Total Hip Replacement (THR) Surgery : Procedure, Benefits & More

Damaging your hip can be one of the most painful and distressing aspects of life. Whether it is due to arthritis, a fracture, or any other condition, a damaged hip can make everyday activities like walking or even putting on your shoes agonizing and difficult. 

Though there are medications, walking supports, and lifestyle changes that may help your symptoms, sometimes none of these would suffice, and your doctor may suggest a total hip replacement surgery to relieve pain and help you lead a normal life.  So what is a total hip replacement? When and how is it performed? What are its benefits and risks? Let’s find out in this article.

Total hip replacement (THR), also called total hip arthroplasty, is a surgical procedure that replaces a damaged hip joint with an artificial implant called a prosthesis. This prosthesis or hip implant helps reduce pain and improve the function of the hip.

The hip joint is made up of 2 parts, both of which are replaced during total hip replacement:

• The hip socket (the acetabulum, a part of the pelvic bone)
• The upper end of the thigh bone (the femoral head)

During total hip replacement surgery, the surgeon removes the damaged sections of the hip joint and replaces them with:

• A socket, usually made of strong metal to replace the damaged cartilage surface of the socket (acetabulum). The socket may be held in place with screws or cement. 
• A metal or ceramic ball to replace the femoral head.
• A plastic (may also be ceramic or metal) liner or spacer, which fits between the ball and socket and allows smooth movement of the hip.
• A metal stem, placed in the hollow center of the thigh bone to anchor the joint.

When the damaged hip joint on the right side of the body is replaced with an artificial joint, the surgery may be known as right hip arthroplasty. When the damaged hip joint on the left side of the body is replaced with an artificial joint, the surgery is called left hip arthroplasty.

If you are suffering from a damaged hip, the doctor may first suggest options such as medication for the pain and inflammation, injections for the joint, walking support, and physiotherapy. However, if the pain and stiffness of the hip are unmanageable with these measures and are affecting your quality of life, the doctor may recommend a total hip replacement. 

A total hip replacement or total hip arthroplasty may be recommended for pain, inflammation, and damage to the hip joint due to conditions such as:

• Osteoarthritis: The most common type of arthritis, this condition involves the breakdown of the cartilage within a joint and changes in the underlying bone.
• Rheumatoid Arthritis: An autoimmune disease where the immune system attacks the tissue lining the joints.
• Osteonecrosis: Also called avascular necrosis, this condition includes the death of bone tissue and eventual collapse of the joint due to a lack of blood supply.
• Injury: Damage to the joints due to causes such as fractures in the hip or thigh bone may also necessitate a total hip replacement. 
• Tumor: The abnormal growth of cells in the hip joint could cause damage to the hip joint and a total hip replacement may be required. 

The doctor may recommend a total hip replacement for hip problems such as: 

• Persistent pain despite medication
• Hip pain that continues while resting
• Lack of restful sleep because of pain
• Difficulty with everyday tasks such as walking, bending, or climbing stairs
• Inability to participate in the activities you enjoy
• Stiffness in the hip that restricts you from moving or lifting your leg
• Pain while walking even with a cane or walker

• Before you decide to go ahead with total hip arthroplasty, your surgeon will schedule a consultation to discuss the procedure at length, its benefits, and risks, along with your expectations and questions. 
• During this consultation, the surgeon may also ask about your medical and surgical history. 
• Discuss your current medications, supplements, and herbs with the surgeon. You may be asked to discontinue medications that increase the risk of bleeding during the procedure or make it more likely for you to contract an infection.
• The surgeon will inquire about the extent of your hip pain and how it affects your ability to perform everyday activities.
• As part of pre-surgery preparation, the surgeon may conduct a thorough physical examination and order tests such as blood and urine tests, an electrocardiogram (ECG), and a chest X-ray.
• The surgeon will examine your hip to check the range of motion in your joint and the strength of the surrounding muscles.
• The surgeon may also order an X-ray of the hip to help determine the extent of damage to the hip.
• In some cases, a magnetic resonance imaging (MRI) scan may be needed to determine the condition of the bone and soft tissues in the hip.
• If you are overweight, the doctor may ask you to take some time to lose weight before the surgery to minimize the stress on the hip replacement. 
• You will be asked to stop smoking if you do, as tobacco use can interfere with healing.
• You will be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• You should arrange for someone to drive you home after the surgery and help with routine tasks at home for several weeks after the surgery. 
• The surgeon will give you a list of instructions for preparing your home for better recovery after the surgery. Make sure you follow the instructions. 
• Before the surgery is scheduled, you can practice using a cane, walker, crutches, or wheelchair to walk, go up and down stairs, and use the toilet and shower. 

• Total hip replacement or total hip arthroplasty is performed under general anesthesia or with the help of spinal, epidural, or regional nerve block anesthesia, which numbs the lower half of your body.
• The surgeon may also inject numbing medicine in and around the hip joint to help manage pain after the surgery.
• An intravenous (IV) line is attached to your hand or arm. A urinary catheter may be inserted as well.
• You will be placed in an appropriate position for the surgeon to access the hip joint and make an incision based on the approach (front, back, or side) preferred by the surgeon.
• There are two types of hip replacement approaches. In anterior hip replacement surgery, the surgeon makes an incision on the front side of the hip joint to access the damaged joint. In posterior hip replacement surgery, an incision is made on the backside of the hip joint to access the damaged hip joint.
• The surgeon makes an incision over the hip, through the layers of tissue.
• Next, the surgeon removes the damaged bone and cartilage and leaves the healthy bone intact.
• The surgeon removes the head of the femur and makes an opening at the top of the femur. Then, they insert the stem of the ball prosthesis. 
• The replacement head is attached to the top of the femur implant.
• Next, the surgeon removes the damaged cartilage from the acetabulum and attaches the new cup.
• The prosthetic components may be “press fit” into the bone so that the bone can grow onto the components or they may be cemented into place. 
• The surgeon checks that the hip replacement is functioning properly by bending and moving your leg.
• The layers of tissue are closed with dissolvable sutures and the outermost skin layer is closed with surgical glue.

• After the surgery, you will be taken to the recovery room for a couple of hours where your vitals such as blood pressure, pulse, alertness, etc. will be monitored. 
• Depending on your condition, you may be allowed to go home on the same day or be asked to spend a night in the facility. 
• The surgeon may require you to undergo X-ray imaging immediately after the procedure and during recovery to confirm the success of the surgery and check that the hip replacement is healing well.
• The surgeon will encourage you to move around and walk as soon as possible after the surgery. This helps prevent blood clots in your legs. 
• The surgeon may instruct you to wear elastic compression stockings or inflatable air sleeves on your lower legs after the surgery to prevent blood from pooling in the leg veins and reducing the chance of clot formation.
• The surgeon may also prescribe medication to manage pain post-surgery. They may also ask you to take blood thinners after surgery to reduce the risk of blood clots.
• Before you go home, the surgeon will provide a list of instructions to take care of the operated area. Follow the instructions diligently. 
• Expect some fluid discharge from the incision for a few days after the surgery. 
• Some patients may need to live for some time at a rehabilitation unit to prepare for independent living at home. Your surgeon will advise you about the same. 
• Speak to your doctor about activity and exercise to regain the use of your joint and muscles. You can work with a physical therapist on strengthening and mobility exercises and learn to use a walking aid.
• Follow these tips for faster and easier recovery:
  • Avoid getting the operated area wet until it has thoroughly sealed and dried. 
  • Elevate the leg and use ice to control swelling.
  • Avoid driving until the doctor says it is safe to do so.
  • Place items of everyday use nearby and at waist level to avoid having to bend down or reach up for them. 
  • Follow a balanced diet and drink plenty of fluids during recovery. 
• You can resume most daily activities (non-vigorous) such as sitting, standing, and climbing stairs within 3 to 6 weeks of the surgery. Full recovery may take 3 to 6 months. 
• Contact the doctor immediately if you notice increased redness, swelling, drainage from the incision, high fever, chills, or severe pain. 

Benefits

The benefits or advantages associated with total hip replacement (THR) include:

• High rate of success of the surgery
• Relief from persistent hip pain
• Improved strength of the hip joint 
• Increased mobility
• Long-lasting results of the surgery
• Enhanced quality of life

Risks

As with any surgical procedure, there are some risks or potential complications associated with a total hip replacement. These include:

• Bleeding
• Infection
• Blood clots
• Continued pain or stiffness
• Fractures in healthy portions of the hip joint during surgery
• Change in leg length
• Dislocation of the hip joint
• Loosening or wearing out of the implant
• Rarely, injury to the nearby nerves

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