The hip joint is composed of the pelvic bone, which has a socket to receive the end (ball) of the thighbone. When the cartilage or bones in the joint are diseased or seriously damaged, a surgical procedure called total hip replacement may be done to remove the diseased ball and socket and replace them with prosthetic materials or hip implants.
The goals of surgery are to improve the function of the joint and to relieve chronic symptoms of severe pain. It is usually performed because of progressive worsening of arthritis in the hip, which is often due to degenerative arthritis or osteoarthritis. This condition is generally associated with aging, congenital abnormality, or trauma to the joint.
Other conditions that may lead to total hip replacement include rheumatoid arthritis, fractures of the hip joint, and death (necrosis) of the hip bone. Necrosis can be caused by hip fracture, chronic drug intake, alcoholism, and some diseases (such as lupus).
Hip replacement surgery is a major operative procedure that involves some risks and complications. Aside from the usual complications that are associated with most surgeries in the immediate post-operative period (such as bleeding, infection, fever, pain, nerve injury, and blood clots), the surgical procedure also carries some long-term risks and complications, which could occur months or years after a patient is discharged from the hospital. These can result in implant failure, which may be due to various causes such as:
- Loosening of the implants in the absence of infection. This is a common problem, which may be caused by various factors such as the type of implant chosen, the surgical technique, and the amount of force applied on the joint by the patient.
- Bone fracture
- Component fracture
- Late infection
- Late dislocation
- Joint stiffness
- Abrasive forces in the joint leading to debris production
- Bone loss (osteolysis), which occurs when the body reacts to remove the debris when it recognizes it as foreign particles. This is the most common long-term complication of hip replacement, causing of nearly 75% of all hip implant failures. Severe joint pain may result from debris production and osteolysis.
Surgeons often refer their patients to a rehabilitation team after surgery to help them with physical and occupational therapy. Patients are instructed to observe some precautions for several weeks to avoid dislocation of their new hip. These include:
- Not bending the hip more than 90 degrees
- Not crossing one's legs
- Not rotating the affected leg in or too far out.
Total rehabilitation usually takes at least six months. Patients are also placed on an exercise program to follow after they go home, even while still having physical therapy to help speed their recovery. Weight control is also necessary to reduce stress on the hips. However, one should stay active to maintain flexibility, strength, and endurance. Activities may include walking, swimming, dancing, and stationary bicycling. More strenuous activities, such as tennis or jogging are not advisable.
Most hip joint implants last for 10 to 20 years without loosening. This may depend on such factors as the patient's lifestyle, how much stress is placed on a joint, the patient's weight, and how well the healing process goes.
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