Hip Replacement

What is hip replacement?

Hip replacement surgery (hip arthroplasty) is the process of replacing the damaged parts of your hip joint with metal, plastic or ceramic alloy prostheses.

The hip joint consists of the ball (head of the femur) and the socket (acetabulum in the pelvis). Hip replacement surgery is performed to treat problems in these structures caused by osteoarthritis (calcification), tumor, advanced age hip fracture, bone necrosis, hip dysplasia (hip dislocation) and other hip joint damage.

The operation is performed in two types as replacement of one (regional hip replacement) or both parts (total hip replacement).

If the surgeon’s experience is insufficient or the conditions of the health institution are not sufficient, hip replacement is not appropriate if the highest quality prostheses will not be used.

Who is a suitable candidate for hip replacement?

Hip prosthesis is often recommended in cases of hip pain that limits daily activities such as walking or bending, continues at rest, stiffness that limits the ability to move or lift the leg, and inadequate anti-inflammatory medications and/or physical therapy.

Most patients who undergo hip prosthesis are between the ages of 50 and 80. However, surgeons evaluate patients individually. The operation has been successfully performed at all ages, from young adolescents with juvenile arthritis to elderly patients with degenerative arthritis.

Patients with chronic medical conditions such as heart disease or kidney disease may need to be evaluated by a specialist such as a cardiologist or nephrologist before surgery.

Those with poor personal hygiene, dementia or mental illness, active infection in the hip, advanced artery or vein insufficiency, or muscle paralysis around the hip due to neurological diseases are not suitable candidates for this surgery.

Surgeons may recommend that you adjust your weight before surgery to avoid complications.

What evaluations are made for hip replacement surgery?

Your doctor may request additional evaluations specific to your condition. However, the following evaluations are usually performed prior to surgery:

  • Patient Medical History
  • Physical Examination
  • Quantity Tests
  • Imaging (X-ray, CT, MRI, etc.)

After reviewing the results of your evaluation, your surgeon will determine if hip replacement surgery is the best option to relieve your pain and increase your range of motion.

What are the methods used in hip prosthesis?

Hip replacement surgery has been successfully performed since the 1960s and is continuously being developed with bioengineering technologies. Initially mostly applied to middle-aged and older individuals, today the surgery also offers an effective solution for conditions such as developmental hip dysplasia (hip dislocation) and avascular necrosis (blood supply problems in the femoral head) in individuals between the ages of 20-40.

The surgical approach your doctor will recommend depends on various factors such as how the surgeon will access the hip; the type of prosthesis, its style, how it will be attached, your age, your activity level, the shape and health of your hip bones. Hip replacement surgery is basically divided into two as regional and total.

Regional hip replacement involves replacing only the upper end of the femur (ball) of the joint and leaving the section connected to the hip in the pelvis (socket) in place. It is a more minimal surgery compared to total surgery.

Regional hip replacement surgery is usually performed in elderly patients to repair a specific hip fracture. This surgery is an option when the hip joint socket is healthy.

How to decide on the type of prosthesis?

There are many different designs and types of materials used in hip replacements today. Each consists of two basic components:

  • Ball component (polished, strong metal or ceramic, etc.)
  • Socket component (durable plastic, ceramic, or metal, etc.)

The prosthetic components can be “press-fit” or cemented into place to allow your bone to grow into the components. The decision to press-fit or cement the components is based on a variety of factors, including the quality and strength of your bone. A combination of a cemented stem and an uncemented socket can also be used.

What is total hip replacement surgery?

Total hip replacement is a procedure in which damaged bone and cartilage are removed and replaced with prosthetic components. Once complete, the joint parts have smooth surfaces, greatly improving movement and reducing pain and stiffness. Patients who are candidates for this surgery are usually those with moderate to severe osteoarthritis, rheumatoid arthritis, or severe damage to their hip joints. This procedure is preferred if the patient’s health can handle a longer, more challenging recovery period.

What methods are used to perform total hip arthroplasty?

Traditional and modern approaches can be preferred in hip replacement. Traditional hip replacement is performed with a single, large incision that helps the surgeon access the hip, usually from the side (lateral approach) or from the back (posterior approach). Recovery can take time in traditional surgery because the surgeon must cut or separate some muscles and tendons to reach the joint. (Muscles and tendons are repaired when hip replacements are placed.) There may be a risk of dislocation until all supporting structures heal.

Today, with developing technologies, minimally invasive modern techniques have generally become preferred. The most recent of these is robotic arm-assisted prosthesis surgeries. This method is also known as robotic arthroplasty, robotic surgery, robotic prosthesis surgery and makoplasty.

How to prepare for total hip replacement?

After all the tests and examinations before the hip replacement surgery, the surgical method is decided. The following conditions are taken into consideration during the preparation process:

  • Your doctor will ask you to report any skin irritations such as cuts, scratches, abrasions, redness or insect bites on the skin of the area to be operated on. Any deterioration in skin integrity (skin health) may increase your risk of infection and if you have an infection, your surgery will be canceled.
  • Healthcare professionals will inform you about which medications you should stop taking and which ones you should continue taking before the surgery.
  • Although infections are not common after total hip replacement surgery, infections can occur if bacteria enter your bloodstream. Therefore, major dental procedures (such as tooth extractions and periodontal procedures) should be completed before your total hip replacement surgery.
  • People with a history of recent or frequent urinary tract infections should undergo a urological evaluation prior to surgery.
  • Older men with prostate disease should consider completing the necessary treatment prior to surgery.
  • Although you may be able to walk with a cane, crutches, or a walker shortly after surgery, you may need assistance with tasks such as cooking, shopping, bathing, and laundry for a few weeks.
  • When you are discharged from surgery, a few changes can be made to make it easier to navigate your home during your recovery (railings, grab bars in the shower and toilet, etc.).

How is total hip replacement surgery performed?

Total hip replacement surgery is performed under general anesthesia. The procedure usually takes 1 to 2 hours. The basic steps of the surgery are:

  1. The surgeon makes one or more incisions in the back or side of your hip.
  2. The damaged hip joint is separated.
  3. The upper end (ball) of the thigh bone is cut and removed.
  4. A new ball is placed at the end of the thigh bone.
  5. The hip socket is drilled and a new socket is placed.
  6. The new hip is put back together.
  7. The surgeon closes the incision or incisions using stitches or clips and covers them with a dressing and bandage.

What are the advantages of robotic prosthesis surgery (robotic arthroplasty) in hip replacement?

With developing technologies, robotic arms have begun to be used frequently as support in joint prostheses. With this technology, the operation plan can be made in a patient-specific manner (for example, three-dimensional virtual modeling specific to the patient’s anatomy). By working more meticulously, surgeons can determine the accuracy of the prosthesis placement more clearly, and the patient can recover faster and achieve better results. For a detailed article on robotic surgery, you can visit our robotic prosthesis surgery – robotic arthroplasty page.

The advantages of robotic surgery can be listed as follows:

  • Creating a personalized surgical plan and selecting the ideal prosthesis dimensions before surgery
  • Reducing the risk of abnormal friction of the prosthesis against the bone, thus extending the life of the prosthesis
  • More accurate adjustment of leg length equality
  • Minimizing errors that may occur in patients with different joint anatomy
  • Providing more precise surgery in difficult cases due to anatomy (rheumatism, hip dislocation, etc.)

What is the process before robotic surgery?

The preparation process begins with a computed tomography (CT) scan of the joint. The CT scan data is used to create a three-dimensional (3D) virtual model of the patient’s anatomy. This virtual model is loaded into the arm’s system software and used to create a personalized pre-operative plan.

The surgeon reviews the plan, size, and placement of the prosthesis before surgery. If necessary, he or she changes the surgical plan to check measurements important to the stability of the hip.

During surgery, the surgeon marks points on the hip to record the anatomy and system. This process establishes the relationship between the patient’s actual anatomy in the operating room and the 3D model used in the planning process. This step helps ensure that the procedure is carried out according to plan.

Once the anatomy is recorded on the 3D model, the surgeon has the flexibility to change the pre-operative plan based on his or her assessment of the patient’s anatomy.

How is prosthesis surgery performed with robotic surgery?

The surgeon guides the robotic arm to remove the problem area from the hip. A virtual boundary provides tactile resistance to prevent the surgeon from removing more than the problem area identified in the preoperative plan. Green visual cues appear on the screen to indicate how much bone will be removed.

The robotic arm allows the surgeon to prepare the hip socket in a controlled and accurate manner. The robotic arm guides the socket at the angle defined in the surgical plan as the surgeon prepares to place the prosthesis in its final position. Once the problem bone is gone, the hip prosthesis is placed in the joint space.

What is the process after total hip replacement and what should be taken into consideration?

The success of your surgery will depend largely on how well you follow your orthopedic surgeon’s instructions at home during the first few weeks after surgery.

  • The stitches or staples will be removed approximately 2 weeks after surgery. Avoid getting the area wet until the wound is completely closed and dry. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
  • You will be given special stockings to wear after surgery to reduce the risk of blood clots. You should wear these as directed.
  • Loss of appetite is common for several weeks after surgery. A balanced diet, often including iron supplements, is important to promote tissue healing and restore muscle strength. Also, be sure to drink plenty of fluids.
  • Exercise is a critical component of home care, especially during the first few weeks after surgery. You should be able to return to most normal light daily activities within 3 to 6 weeks after surgery. Some discomfort during activity and at night is normal for a few weeks.
  • After surgery, patients with certain risk factors may need to take antibiotics before having dental work, including teeth cleaning, or before any surgical procedure that could allow bacteria to enter the bloodstream.
  • A fall during the first few weeks after surgery can damage your new hip and may cause you to need further surgery. Stairs are especially dangerous until your hip is strong and mobile. You will need to use a cane, crutches, a walker or handrails, or have someone help you, until you improve your balance, flexibility and strength.
  • Your doctor may recommend physical therapy after surgery. A physical therapist will give you exercises to help you maintain your range of motion and regain your strength. For detailed information about physical therapy applications, you can visit our Physical Therapy and Rehabilitation page.

Are there any complications of total hip replacement surgery?

Hip replacement is a common and safe procedure. However, as with any surgery, there are risks. Some of these risks include:

  • Depending on the blood flow after the surgery, you may develop blood clots or DVT (deep vein thrombosis). Your doctor may prescribe anticoagulant medications.
  • Sometimes, a blood clot in your leg can travel to your lungs (pulmonary embolism). This can cause serious complications.
  • Your hip wound is unlikely to become infected after surgery. The infection is usually treated with antibiotics. If it spreads deeply into your hip joint, you may need another operation.
  • There is a chance that a blood vessel, nerve or ligament around your hip joint may be damaged during surgery. This is uncommon and can be repaired during surgery or healed afterwards.
  • Modern hip replacements are designed to last a long time. However, they can wear out over time, causing pain or swelling. Although it’s rare, if your hip replacement becomes dislodged or worn, you may need another surgery to fix it. If you have a metal hip replacement, you should have it checked regularly for wear.

Frequently Asked Questions About Hip Replacement

  1. How can I protect my hip replacement?

Here are some things you should do to protect and extend the life of your hip replacement:

  • Do regular gentle exercise to maintain proper strength and mobility in your hip.
  • Take special care to avoid falls and injuries.
  • Talk to your orthopedic surgeon about whether you should take antibiotics before dental procedures. Make sure your dentist knows you have a hip replacement.
  • Even if your total hip replacement seems fine, visit your orthopedic surgeon regularly for routine follow-up exams and X-rays.
  • Talk to your surgeon about any precautions you should take to resume sexual activity.
  1. When can I have sexual activity after hip replacement?

In general, if your surgeon approves, you can have sexual activity 3 to 8 weeks after surgery, provided you follow the movement instructions he or she gives you.

  1. When is a second operation (revision) required?

Although most hip prostheses are used for many years, revision surgery may be required in cases such as loosening of the prosthesis, wear, displacement of the inserted ball from the socket, infection in the prosthesis area, fracture of the upper part of the femur (thigh bone) due to a fall or other impact, etc.

  1. Can hip prosthesis be applied to all ages?

Total hip prostheses are usually performed on patients between the ages of 60 and 80. However, with developing technologies, the operation can now be performed at older and younger ages. Since it allows for a faster return to daily life compared to the past, prosthesis applications can also be preferred in young patients with advanced osteoarthritis.

 

  1. When can I return to driving after surgery?

The time it takes to return to driving after hip replacement surgery depends on the type of surgery, pain management, the success of physical therapy if applied, and personal recovery. It is generally recommended that 4 to 8 weeks pass before getting behind the wheel. Your doctor will inform you when you can drive during your check-ups.

  1. When can I return to sports activities after surgery?

Returning to sports activities is possible after hip replacement surgery. However, it depends on the type and intensity of the activity and usually occurs 2 to 3 months after surgery. Your surgeon, who knows you well, what type of surgery you had and whether there are any complications, should decide on your return to sports. From a medical perspective, continuing sports activities provides psychological and cardiovascular benefits as well as improving muscle tone and endurance.

 

  1. Is physical therapy mandatory after hip replacement?

Physical therapy is not mandatory for every patient after the operation. However, when needed, it has been observed that patients receiving physiotherapy support can reach their recovery goals faster. Physical therapists play a role in post-operative pain management, regaining mobility, increasing strength, preventing complications, accelerating recovery and improving overall quality of life.

  1. What is the cost of hip replacement surgery?

The cost of hip replacement surgery is determined by the type of operation, surgeon, hospital equipment, diagnostic tests, type of prosthesis and additional services (accommodation, transportation, etc.).