Questions and Answers about Hip Replacement
What Is a Hip Replacement?
Hip replacement, or arthroplasty, is a surgical procedure in which the
diseased parts of the hip joint are removed and replaced with new, artificial
parts. These artificial parts are called the prosthesis. The goals of hip
replacement surgery are to improve mobility by relieving pain and improve
function of the hip joint.
Who Should Have Hip Replacement Surgery?
The most common reason that people have hip replacement
surgery is the wearing down of the hip joint that results from osteoarthritis.
Other conditions, such as rheumatoid arthritis (a chronic inflammatory disease
that causes joint pain, stiffness, and swelling), avascular necrosis (loss of
bone caused by insufficient blood supply), injury, and bone tumors also may
lead to breakdown of the hip joint and the need for hip replacement
Before suggesting hip replacement surgery, the doctor is
likely to try walking aids such as a cane, or non-surgical therapies such as
medication and physical therapy. These therapies are not always effective in
relieving pain and improving the function of the hip joint. Hip replacement may
be an option if persistent pain and disability interfere with daily activities.
Before a doctor recommends hip replacement, joint damage should be detectable
on x rays.
In the past, hip replacement surgery was an option primarily
for people over 60 years of age. Typically, older people are less active and
put less strain on the artificial hip than do younger, more active people. In
recent years, however, doctors have found that hip replacement surgery can be
very successful in younger people as well. New technology has improved the
artificial parts, allowing them to withstand more stress and strain. A more
important factor than age in determining the success of hip replacement is the
overall health and activity level of the patient.
For some people who would otherwise qualify, hip replacement
may be problematic. For example, people who suffer from severe muscle weakness
or Parkinson's disease are more likely than healthy people to damage or
dislocate an artificial hip. Because people who are at high risk for infections
or in poor health are less likely to recover successfully, doctors may not
recommend hip replacement surgery for these patients.
What Are Alternatives to Total Hip Replacement?
Before considering a total hip replacement, the doctor may
try other methods of treatment, such as an exercise program and medication. An
exercise program can strengthen the muscles in the hip joint and sometimes
improve positioning of the hip and relieve pain.
The doctor also may treat inflammation in the hip with
nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin
and ibuprofen. Many of these medications are available without a prescription,
although a doctor also can prescribe NSAIDs in stronger doses.
In a small number of cases, the doctor may prescribe
corticosteroids, such as prednisone or cortisone, if NSAIDs do not relieve
pain. Corticosteroids reduce joint inflammation and are frequently used to
treat rheumatic diseases such as rheumatoid arthritis. Corticosteroids are not
always a treatment option because they can cause further damage to the bones in
the joint. Some people experience side effects from corticosteroids such as
increased appetite, weight gain, and lower resistance to infections. A doctor
must prescribe and monitor corticosteroid treatment. Because corticosteroids
alter the body's natural hormone production, patients should not stop taking
them suddenly and should follow the doctor's instructions for discontinuing
If physical therapy and medication do not relieve pain and
improve joint function, the doctor may suggest corrective surgery that is less
complex than a hip replacement, such as an osteotomy. Osteotomy is surgical
repositioning of the joint. The surgeon cuts away damaged bone and tissue and
restores the joint to its proper position. The goal of this surgery is to
restore the joint to its correct position, which helps to distribute weight
evenly in the joint. For some people, an osteotomy relieves pain. Recovery from
an osteotomy takes 6 to 12 months. After an osteotomy, the function of the hip
joint may continue to worsen and the patient may need additional treatment. The
length of time before another surgery is needed varies greatly and depends on
the condition of the joint before the procedure.