Hip Replacement Surgery: Types, Procedure & Risks Of Hip Arthroplasty

A problematic hip joint resulting from an injury or other ailment can cause a person discomfort in their daily lives, often limiting them from enjoying certain activities. In such a case, after a thorough examination, a doctor may recommend the patient to undergo a hip replacement surgery.

In simple words, hip arthroplasty is the procedure of manipulating and/or reconstructing the hip joint to restore optimum mobility. Orthopaedic surgeons use the artificial replicas of the hip joint to reconstruct a troubling hip joint. It is an advanced surgery that can significantly improve the overall quality of the patient’s life.

Did you know that arthroplasty is a combination of two words derived from the Greek language—arthro meaning ‘joint’ and plasty meaning ‘to shape, form, or mould’? Thus, hip arthroplasty translates to forming the hip joint in modern medical terminology. This is why hip replacement surgery is also referred to as hip arthroplasty, and both terms are used interchangeably. Sometimes, people may also refer to the procedure as a hip replacement operation.

Here, you will find information about the hip replacement operation, including the procedure, risks, and long-term outlook for patients.

Why is the hip replacement surgery performed?

Hip arthroplasty is an excellent treatment option for people who have a deformed or damaged hip joint or have any of the following conditions:

1. Rheumatoid arthritis
   This is caused by an overactive immune system and leads to inflammation. This inflammation can erode the cartilage (soft rubber like tissue that helps your joint move smoothly) and occasionally the underlying bone.
2. Osteoarthritis
   This condition also damages the cartilage and makes the movement of the joint difficult and painful.
3. Osteonecrosis
   This condition is usually caused by a fracture or dislocation that disrupts the blood supply to the ball portion of the hip joint and may lead to the collapsing and deformity of the bone.

Who needs a hip replacement surgery?

People who have damaged hips due to heath conditions or injuries, including arthritis and fracture, are advised to consider hip replacement surgery. In the case of a damaged hip joint, people find it difficult to get in and out of bed, walk down the stairs, and other physical movements. Some people also have trouble while wearing socks or shoes and uncomfortable while resting.

Your doctor will likely recommend a hip replacement surgery after proper diagnosis. The following group of people are usually recommended hip replacement surgery:

1. People who have intense pain in the hip region, which limits their everyday activities such as walking
2. People who have constant pain in the hip region even while resting irrespective of the time
3. People who have a stiff hip joint, limiting them from moving or lifting their leg
   Sometimes, people see substantial improvement in their hip mobility due to medication, walking supports, and certain lifestyle changes. Those who don’t see any improvement with these non-operative treatments should consider hip arthroplasty. This surgery is a relatively older treatment option, and the procedure has been improved over time since its introduction in the early 1960s. A hip replacement surgery is an effective and safe procedure for people who are looking to enhance their mobility.

Visiting an orthopaedic surgeon

Your appointment with an orthopaedic surgeon should cover the following aspects of your health and lifestyle:

1. Current health status
   The doctor will probe you about the symptoms and your medical history on your first visit to understand your condition. They may also gather information about your general health, lifestyle, and other factors to assess your hip pain.
   They will do a physical examination to check your hip mobility, alignment, and strength in addition to how much it affects your daily life.
2. Tests
   The doctor will also order some tests to get a clear understanding of your hip joint and the problem it causes. You will be ordered to take tests including an X-ray and magnetic resonance imaging (MRI) scan, to prepare a suitable treatment plan.

Types of hip arthroplasty

Once it is established that you need a hip replacement surgery, the doctor will consider several factors to determine the right type of hip arthroplasty for you. Hip replacement surgeries have two categories:

1. Total hip replacement, also known as total hip arthroplasty, in which both the ball and socket of hip joint are replaced with artificial parts.
2. Partial hip replacement in which only the ball of the hip joint (or the head of the femur) is replaced.

Additionally, there are two types of hip replacement surgery—the traditional method and the minimally invasive method. In the traditional method, uncommon today, the surgeon is required to make a large incision to access the hip joint. This type of hip arthroplasty demands more healing time after the surgery than the minimum-invasive method; it also involves a risk of dislocating the new joint until all the supportive muscles and tissues heal completely.

On the other hand, minimally invasive hip replacement surgery is a highly efficient way of reforming your hip joint while ensuring minimum damage to the surrounding healthy tissues and ligaments. This approach has many advantages over the traditional method, including the following:

1. Less pain post-surgery
2. Reduced risk of dislocation
3. Faster recovery
4. Minimal muscle damage
5. Short observatory stay in the hospital

It is important to note that your surgeon will make the final call on which type of surgery to perform considering factors like your age, health, and weight. If you have any doubts, it is important to address them and discuss with your surgeon to get a clear understanding.

Hip replacement surgery procedure

Most people are admitted to the hospital on the day of the surgery.
Your vitals will be checked, and the surgical preparations will begin. You will be asked to wear a robe and a medical professional will clean your hip area and shave it. You will be urinating into a bag though a catheter for up to a few days after the surgery.

Upon entering the operation theatre you will be given general anaesthesia, antibiotics, and other medicines to put you to sleep and keep your health stable. The doctor will then start the procedure of hip replacement surgery, which usually take about 1 to 2 hours.

The surgeon will begin by marking your leg to make an incision and proceed further with the help of a team or nurses and doctors to dislocate your joint. In case of total hip arthroplasty, they will use different tools to remove the ball (head of the femur) and drill in to make enough space for the artificial ball prosthesis to implant. They will also create a cavity into the hip and the cartilage on your socket joint for the new socket and place it securely in position.

These prostheses are secured in a position by using a press-fit technique or a special medical grade cement that is prepared fresh at the time of surgery. Sometimes, screws may also be drilled into the hip through the socket implant to secure it. The implants used for hip replacement surgery are usually made of metal, plastic, or ceramic.

Once everything is in place, the surgeon will manually move your leg to check whether the new replacement joint is working properly or not. After ensuring the successful movements of the implants, they will begin closing your wound by following standard protocols. They may also leave a small drainage pipe to allow any excess bodily fluids to pass and ensure speedy recovery.

You will be placed under observation in the recovery room until you regain consciousness and your vitals stabilise. Blood transfusions are also kept at-the-ready during all times during the procedure since the surgery may result in excessive blood loss. You may also have a blood transfusion in the recovery room after the operation.

Risks involved with the surgery

Although most people respond well to the treatment and do not have any complications, there are certain risks associated with hip arthroplasty, including the following:

1. Blood clot formation
   After the surgery, blood vessels can have blood clots, which can prove to be dangerous. In worst case scenario, blood clots can travel to the heart, lungs, or brain (rarely) and cause damage. Blood-thinners are recommended to patients who develop blood clots.
2. Infection
   To ensure that you don’t contract any infections during the surgery, antibiotics are administered to you intravenously in addition to ensuring appropriate hygiene conditions in the operation room.
3. Fracture
   Heavy equipment including a saw, nail, and hammer are used in hip arthroplasty, which can cause fractures in the hip joint if they are not handled properly.
4. Dislocation
   As your body starts to adjust to the new hip joint, certain movements or positions may dislocate the joint (especially during first few months post-surgery), causing you pain and discomfort.
5. Changes in the length of the legs
   Extensive pre-operative planning is done to avoid this, but sometimes the length of legs may mismatch after the operation. This may be caused due to the faulty placement of the implants or contraction of muscles around the hip.
6. Loosening of the new implants
   Although rare, sometimes the new hip implants are not secured properly and may loosen over time. This results in pain and may need another surgery to be fixed.
7. Nerve damage
   This is also uncommon, but a mistake during the procedure can lead to permanent or temporary nerve damage leading to pain, weakness, and numbness. Sciatica nerve plays an important role in the movement of the lower body; this nerve passes through the glutes, making it more vulnerable for unintentional damage.

Preparing for the Hip replacement surgery

The preparatory stage is important in order to conduct a hip replacement operation successfully. It includes the following steps:

1. Examination by a primary care doctor
   Your surgeon will ask you to consult your doctor and address any existing health problems that may affect the operation or the recovery. Before you can undergo the surgery, the surgeon has to ensure that your body is healthy enough to avoid complications.
2. Tests
   As a part of the standard protocol, your orthopaedic surgeon will order few tests including the following to ensure your readiness for the surgery:
   a. Blood tests including complete blood count
   b. Urine tests
   c. Electrocardiogram (ECG)
   d. X-rays
3. Ongoing medication
   You should inform the doctor about any medication you are currently consuming; this helps them prepare a suitable care plan for you.
4. Weight loss and physical exercise
   Although it might not be possible for the patient to brisk walk or run, it is important that they try to maintain best physical health in preparation for the surgery. You can ask your surgeon for appropriate exercises that will not cause further damage to your joint. Additionally, losing some weight if you are overweight can minimise the stress on your new hip joint and reduce other risks.
5. Social and home planning
   After your surgery, you may not be able to attend many social events during the recovery period as you will likely need assistance in performing basic daily tasks. Thus, it is important that you plan accordingly and avoid major life events such as your marriage right after the surgery.
   Additionally, you will need to make some adjustments to your home to make it easy for you to recover fast and reduce stress on the new implants. You can consider installing a raised toilet seat and secure handrails along staircases, in the bathroom, and near the bed.
6. Dental procedures
   Your surgeon will ask you to complete any necessary procedures, such as tooth extraction, before the surgery. This is because a bacteria may enter your bloodstream during the dental procedure and cause infection. Routine procedures such as cleaning can be scheduled 4–6 weeks after (not before) the surgery.

Consider this before going through with the Hip replacement surgery

Your orthopaedic surgeon will discuss the right hip arthroplasty method with you along with associated risks. Your life will change drastically if you decide to go through with the surgery, but there are certain things that the surgery can and can’t do for you. Majority of the people who get a hip replacement see a significant reduction in pain and discomfort; their ability to perform day-to-day activities also increases.

However, the hip implants begin to wear down over time. Strenuous physical activity or being overweight may cause the hip replacement to loosen and wear down faster. This will necessitate you to undergo another surgery to rectify or replace the implants. This is the reason why most surgeons ask patients to avoid high-impact physical activities including running and jumping.

Cost of hip arthroplasty

Total hip replacement surgery cost in India averages around INR 3,50,000, with the minimum being about INR 2,50,000 and maximum about INR 7,50,000. You can ask your insurance provider (if you have any) about coverage for the treatment. Some hospitals may give you a discounted price if you have to undergo bilateral hip replacement surgery, that is, replacing both hips. Additionally, you can try for getting an appointment at a reputed government hospital to avail lower hip replacement costs.

Hip arthroplasty costs vary depending on multiple factors, including the following:

1. Location or city
2. Additional services provided at the hospital
3. Expertise of the surgeon
4. Cost of the implants

Recovery time and post-surgery care

Most people recover completely from a hip arthroplasty in about 3 months. Following the doctor’s guidelines post-surgery can greatly impact the recovery time along with avoiding any complications. The first few weeks after the surgery can set the right tone for your rehabilitation period or lead to a complication requiring another hip surgery.

After you get discharged from the hospital, you will be using catheter to urinate in a bag taking pain medicines at least for the first few days.

You will likely have stitches or staples on the side of your leg or the back of your glute (rare). These are usually removed about 2 weeks after the operation, and you should avoid getting them wet meanwhile; this may entail less frequent and assisted baths.

Another important factor in your speedy recovery is taking a balanced nutritional diet. Taking plenty of fluids, and a diet with adequate micro and major nutrients is essential. You may observe a loss of appetite or reduced hunger; consult your doctor if this persists for long.

Physical therapy is one of the most important components of your recovery post operation. Your doctor will recommend few basic exercises during your first visit after the surgery and increase the intensity with passing time. You will be able to perform normal daily activities, such as walking and bathing, without additional support within 3–6 weeks post-surgery. Some patients (for example the elderly, physically challenged individuals, and athletes) may also require support from a physiotherapist.

Outlook for people who have had a hip replacement surgery

A hip arthroplasty can have a great impact on the overall quality of your life and drastically reduce the persistent hip pain. However, you will have to protect your hip replacement and increase the implants’ longevity. Following tips can be helpful:

1. Maintain good health and participate in mild exercises regularly.
2. Avoid falls or injuries as it may lead to a bone fracture and require additional surgery.
3. Inform you dentist about recent hip arthroplasty before undergoing any procedure.
4. Visit your orthopaedic surgeon for routine check-ups.

Some people may feel numbness or stiffness around the surgery scar initially, but this subsides over time. If you choose metal implants for your hip, you may activate metal detectors at the security check. You should inform the security personnel about your surgery in case this happens; it’s also good to carry your medical records in a soft copy or a digital locker to present to concerned authorities if needed.