Total hip replacement involves surgically removing a diseased hip joint and replacing it with an artificial joint, called a prosthesis. The hip joint – made up of the femur (thigh) bone and pelvic bone – connects the leg to the body and allows you to walk, sit and squat.
“The hip is part of every body movement you make,” said Dr. Sudhakar Madanagopal, associate professor of orthopaedics at the USA College of Medicine and an orthopaedic surgeon with USA Physicians Group.
According to Dr. Madanagopal, the most common cause of hip pain that requires a hip replacement is degenerative arthritis (osteoarthritis), or wear and tear of the joint. Arthritis in early age, he said, can be genetic.
“Your bone has a cartilage covering on it that wears down as you age, which can lead to osteoarthritis,” he said. “With a hip replacement, patients have an improvement in both function and pain relief.”
The second reason Dr. Madanagopal performs hip replacements is for post-traumatic arthritis. “Sometimes hip pain and arthritis can come secondary to injury such as fractures – for example, a previous fall that injured the hip,” he said.
Dr. Madanagopal said the most important thing he asks patients with hip pain is how they are functioning, including their ability to stand, sit, walk, climb stairs, squat, knee and run. “If you come to me saying you can’t walk more than a block or stand more than 10 minutes, I will ask you what your realistic goal is – what you want to be able to do. Then, we base the treatment off of that goal. The entire idea is to improve function.”
He said it is important to understand that not every patient with hip pain will need surgery. “It all depends on the individual person and that person’s medical condition and realistic goal.”
Initial management for hip pain may include anti-inflammatory medications, physical therapy, weight loss, or activity modification. “We always look at the results of these treatments first before proceeding with a hip replacement,” said Dr. Madanagopal. “If that helps patient achieve the goal, then you don’t need to go through surgery.”
Dr. Madanagopal said the only reason to do hip replacement is for relief of hip pain that affects activities of daily living. “The pain is the only thing I can guarantee to take away by doing a hip replacement,” he said. “A bonus may include better mobility.”
During a total hip replacement, the diseased or damaged bone and cartilage is removed and the prosthetic is implanted into your pelvic bone to replace the damaged socket. Then, the round top of your femur is replaced with a prosthetic ball, which is attached to a stem that fits into your thighbone.
According to Dr. Madanagopal, the new, artificial joint is designed to mimic the natural, gliding motion of a healthy hip joint. “With hip replacement, you will not even know you have an artificial hip,” he said. “It is a very successful surgery.”
Total hip replacement surgery requires a hospital stay between three to five days, and limited physical therapy is needed. Six weeks following surgery, Dr. Madanagopal said you can resume all activities such as standing, walking, climbing stairs, driving, and bending. The hip is usually healed completely in three to six months.
Dr. Madanagopal recently gave an overview of hip replacements at the October Med School Café lecture. To view the lecture in its entirety, click here.