Hip replacement 101

Your hip is one of your largest and most important joints. When arthritis or an injury causes problems with your hip joint, your whole life can be affected. You may have trouble doing even simple, daily activities like walking or sitting in a chair. If you have tried non-surgical methods of controlling pain in your hip but they have not worked, your doctor will probably recommend hip replacement surgery.

Having your hip replaced can seem overwhelming, especially when you do not know all the details. The truth is that hip replacement surgeries are fairly common, with about 300 thousand being done each year (this is based of 2010 data from the CDC and these numbers are rising fast). When you need to get any kind of surgery, it is important to have a good understanding of what the surgery entails, potential risks, who needs it, and what you can expect while you recover.

Below, you will find an in-depth guide to total hip replacements, so you can make the decision to get surgery armed with all the information you need.

What is a total hip replacement?

The name says it all. A total hip replacement is a surgery that removes damaged parts of your hip joint and replaces them with new, man-made parts. Ideally, having a total hip replacement will give you back your mobility. After recovery and physical therapy, you should be able to resume doing the activities you used to love. A study published in the British Medical Journal found that patients who had a total hip replacement experienced some great benefits:

• More range of movement in hip
• Considerable pain relief
• More mobility
• Improved ability to complete daily living activities (like climbing stairs or taking a shower)

Overall, hip replacement surgeries have shown to be a highly effective method for treating hip pain and loss of function. Let us take a deeper look.

How is total hip replacement done?

Hip replacements take about 1 to 2 hours to complete (but could take longer if you are in poor health or are obese) and are typically done as inpatient procedures, meaning you will stay overnight in the hospital. Some people qualify for an outpatient hip replacement but that will depend on your personal health, so talk to your doctor to find out if that is a possibility for you.

During a hip replacement surgery, your surgeon will make an incision on the side of your hip. Depending on your gender and weight, the incision can range from small to quite large — it just depends on how large the area is. Your doctor will move the muscles that are connected to the top of your thigh bone aside, so they can view your hip bones.

Next, the ball portion of your hip joint — called the femoral head — is removed from your thigh bone with a medical saw. Sounds painful but you will be under general anesthesia and will not feel a thing. An artificial joint, shaped just like the one removed, is then attached to your thigh bone.

After that, your surgeon will remove the damaged cartilage from your hip bone and attach an artificial socket (the socket is called the acetabulum). Then, the artificial ball joint and socket are attached to each other, just as they were before. Your muscle is moved back into place and your doctor will close the incision.

Once the surgery is complete, you will be moved to a recovery room in the hospital. You will most likely be asked to walk around very soon after your surgery to help prevent blood clots from forming in your legs. You will also see a physical therapist who will help you learn how to move with your new hip. You can expect to spend 1 to 4 days in the hospital but do not worry. With Carrum Health, you will spend almost a day less than the average patient in the US — and your Carrum Concierge will walk you through everything you need to know before you get surgery.

Who performs total hip replacements?

When you are getting a total hip replacement (or any kind of surgery, for that matter), you want to know who will be performing your surgery and just how qualified they are. Total hip replacements can be done by general surgeons but are usually done by board-certified orthopedic surgeons. To learn more about how to choose the right surgeon, check out this helpful guide. When you use the Carrum Health benefit offered by your employer, you will have access to the highest quality surgeons in the country. Our surgeons have gone through orthopedic surgery fellowship training in addition to regular surgery training.

What are the potential risks of a total hip replacement?

In general, hip replacements are a common, safe surgery. Two of the key factors to look at when determining risk are the mortality rates (how many people died after having the surgery) and readmission rates (how many people had to go back to the hospital after surgery). One study found that the rates for a total hip replacement are:

• 30-day mortality rate (death within 30 days of surgery) — 0.30%; with Carrum Health’s hospitals and surgeons, this is 0.0%
• 90-day mortality rate (death within 90 days of surgery) — 0.65%; with Carrum Health’s hospitals and surgeons, this is 0.0%
• 30-day readmission rate — 4.3%; 1.7% with Carrum Health’s hospitals and surgeons

The most common reasons patients who were readmitted to the hospital after a total hip replacement were:

• Dislocation
• Surgical site infection
• Postoperative hematoma (an abnormal collection of blood outside of the blood vessels)

These numbers do not need to alarm you. There are many factors that affect mortality and readmission rates, a large number of them related to the health of the patient. If you are concerned about how your health could impact your surgery’s safety and effectiveness, bring that up with your surgeon.

Readmission and mortality aside, there can be other complications with a hip replacement. These include:

• Blood clots
• Infection
• Fracture
• Dislocation
• Change in leg length
• Loosening of the implant

All of these risks can be addressed with your surgeon and should not keep you from having a total hip replacement if you really need one. 

Who needs a hip replacement?

There are many telling signs that you may be ready for a hip replacement. If you experience any of the following, you should talk to your doctor and get their opinion:

• Persistent or recurring hip pain
• You cannot stand on your “problem” leg for longer than a minute
• Hip pain during and after exercise
• Your hip becomes stiff after sitting for long periods of time
• Walking up and down stairs is difficult
• Your hip is swollen
• You have decreased mobility due to hip pain

Once you and your doctor have identified the potential need for a total hip replacement, you will need to meet these guidelines outlined by the National Institutes of Health (NIH) in order to qualify:

• Joint disease has been identified through an MRI or X-ray
• Pain caused by the joint disease that affects your ability to walk or care for yourself
• Unsuccessful attempts at treating the disease with non-surgical methods for a minimum of 3 months

As with most surgeries, comorbidities, or the presence of more than one chronic conditions, can also play a role in your eligibility for joint replacement surgery. For example, if you are obese with a body mass index (BMI) higher than 45, your care team may recommend a weight loss program before you can qualify for a hip replacement. Obesity can negatively affect the success of joint replacements. Other comorbidities that could impact your eligibility for a total hip replacement include:

• Hypertension
• Cardiovascular disease
• Endocrine disease
• Gastrointestinal disease

Your doctor or a Carrum Health Concierge can help you determine whether you qualify for a hip replacement.

How long will a new hip joint last?

If you are going to go through with getting a hip replacement, it is only normal to wonder how long your new hip will last. There is no guaranteed answer, however, studies have found that “about 80% of hip replacements were functioning well after 15 years in the younger (less than 65) patients, and 94% of the older (over 65) patients.” Those are great odds.

If your new hip stops working, you would have what is called a revision hip replacement. This is simply a replacement of the originally implanted hip parts.

Are there alternatives to a total hip replacement?

Realistically, if your doctor is bringing up a total hip replacement, you probably need one. They are not usually recommended until at least 3 other methods for managing pain and increasing mobility have been tried.

However, losing weight, strengthening muscles, and increasing flexibility in your hip can help you avoid the need for a hip replacement if started early. Even if you do not start doing any of these things until just before your surgery, they can still help make your hip replacement safer and more effective.

Recovering from a hip replacement

Your total hip replacement is done. Now what? Recovery can take up to 12 weeks, depending on your overall health and the success of your knee replacement surgery. Before you even leave the hospital, a physical therapist will show you different exercises you can do at home to strengthen your hip and regain mobility. After you have been discharged, you will want to keep doing those at-home exercises, as well as attending physical therapy appointments.

Your surgeon will follow up with you at different points throughout your recovery, to see if you are meeting the milestones you set together. These can include things like walking without assistance, walking up and down stairs, and taking a bath on your own.

Recovery can take a while, so do not get discouraged if you cannot do all the things you want to do right away. Practice and patience (and following recovery instructions from your care team!) will help make sure your recovery goes smoothly.

There you have it — a look at the key things you need to know about having total hip replacement surgery. It is a lot of information but when you book your surgery using your Carrum Health benefit, you will not have to go it alone. You will have a Carrum Concierge to help you at every step of the way. If you are a candidate for hip surgery, your next step is to schedule a free consultation.