Total hip replacement surgery aims to relieve hip pain and increase hip function by resurfacing the bones that meet at the hip joint. The surgeon removes the femoral head and replaces it with an artificial one. This prosthetic femur head is shaped like a ball, and fits perfectly into the rounded cup prosthesis that becomes the new socket of the pelvis.

Below is a detailed description of a typical total hip replacement surgery. The actual surgery usually takes about two hours.

Total Hip Replacement Step-by-Step Description

Surgical procedures differ depending on the patient’s needs and the surgeon’s approach, but generally the steps are as follows:

  • The patient’s vital signs are checked to make sure blood pressure, heart rate, body temperature, and oxygenation levels are normal and surgery can proceed. A mark is made on the hip undergoing surgery.
  • Anesthesia is administered. A patient may receive general anesthesia (be put to sleep) or be given a regional anesthesia to block sensation from the waist down, along with a relaxant. The type of anesthesia a patient receives is decided well ahead of time.

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  • The surgeon makes a 10 to 12 inch incision, usually at the side or back of the hip, cutting through skin and then through muscle and other soft tissue to expose the bones at the hip joint. A surgeon performing minimally invasive total hip replacement will make a smaller incision and/or cut through less soft tissue.
  • The surgeon dislocates the joint, removing the head of femur from its socket in the pelvis. This socket is called the acetabulum.
  • The arthritic femoral head is cut off with a bone saw.
  • The surgeon prepares the acetabelum for its acetabular cup prosthesis by using a special tool called a reamer to grind down and shape the socket.
  • The acetabular cup is placed into the reshaped socket. This cup may be porous to allow the bone to grow into it over time. Other acetabular cups are adhered with special bone cement. The type of cup and how it is adhered to the bone can depend on the surgeon’s preference and the patient’s physiology.
  • The surgeon puts a rounded acetabular insert/liner inside the acetabular cup. The insert may be ceramic or plastic and will facilitate smooth movement within the new joint.
  • The surgeon prepares the femur bone and inserts the prosthetic femoral stem into it. The femoral stem is a narrow, tapered metal shaft that fits several inches down inside the femur. The top of the stem is designed to hold a prosthetic ball that will replace the femoral head.
  • A temporary prosthetic ball is attached to the top of the femoral stem. This ball is specially shaped to move with the new acetabulum cup and insert. The surgeon will insert a temporary ball into the new socket and move the hip around, checking to make sure the joint has ease of motion and does not dislocate.
  • The surgeon will remove the trial component and insert the final ball into the new socket, checking again for ease of movement and dislocation. The surgeon will also attempt to restore optimal leg length using one of several clinical techniques. Finally, X-rays are often taken to assure proper sizing and positioning of the components.
  • The muscle and other soft tissues that were cut are repaired and the skin incision is stitched or stapled back together.
  • Depending on the surgeon’s preference and surgical technique/approach to the hip, prior to transferring the patient to the recovery room, a wedge pillow may be placed between the legs to prevent dislocation of the hip replacement.

After surgery, patients may spend several hours in a recovery room while the surgical anesthesia wears off. Afterwards, a patient typically is taken to a hospital room where he or she will spend 2 to 5 days recovering before being discharged.

A surgeon may give a patient a list of recommended post-surgical precautions. Hip precautions typically address one of two issues:

  • Range-of-motion precautions. These precautions are recommended to minimize the chance of dislocation. For example, a patient may be told not to cross his or her legs.
  • Weight bearing precautions. These precautions maximize the chance that the natural bone has an opportunity to grow into the implants. For example, a patient may be told not to stand or walk without using crutches or a walker.

These precautions are frequently recommended for a minimum of 6 weeks.

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