If you have experienced persistent or progressive hip pain and worsening joint function despite nonsurgical treatments such as medications and therapy, it may be time to consider hip replacement surgery. First performed in 1960, hip replacement surgery is one of the most successful operations in modern medicine. During a Total Hip Replacement (also called Total Hip Arthroplasty or abbreviated THA), damaged bone and cartilage are removed from the hip joint and replaced with prosthetic components. Continued medical advancements in total joint replacement surgical techniques and technology have greatly increased the effectiveness and patient improvements seen with Total Hip Replacement. Dr. Cory Calendine, Orthopaedic Surgeon offers state-of-the-art Robotic-Assisted and Minimally-Invasive Hip Replacement Surgery options that optimize patient outcomes.

One of the first steps when considering hip replacement is to meet with a qualified and experienced surgeon to determine if you are a candidate for Total Hip Replacement surgery. Dr. Calendine will take your medical history, perform a physical examination and complete x-rays. Even if the pain is significant, and x-rays show advanced joint, first line treatment typically includes non-operative options. Nonsurgical treatments include weight loss if appropriate, exercise and/or physical therapy, medications, bracing, and even joint injections. If hip symptoms persist despite these measures, hip replacement surgery becomes a consideration. The decision to move forward with surgery often involves thoughtful conversation with your surgeon, medical team, and loved ones. Final decision to have joint replacement surgery is most often based on the impact that pain and disability have on your quality of life and daily activities. Patients that decide to proceed with hip arthroplasty commonly report that their symptoms limit daily activities such as walking, taking stairs, working, sleeping, putting on socks and shoes, and sitting for extended periods of time. Joint replacement surgery is an effective next step for many patients when non-surgical treatments have failed to provide appropriate joint pain relief.

In a Total Hip Replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components (pictured below). The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur (thighbone). The femoral stem may be either cemented or "press-fit" into the bone. A ceramic (or less commonly, metal) ball is placed on the upper part of the stem. This ball replaces the removed damaged femoral head. The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal cup and liner. Screws or cement are sometimes used to hold the cup in place. The plastic, ceramic, and metal components forming the new ball and the socket joint allow for a smooth gliding surface that replicates the original ball and socket joint of the hip.

Most implants (pictured above) today have become very similar as surgical experience has determined which designs work best. A variable that still remains is the bearing surface (or the ball and liner) that attaches to the stem and cup that fix to the bone. The ball can be composed of either metal (cobalt chromium alloy) or ceramic, and the liner can be made of plastic (polyethylene), metal, or ceramic. The ball and liner can then be used in different combinations and are named for the respective ball liner combination (metal on poly, ceramic on poly, ceramic on ceramic, etc.). Today the vast majority of bearings utilized a polyethylene liner with either a metal or ceramic head, with other combinations being used with less frequency. You can discuss implant differences and preferences with your surgeon to determine which implant is best for you.

Hip replacement surgery can typically lasts 1-2 hours. Dr. Calendine will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip. Immediately after surgery, you will be moved to the recovery room where you will remain for a few hours while you recover from anesthesia. [Read more about anesthesia for hip replacement surgery.] Advances in hip surgery techniques and technology has significantly decreased the amount of time that patients have to spend in the hospital following surgery. Most patients will begin ambulating and moving the joint soon after surgery and some patients will even go home the same day. This is highly dependent upon your condition before surgery, age, and concurrent medical problems which can influence your recovery and rehabilitation. A safe and personalized discharge plan will be arranged for you by your orthopedic team.

Success of hip replacement surgery depends in large part on your physical condition prior to surgery and how well you follow your orthopedic surgeon's instructions regarding home care during the first few weeks after surgery. Dr. Calendine and your medical team will emphasize ambulating and getting you out of bed quickly. Most joint replacement patients are walking with the assistance of a walker on the day of or day following surgery. Early ambulation has proven to speed post-operative recovery and reduce the risk of complications including blood clots. Progression to using a cane or nothing at all typically occurs within the first 4-6 weeks after surgery and depends on each individual’s progress. Wound stitches or staples are typically removed within 2 weeks following surgery. Home wound care instructions will carefully explained prior to discharge and included in your written care plan. [Read more about what to expect the first week following hip replacement surgery.]

The majority of Total Hip Replacement surgery patients are able to participate in most of their daily activities within six weeks. Dr. Calendine typically allows patients to drive at four to six weeks after surgery and sometimes sooner (especially if the operative leg is the left leg). There is some literature that states that your reaction time will not be back to normal prior to six weeks. You should not drive while on narcotics, and should discuss returning to driving with your operating surgeon. By three months, most people have regained much of the endurance and strength lost around the time of surgery, and can participate in daily activities with few restriction. Even after daily activities have resumed, it is important to avoid high impact activities to give you the best long-term outcome with your hip. Returning to work is highly dependent on your general health, activity level and demands of your job. If you have a sedentary job, such as computer work, you can expect to return to work in four to six weeks. If you have a more demanding job that requires lifting, walking, or travel, you may need up to three months for full recovery.

Initially, you will often receive some physical therapy assistance immediately following surgery while in the hospital. Depending on your preoperative conditioning and support, you may or may not need additional therapy as an outpatient. Much of the therapy after hip replacement is walking with general stretching and thigh muscle strengthening, which you can do on your own without the assistance of a physical therapist. Dr. Calendine most often uses Anterior Approach Hip Replacement which decreases your risk of implant dislocation and activity limitations immediately following surgery. Post-operative precautions will vary from patient to patient, depending on the surgical approach performed and any additional concurrent medical limitations. Prior to being discharged home from the hospital, Dr. Calendine and your medical care team will provide you with any specific precautions you need to follow.

Fall precautions are always a priority during the first few weeks following surgery. Stairs are a particular hazard until your new hip is strong and mobile. Patients should use a cane, crutches, walker, or handrails, and have someone assist them until balance, flexibility, and hip strength is improved. Dr. Calendine and your physical therapy team at the Bone and Joint Institute of Tennessee will assist you assistance device choice and correct use during your recovery period.
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Follow up after your joint replacement is vitally important to assure optimal recovery. The frequency and timing of follow-up visits after surgery is dependent on many factors including age, complications, demand levels placed on the joint, and the type of joint replacement completed. Dr. Calendine and your medical team will carefully consider each of these factors and tailor a follow-up schedule to best serve your needs.

Source: American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/; American Association of Hip and Knee Surgeons, https://hipknee.aahks.org/total-hip-replacement/