Total Hip Replacement

The hip is a ball-and-socket joint between the round head of the thigh bone (femur) and the socket in the pelvis (acetabulum). Osteoarthritis, avascular necrosis, inflammatory arthritis, developmental hip dysplasia or old fractures can wear away the joint cartilage. When pain and stiffness can no longer be controlled with medication and physiotherapy, the worn surfaces are replaced with a total hip replacement.

Symptoms

Complaints that may lead to a hip replacement:

• Deep pain in the groin, hip or thigh
• Gradually shorter walking distance, limping
• Pain that continues at night or at rest
• Difficulty putting on socks and shoes or getting in and out of a car
• Marked stiffness and limited hip movement

Diagnostic Methods

The examination assesses hip range of motion, gait and leg length. X-rays show narrowing of the joint space, bone spurs and the shape of the joint. MRI may be requested if early-stage avascular necrosis is suspected. Implant sizes are planned on the X-rays before surgery, and blood tests and any necessary consultations check general health.

Treatment Approach

Non-Surgical Treatments

In early stages, non-surgical treatment comes first: weight control, physiotherapy to strengthen the muscles around the hip, pain relievers and anti-inflammatory medication, a walking stick when needed and activity modification. In selected patients, joint injections can give temporary relief.

Surgical Treatment

In a total hip replacement the worn femoral head is removed and replaced with a metal stem and a ceramic or metal head; the socket is renewed with a metal cup and a polyethylene or ceramic liner. The components are fixed to the bone either without cement (the bone grows onto the implant surface) or with cement, depending on age and bone quality.

Surgical Process

Usually performed under spinal or general anaesthesia, taking 1–2 hours. Preventive antibiotics and blood thinners reduce the risk of infection and clots. Most patients stand up with a physiotherapist on the day of surgery or the next day.

Hospital Stay

The hospital stay is usually 2–4 days; you go home once you can walk and manage stairs safely.

Recovery Process

• First 2 weeks: Walking with a frame or crutches, wound care, home exercises
• Weeks 2–6: Reducing support, muscle strengthening; hip precautions as advised for the surgical approach
• Weeks 6–12: Return to most daily activities, walking without support
• Months 3–6: Building strength and endurance; low-impact sports such as walking, swimming and cycling

Return to Work

Desk work usually after 4–6 weeks, standing jobs after 8–12 weeks, heavy physical work after 3 months or more.

Potential Complications

Possible problems: infection, deep vein thrombosis and pulmonary embolism (reduced with preventive medication), dislocation of the implant, leg length difference, a bone crack during surgery, and nerve or blood vessel injury (rare). Over the long term the components may wear or loosen and need revision surgery, so regular check-ups are recommended.