Total Hip Replacement (Total Hip Arthroplasty)

What is a total hip replacement?

Total hip replacement, also known as total hip arthroplasty, is a surgical procedure that replaces the femur and the acetabulum with artificial joints.

During the procedure, your surgeon will replace the damaged or diseased 'ball and socket' joint with:

• An artificial femur (ball) made of strong metal or ceramic; and
• An artificial acetabulum (socket) made of a durable, wear-resistant plastic called polyethylene.

This artificial joint is designed to glide together to replicate the movement of the hip joint. With care, it can last around 20 years.

Ongoing improvements in surgical techniques and artificial joint materials may help these implants to last even longer.

Why do you need a total hip replacement?

You may consider hip replacement if:

• Conditions such as arthritis affect your everyday activities
• Non-surgical alternatives such as physiotherapy and anti-inflammatory medicines are unable to relieve hip pain

Conditions that may contribute to the need for hip replacement surgery include:

• Osteoarthritis, where a breakdown of cartilage (connective rubbery tissue) can lead to pain, swelling and deformity. Osteoarthritis occurs when damaged cartilage is unable to absorb shock or impact.
• Rheumatoid arthritis, a chronic inflammatory condition that leads to severe pain, stiffness and swelling that affects mobility.
• Osteonecrosis, where a lack of blood supply to the 'ball' portion of the hip joint may result in the collapse or deformity of the bone.

Hip replacement is only recommended after a careful diagnosis of your joint problem. With proper care after surgery, hip joint implants may last 20 years or longer.

What are the risks and complications of a total hip replacement?

Hip replacement surgery is a generally safe procedure. As with any form of surgery, a total hip replacement comes with some risks, such as:

• Blood clots in the leg veins due to limited walking during the initial period after surgery.
• Infection at the site of incision or in the deeper tissue near the new hip.
• Injury to nerves and blood vessels from swelling or pressure in and around the implant area.
• Need for additional surgeries due to the loosening of the new joint over time.
• Dislocation of the ball of the new joint from its socket due to moving or resting in the wrong position.

Those with severe rheumatoid arthritis, systemic lupus, diabetes or haemophilia may face a higher risk of complications. You are encouraged to speak with your surgeon to understand if this surgery is right for you.

How do you prepare for a total hip replacement?

Before the operation, your doctor will undertake a preoperative evaluation to review your medical history and suitability for surgery. You may undergo a physical examination as well as tests or imaging.

In general, you need to fast before the procedure.

Note: If you are taking any medication or herbal supplements, you should inform your doctor. You may need to adjust or stop taking some medication before the procedure (e.g. aspirin, blood thinners).

What can you expect in a total hip replacement?

Total hip replacement, or total hip arthroplasty, may be done through standard open surgery or minimally invasive surgery.

In minimally invasive surgery, the incision is smaller and the procedure takes less time. Patients also typically stay in the hospital for a shorter time.

Estimated duration

The procedure takes a few hours.

During the procedure

Hip replacement surgery is performed under anaesthesia. If you are given general anaesthesia, you will be asleep throughout the procedure. If you are given a spinal anaesthetic, you will be awake but numb from the waist down.

During the procedure, your surgeon will:

• Make an incision over the front or side of the hip.
• Remove the diseased or damaged portion of the hip bones.
• Replace the diseased or damaged portions with the prosthetic ball and socket.

After the procedure

Post-operative pain is normal and will be managed with medication. Steps will also be taken to reduce swelling and prevent deep vein thrombosis.

To help you regain your mobility and strength and flexibility, you may consult a physiotherapist to speed up your recovery and regain function.

Care and recovery after a total hip replacement

During the initial part of recovery, your movement may be limited. To reduce the risk of falls and help facilitate a smooth recovery, you may need to:

• Limit the use of stairs
• Opt for firm, straight-back chairs
• Arrange for help for meals and housework
• Use an elevated toilet seat to reduce bending
• Remove rugs, carpets, wires and other trip hazards
• Install handrails, shower seats and other safety aids to prevent falls

You should also avoid the following movements for up to 1 year after your surgery:

• Turning the involved leg inwards
• Pivoting or twisting on the involved leg
• Crossing the involved leg past the midline of the body
• Bending at the hip past 90 degrees, including squatting
• High-impact sports and heavy activities

With proper care, hip joint implants can last 20 years or longer.