Total Hip Replacement

Total hip replacement surgery, also called total hip arthroplasty, is a procedure where damaged bone and cartilage is removed from the hip joint and replaced with prosthetic components. Hip replacement surgery has the ability to relieve pain and restore normal function to the hip joint.

Hip replacement surgery is recommended when:
  • Hip pain limits everyday activity and mobility
  • Hip pain continues while you are resting, either during the day or at night
  • Stiffness in the hip joint limits your ability to move or lift the leg
  • Conservative treatment such as anti-inflammatory medication, physical therapy, or walking support does not adequately relieve symptoms and pain
Common Causes of Hip Pain

The most common cause of chronic hip pain is arthritis. When a patient has arthritis in the hip, the underlying bone can develop spurs and irregularities which can cause pain and loss of motion.

Types of arthritis that contribute to hip pain are:
  • Osteoarthritis: age-related, wear and tear, arthritis. It typically occurs in patients 50 years of age and older and often in inpiduals with a family history of arthritis.
  • Rheumatoid Arthritis: an autoimmune disease where chronic inflammation of the synovial membrane causes damage to the cartilage in the hip joint, resulting in pain and stiffness.
  • Post-traumatic Arthritis: arthritis caused when cartilage is damaged during serious hip injury or fracture.

Another common cause of hip pain is avascular necrosis. Avascular necrosis simply refers to a lack of blood supply to the bone. An injury to the hip joint, such as a dislocation or fracture, may limit blood supply to the femoral head. This causes the surface of the bone to collapse resulting in arthritis

Treatment Options

Conservative, nonsurgical treatment options can be used to address the symptoms of hip arthritis. Medications can help ease any inflammation and reduce pain. Steroid injections into the hip joint may also help reduce inflammation. Physical therapy can improve the range of motion in your hip and strengthen the muscles that support the hip joint. Walking supports, such as crutches or a walker, can relieve pain and discomfort by reducing weight and stress to the hip joint.

Surgical Procedures

During a total hip replacement, a small incision is made over the front, side, or back of the hip to gain access to the joint. Your surgeon will then remove any diseased or damaged bone and cartilage, while leaving the healthy bone intact. A prosthetic socket is implanted into the pelvic bone to replace the damaged socket and a prosthetic ball and stem is inserted into the femur to replace the damaged femoral head.

There are three minimally invasive procedures performed by the physicians at SportsMED to replace the hip joint: the posterior approach (back), anterior approach (front), and lateral approach (side).

  • Posterior Approach is the most commonly used method for hip replacement surgery. The posterior approach is a minimally invasive surgical procedure that allows the physician to gain access to the hip joint from the back of the hip. Entering from the back of the hip allows the physician to avoid the primary leg muscles and gives the physician the best view into the hip joint.
  • Anterior Approach is a minimally invasive alternative to hip replacement where the surgeon enters the joint from the front of the hip. Entering from the front of the hip is a muscle-sparing technique that allows for faster initial recovery time and less postoperative restrictions that can sometimes delay recovery.
  • Lateral Approach is a minimally invasive surgical technique in which the physician enters into the hip joint from the side of the hip. The lateral approach allows the physician to preserve the posterior tissue structures, which decreases the risk of hip instability and dislocation.

Deciding which surgery option is best for you is determined through physical examination, diagnostic imaging (x-ray, MRI, etc.), and discussions with your surgeon.

Post-Op Recovery

The average short term recovery time, meaning a patient no longer requires walking aids and can walk around the house without pain or resting, is around 6 weeks. The average long term recovery time, meaning a patient has regained the normal activities of daily living, is around 6 months. Full recovery from a total hip replacement takes about 4 to 6 months, depending on your overall health and the success of your rehabilitation.

Physical therapy is extremely important in the outcome of hip replacement surgery. Patients will begin a physical therapy program immediately following surgery. The goals of physical therapy are to strengthen muscles around the hip joint, prevent contractures, and improve patient education. Contracture refers to the shortening or hardening of muscles, tendons, on other tissue, which can limit range of motion caused by scar tissue.

Limitations Following Surgery
  • Do not cross your legs at the knees for at least 6 to 8 weeks
  • Do not bend at the waist beyond 90 degrees
  • Do not bring your knee up higher than your hip
  • Do not lean forward while sitting or as you sit down
  • Do not turn your feet excessively inward or outward when you bend down
  • Do not reach down to pull up blankets when lying in bed

H Cobb Alexander, M.D.
Matthew D. Clayton, M.D.
Dale Culpepper, M.D.
Brett Franklin, M.D.
Randall Tindell, M.D.