissue, as well as any bone spurs, are cleared from the hip socket, which is then smoothed and shaped to receive the new implant.
- Placing the new socket – An artificial acetabular cup is implanted, and a polyethylene liner is fitted inside it to create a smooth new bearing surface.
- Preparing the femur – A stem — typically titanium — is either press-fit or cemented into the femur to anchor the new ball.
- Attaching the new ball – A ceramic or metal ball is secured to the stem, replacing the natural head that was removed.
- Testing the joint – The surgeon moves the hip through its full range of motion to check fit, stability, and tension, making any needed adjustments before finalizing the implant.
- Repairing the capsule – The joint capsule opened during surgery is carefully repaired — a step that plays a key role in early recovery.
- Closing the incision – The tissue and skin are closed with stitches, staples, or surgical adhesive, and a sterile dressing is applied. You’re then moved to recovery, where the team monitors you and manages pain.
What the Replacement Achieves
Positive Outcomes
After the procedure, you will need to monitor for blood clots, risks, or other limitations. Your surgeon will encourage you to walk around and stay moving as much as possible. Your care team may also suggest physical therapy to help restore range of motion and help you with your everyday responsibilities.
Schedule Your Hip Replacement Consultation Today
If hip pain is limiting your quality of life, call 414-384-6700 to schedule a consultation with our orthopedic specialists at Midwest Orthopedic and Musculoskeletal Alliance in Southeastern Wisconsin. We’ll help you understand your options and create a personalized plan to get you moving comfortably again.