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Hip Replacement

  • Definition

    Article updated and reviewed by Stephen Burnett, MD, FRCS(C), Assistant Professor, Department of Orthopaedic Surgery, Washington University School of Medicine on July 11, 2005.

    A surgical operation to replace the inside surface of the hip joint (the “ball and socket”).


    Time, injury to the joint, coupled with arthritis, may lead to degeneration of the hip joint, causing pain, deformity, and restricted movement. Hip replacement surgery, also called total hip arthroplasty (THA), hip resurfacing, or total hip resurfacing may be an option if your daily activities are limited by uncontrollable pain and your x-rays show an end-stage arthritis not amenable to other treatments.

    The goals of hip replacement surgery are pain relief, return to function, and routine activities of daily living. For more than 30 years, hip replacement surgery has provided an improvement in quality of life and led to a dramatic change in patients’ lifestyles that suffered from arthritic conditions of the hip joint. In the U.S., more than 200,000 hips are replaced each year. The operation is by far the most successful surgery for treating advanced arthritis of the hip, and it may be one of the most successful surgeries ever developed in terms of dramatic change in patient function.

    The most common reasons for hip replacement surgery are:

    osteoarthritis: Generally attributed to wear and tear with age, osteoarthritis is a gradual deterioration of the cartilage that cushions bones within a joint. As cartilage wears away, surrounding joint structures grow irregularly and can become inflamed and painful. Eventually bone can begin to rub against bone. Most forms of osteoarthritis are likely due to a structural or anatomical minor abnormality of the joint that produces abnormal mechanics of the joint over the years, leading to wear.

    rheumatoid arthritis: Inflammation of the tissues surrounding joints leads to worn and swollen joints. This disease may eventually lead to deterioration of cartilage and destruction of joints. Typically, multiple joints are involved, including the neck (cervical spine) which may be life-threatening if left untreated.

    Osteonecrosis: (also known as avascular necrosis (or AVN)): A loss of blood supply to the ball of the hip joint occurs. There may be an association with blood clotting factors or proteins and cholesterol metabolism.The result is pain, eventual collapse of the surface of the ball (femoral head), and in the end-stages, severe arthritis may develop, The most common causes that lead to a loss of this blood supply are: heavy alcohol intake on a regular basis, chronic use of oral steroids, such as Prednisone, prior trauma or surgery to the hip (hip dislocation or fracture), blood disorders that may block the blood supply (sickle cell disease), HIV disease (likely causes osteonecrosis in relation to the medications prescribed for HIV), and idiopathic (no known reason established). Less common disorders include metabolic diseases and chronic exposure to high underwater atmospheric pressure (Caisson’s disease).

    Hip disorders or fractures: Hip replacement surgery is also used to repair disorders and fractures of the hip, although less commonly. Occasionally, a partial hip replacement (hemiarthroplasty) may be performed in the treatment of a hip fracture.


    Different Types of Hip Replacements

    Total Hip Replacement: Both the ball and the socket are replaced; the socket is replaced wit ha metallic or plastic cup (with or without screws), while the ball is replaced with a ball attached to a long stem. The stem is fixed into the upper thigh bone (femur) with either a porous bone ingrowth surface, or, with cement. The movement of the hip occurs as the head or ball rotates on the surface of the cup. Various surface combinations are available (see below).

    Hip Resurfacing: Total and Hemi (partial): Less commonly performed, these procedures are now becoming available in the U.S. They are similar to a total hip replacement. In total resurfacing, no stem is placed, and the ball is resurfaced only, and glides against a cup placed in the socket. In a hemi resurfacing, only the head is resurfaced, and the socket is left alone. The metal head glides against the patients own cartilage in the socket. There are advantages and disadvantages of these techniques, which sho0uld be discussed with the surgeon preoperatively.

    Surface Options in Hip Replacement: The surfaces that glide together in a hip replacement make up the bearing surface. This is most commonly a metal ball against a polyethylene (plastic) liner. Other options of bearing surfaces have been developed and studied and are available for use in the U.S. The purpose of these alternatives is to potentially reduce the “wear over time” that occurs with polyethylene. Examples of these surfaces are noted below. Again, there are advantages and disadvantages of each of these surface combinations, and patients should inquire preoperatively which surface is best for them:

    Minimally invasive Hip Replacement Surgery

    Recently, minimally invasive hip replacement surgery has become a popular alternative to having a standard incision hip replacement. There are many advantages and few disadvantages of this less invasive surgery. Not all patients are candidates for this type of surgery. You should discuss this with your doctor to determine if it is appropriate for your condition.


    Is a hip replacement–type surgery needed in this case?

    Are there any non-hip replacement (non-arthroplasty) surgical options that may preserve my own hip joint?

    Why is it necessary?

    Do you recommend a cemented or cementless joint, and why?

    What are advantages and disadvantages of each?

    What should be my expectations in terms of restrictions after a hip replacement?

    What type of bearing surface do you suggest would be appropriate for my case, in order to reduce wear and the need for future revision surgery?

    How soon after surgery can I resume activities of daily living?

    Should I take antibiotics when I have dental or other minor surgery?

    What is the life expectancy of the artificial joint in my case?

    What are the chances that I will require a revision surgery in the future?

    How frequently does my hip replacement need to be monitored in the future?

    What are the most common complications that may occur with hip replacement surgery (e.g., What is a DVT; dislocation; leg length inequality; periprosthetic fracture; autologous blood donation; and anti-coagulation)?

    What would happen if my hip replacement ever became infected?


    Editorial review provided by VeriMed Healthcare Network.


    Hip replacement surfacesBallSocket
    Standard hip replacementmetalpolyethylene (plastic)
    Standard + cross-linked polymetal or ceramichighly cross-linked poly
    Metal – metalmetalmetal
    Ceramic + cross-linked polyceramichighly cross-linked poly
    Oxiniumoxidized zirconiumhighly cross-linked poly