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Total Hip Replacement

Alternative names: Total Hip Arthroplasty (THA)

What is a total hip replacement?

Total hip replacement (THR) is a procedure that has brought increased mobility and less pain to hundreds of thousands of people. Orthopaedic surgeons replace a painful, dysfunctional joint with a highly functional, long-lasting artificial joint. In the past few decades, there have been many advances in the use of artificial hip joints, resulting in a high percentage of successful long-term outcomes.

The hip is a ball-and-socket joint. The round head of the thighbone (femur) moves inside the hollow socket (acetabulum) of the pelvis. This is what allows your leg to swing easily from your hip. To duplicate this action, a total hip replacement implant has three parts: the stem, which fits into the femur and provides stability; the ball, which replaces the spherical head of the femur; and the cup, which replaces the worn-out hip socket. Each part comes in various sizes in order to accommodate various body sizes and types.

What is a partial hip replacement?

If only one part of the joint is damaged or diseased, a partial hip replacement may be recommended. In most cases, the pelvic socket is left intact and the head of the femur is replaced, using a component similar to those of a total hip replacement. Another option uses a device resembling a half circle which fits over the head of the femur so that it need not be replaced. This is fixed to the femur with cement around the femoral head and has a short stem that passes into the femoral neck.

Why would a doctor recommend a total hip replacement?

Total hip replacements are usually performed for serious arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or aseptic necrosis (a condition in which the bone of the hip ball dies). Circumstances vary, but generally patients are considered for total hip replacements if:

  • The pain is severe enough to restrict not only work and recreation, but also the ordinary activities of daily living
  • The pain is not relieved by arthritis (anti-inflammatory) medicine, the use of a cane, and restricting activities
  • There is significant stiffness of the hip
  • X-rays show advanced arthritis, or other problems

What does hip replacement surgery involve?

Several visits to the hospital will probably be necessary before the day of your surgery. In most cases you will be asked to donate some of your own blood for transfusion purposes, and you will also be asked to stop taking certain medications before the operation.

Depending on the type of hip replacement you have (total or partial), the surgery itself can take from two to four hours. Most patients remain in hospital for three or four days after the procedure.

For more information view an example of the guidebook given to patients at Dartmouth-Hitchcock Medical Center in Lebanon, NH.

What types of surgical approaches are offered?

Our surgeons offer a variety of surgical approaches for primary and revision hip replacement including posterior, lateral, and anterior. "Approaches" means the way that the surgeon makes the incision to get to the hip joint. With any of these approaches, our surgeons only make an incision as big as is necessary to safely insert the implants. Here are more details about each approach:

  • Posterior: This is the most commonly used approach. The incision is made from the back of the hip. Small, non-critical tendons are detached to get to the hip joint and then are later re-attached during the operation. Patients who have this approach are usually walking without the aid of a walker, crutches, or cane within six weeks after surgery.
  • Lateral: For this approach, the incision is made midway between the front and side of the hip to reach the joint. This is the second most commonly used technique. Surgeons like this technique because there tends to be less chance of a hip dislocation. Partof the hip muscle is detached from the bone and re-attached later in the process. For some patients, this can mean a longer recovery process but the results within about a year after surgery are similar to patients who have other approaches.
  • Anterior: This is one of the newer approaches in the US for hip replacement surgery, though this approach has been used by a small group of surgeons in France for over 50 years. The anterior approach is currently offered in Lebanon and Manchester. Surgeons who use this approach make a small incision on the front part of the leg near the hip without detaching the muscle or tendons from the bone.

    Hana table
    hana table, Courtesy of Mizuh OSI

    A special table, called the hana® table, is used to position the patient's leg during the surgery so the surgeon can accurately reach the hip joint and implant the replacement pieces. Our surgeons who offer this procedure have gone through extensive training to learn the technique and proper positioning of the patient's leg. Currently, there is no scientific study data that gives reliable results for the benefits of this approach to surgery. Anecdotally, we have seen that patients who have the anterior approach for joint replacement may have a shorter length of stay in the hospital, and a shorter recovery. As with any surgery though, individual recovery time is different from one person to another.

Not every patient is a candidate for all of these approach options. Your surgeon will talk with you about the best options for your individual situation and level of health.

What types of materials are used?

When you have your surgery, your surgeon will replace the ball and socket portion of your hip with a metal ball and a plastic socket. Many different types of designs and materials are currently used in artificial joints. All of them have two basic components: the ball component (made of a highly polished strong metal) and the socket component (a durable plastic cup which may have an outer metal shell). We use advanced bearing surfaces including ceramics, metals, and polyethylenes. Your surgeon will discuss what materials might be best for you during your pre-operative visit.

How long is the recovery after hip replacement surgery?

After the initial time in hospital, you will need to have some help at home since you will not have regained mobility or full strength for several weeks or sometimes months. Patients without help at home may need to arrange to spend some time in a care facility. Your doctor will discuss the recovery period with you and will arrange for you to have a follow-up appointment after about six to eight weeks.

Hip replacement operations are very successful in relieving pain and restoring movement. However, there can be ongoing problems with wear which may eventually necessitate further surgery, including replacing the prosthesis (revision surgery). Men and patients who weigh more than 165 pounds have higher rates of failure. The chance of a hip replacement lasting 20 years is about 80 percent.

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