Total Hip Replacement - Surgery, Benefits & Recovery Time

A total hip replacement (THR), also called total hip arthroplasty, is a surgical procedure where a damaged hip joint is replaced with an artificial joint or prosthesis. The artificial hip joint used in the replacement consists of the following: 

1. A ball made of ceramic or metal, which replaces the natural femoral head

2. A socket that replaces the damaged acetabulum in the pelvis 

This surgery effectively reduces pain and enhances hip function and mobility.

Anatomy and Physiology of the Hip Joint

The hip joint is a ball-and-socket joint that provides a wide range of motion while bearing substantial weight. The anatomy of the hip joint is as follows: 

1. It is made up of a hip bone (pelvis) and a thigh bone (femur). 

2. The thigh bone has a rounded end (femur head) that rests inside a cup-like socket called the acetabulum in the pelvis. 

3. The ball and socket surfaces of the hip joint are lined with articular cartilage. It is a smooth tissue that cushions the bones and facilitates easy movement.

4. The synovial membrane (a thin tissue layer) surrounds the hip joint. In a healthy hip, this membrane produces a slight amount of fluid that lubricates the cartilage, significantly reducing friction during movement.

5. Tissue bands, known as ligaments, connect the ball to the socket, ensuring stability and support for the joint.

Types of Hip Replacement

There are multiple types of hip replacement surgeries based on the socket implant attachment used and the material in the prosthetic component. These include: 

Socket Implant Attachment

1. Cemented Prosthesis: This type uses special bone cement to secure the implant components to the bone.

2. Uncemented Prosthesis: In uncemented total hip replacement, the prostheses attach with a porous surface to promote bone growth. 

Prosthetic Materials

1. Metal-on-Polyethylene: A metal femoral head moves within a plastic (polyethylene) cup.

2. Ceramic-on-Polyethylene: It refers to a ceramic femoral head with a plastic cup. 

3. Ceramic-on-Ceramic: Both components of a ceramic hip replacement are made of ceramic. 

4. Ceramic-on-Metal: It is a ceramic ball with a metal socket. 

Note: The treatment approach is based on the patient’s condition and the doctor’s opinion.

Hip joint replacement is mostly performed in people aged 60 and above. The doctor may recommend this procedure for those who experience hip pain that:

1. Makes it difficult to sleep at night 

2. Does not improve with other treatments like medication and physical therapy 

3. Interferes with daily activities like bathing, walking, or doing household chores 

4. Causes issues with walking, needing the use of a cane or walker 

5. Impairs the ability to climb up and down the stairs 

6. Makes it challenging to rise from a seated position 

Conditions Treated With Total Hip Replacement

Total hip replacement surgery is primarily used to treat a range of conditions that cause significant hip pain and mobility issues. The following are the common conditions that can be effectively managed or resolved through this procedure:

1. Osteoarthritis: Also called wear and tear arthritis, this is the most common reason for hip replacement. It damages the cartilage that covers the ends of the bones, leading to pain and stiffness.

2. Rheumatoid Arthritis: This autoimmune condition causes inflammation of the joint lining and cartilage, resulting in pain, swelling, and deformity.

3. Osteonecrosis (avascular necrosis): It occurs when there is inadequate blood flow to the ball portion of the hip joint. This causes the bone to collapse and become deformed.

4. Hip Fractures: In older adults, severe hip injuries like fractures may be treated with a hip replacement if the bones are unlikely to heal well with other treatments.

5. Bone Tumours: Cancerous growths can impair the functionality of the hip and may necessitate a hip replacement.

Hip replacement is a highly effective procedure for those whose lives are significantly impacted by hip joint problems. It offers the following benefits: 

1. Decrease in Symptoms: One of the most immediate benefits post-surgery is significant relief from pain and stiffness.

2. Improved Mobility: It results in enhanced mobility and increased range of motion. Patients typically find it easier to perform everyday activities such as walking, climbing stairs, and standing from a seated position.  

3. High Success Rate and Durability: Hip replacements are known for their high success rate. According to a study by Ahmed M Negm et al., 2022, the survival rate of THR implants at 5 and 20 years is 90-100% and 60.4-77.7%, respectively.

Patients receive comprehensive instructions from their orthopaedic surgeon to prepare for total hip replacement surgery. It is crucial to follow these guidelines before and on the day of the surgery to ensure the procedure goes smoothly.

Before Total Hip Replacement 

Before undergoing a THR, patients undergo thorough preparations to ensure optimal outcomes. They must clear away in advance any loose rugs, electrical cords, and other items that they can trip over at home. Other preparations and guidelines are as follows: 

On the Day of the Total Hip Replacement 

Patients arrive at the hospital early on the day of hip replacement to undergo final health checks. After being admitted, they are prepared for surgery, which includes the following: 

A total hip arthroplasty is performed in a hospital and takes two hours to complete. While the exact procedure can differ depending on the technique chosen, the general steps are as follows:

1. Anaesthesia: The surgery is initiated by administering general or regional (spinal or epidural) anaesthesia. This ensures the patient feels no pain during the operation.

2. Incision: The surgeon makes an incision over the hip to expose the joint. The location of the cut will depend on the approach (back, front, or side) of the procedure. 

3. Removing Damaged Cartilage and Bone: The surgeon removes the damaged femoral head and cleans the acetabulum. They remove damaged cartilage and prepare the bones to fit the new prosthetic components.

4. Implanting the Prosthesis: The femoral stem is inserted into the hollow centre of the femur with or without cement. Next, the femoral head component is placed on the stem. The acetabular component (artificial socket) is implanted into the pelvic bone.

5. Reattaching Muscles: After the new joint components are in place, the surgeon reattaches the surrounding muscles and tissue with dissolvable stitches. 

Full recovery after hip replacement can vary from one person to another. However, patients can expect improvements in three months after the procedure. Recovery after the surgery begins immediately in the hospital and continues at home. The following is a general guideline: 

Recovery in Hospital

Depending on their condition and individual needs, many patients can return home on the same day of the procedure. Others may need to stay in the hospital for 1-3 days. Here’s what one can expect before discharge: 

1. The patient will be moved to a recovery room until the effect of anaesthesia wears off. 

2. The nurse will check their vitals like blood pressure, heart rate, and breathing. They will also monitor them for complications. 

3. Once the individual’s condition stabilises, they will be moved to a hospital room or discharged to home. 

4. They will be encouraged to walk within a day of surgery with a walker or crutches to promote blood circulation and prevent blood clots. 

At-Home Recovery 

It may take 6-12 weeks before patients can use their hips without restrictions. During this time, the doctor may provide the following instructions to ensure a smooth recovery: 

1. Get a raised toilet seat and shower chair to help with sitting and standing.

2. Keep the surgical area clean and dry. 

3. Take pain medication as prescribed by the medical specialist to manage postoperative pain and inflammation.

4. Attend physical therapy exercises aimed at strengthening the hip and improving flexibility. 

5. Regularly apply ice packs to the hip area to help reduce swelling. 

6. Avoid crossing the legs, bending the hips more than a right angle, and turning the affected leg inward. 

7. Refrain from driving for 3-4 weeks after surgery or until the doctor approves. 

First Follow-Up Appointment 

The first follow-up appointment after a total hip replacement typically occurs 10-14 days after surgery. This initial check-up is important for the following reasons: 

1. The surgeon examines the incision site for proper healing and checks for signs of infection or complications. 

2. They assess the patient’s mobility, pain levels, and overall hip joint functionality. This includes observing how well the person can walk, bend, and carry out daily activities.

Complications after total hip replacement are rare. However, like any surgical procedure, it may have some risks. These include: 

1. Infections

2. Bleeding 

3. Blood clots in the legs or lungs 

4. Hip dislocation 

5. Loosening or wear and tear of the prosthetic hip joints 

6. Change in leg length 

7. Fracture 

8. Nerve damage 

When to consult a doctor? 

After total hip replacement surgery, it is important to monitor recovery and be aware of signs that need a consultation with a doctor. The following are some instances when patients should seek medical advice:

1. A fever higher than 100.4°F

2. Redness, swelling, bleeding, or discharge from the incision site 

3. Increased discomfort around the surgical incision 

4. Pain and swelling in the lower leg 

5. Chest pain or shortness of breath 

Delaying hip replacement surgery when recommended by a healthcare provider can lead to several risks and complications. This is particularly true for individuals with severe hip conditions such as osteoarthritis. Here are some potential risks associated with postponing the surgery:

1. As the hip joint continues to deteriorate, pain can become more severe and persistent, significantly impacting daily activities and quality of life.

2. Delaying surgery leads to further joint damage and degeneration, resulting in decreased range of motion and increased stiffness.

3. The procedure might be more complex when surgery is eventually performed, and recovery could take longer.

The total hip replacement cost in India can vary widely depending on several factors. Generally, it starts at ₹ 80,000 and can go up to ₹ 2,00,000. The average price of the procedure is ₹ 1,20,000. 

Note: These prices are approximate. Individuals considering the surgery should talk to HexaHealth consultants for updated cost information. 

Factors that can affect the expenses of total hip replacement include: 

1. Hospital Facility: The cost can vary depending on whether the procedure is performed in a public hospital, private hospital, or specialised orthopaedic facility. Private and speciality hospitals generally have higher fees. 

2. Location: Hospitals in metropolitan cities often charge more than those in smaller regions due to higher overhead expenses.

3. Surgeon’s Experience: Medical specialists with extensive experience and a higher success rate may charge more for their services. 

4. Type of Implant: The choice of implant greatly influences the expenditure. More durable or specialised implants are costlier.

5. Insurance: Whether or not a patient has insurance and the extent of coverage provided can influence out-of-pocket expenses.

Total hip replacement is a highly effective surgery to relieve chronic hip pain and significantly improve mobility. It helps patients enjoy an active lifestyle free from the harmful effects of hip degeneration. The procedure treats various conditions, such as osteoarthritis, rheumatoid arthritis, and hip fractures, with high success rates. 

HexaHealth can assist patients considering hip replacement surgery by providing access to experienced orthopaedic surgeons. Our experts provide personalised guidance that suits each patient’s specific needs. From initial consultation through recovery, we make the process as smooth and efficient as possible. 

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