Hip Prosthesis: What It Is, Surgery, and Post-Surgery Life

Hip prosthesis surgery, also known as hip arthroplasty, is the procedure of replacing the damaged or worn parts of the hip joint with an artificial implant.

Hip prosthesis surgery, also known as hip arthroplasty, involves replacing the damaged or worn parts of the hip joint with an artificial implant. It may be recommended if there is a hip fracture or if severe hip pain is experienced. Diseases such as osteoarthritis or rheumatoid arthritis are also among the reasons for experiencing these conditions. Hip prosthesis surgery can help improve the range of motion, reduce pain, increase strength, and enhance the quality of life.

What is a Hip Prosthesis?

The hip is a joint that connects the femur to the pelvis. At the top of the thigh bone, there is a ball-shaped end that fits into a socket. The hip is the most flexible and freely moving joint in the body, allowing for forward, backward, and lateral movements. Hip prostheses are artificial medical materials that are inserted in place of the hip portion that needs to be replaced. Hip prosthesis is typically recommended when serious hip damage prevents a person's daily life and other treatments are not effective.

Hip prostheses can be made of metal or plastic. During hip prosthesis surgery, the parts that need to be replaced are removed from the joint. A prosthesis is then placed in the place of the removed part. There are different types of hip prostheses, including partial and total hip prostheses.

Total Hip Prosthesis: Total hip prosthesis is the most common hip surgery. This prosthesis uses an implant to replace the entire hip. During the procedure, surgeons place a stem into the patient’s femur or thigh bone. They replace the head of the thigh bone with a ball and the natural socket in the hip joint with an artificial cup.
Partial Hip Prosthesis: Partial hip prosthesis involves the removal and replacement of the head of the femur or thigh bone. A ball made of ceramic or metal is attached to the top of a stem that is placed in the center of the femur. Surgeons typically perform this surgery to repair certain types of hip fractures.

Who is Suitable for Hip Prosthesis Surgery?

Not everyone with hip pain needs hip prosthesis surgery. However, if the pain prevents daily activities or independent walking, a hip prosthesis can often help improve quality of life. Total hip prosthesis involves implanting the hip without cement and placing the ball-shaped portion on the hip. Various conditions and factors such as excessive wear and tear that can occur over a lifetime can affect the hip, leading to increased pain and difficulty walking. Hip prosthesis surgery is usually preferred when the damage to the hip joint results in reduced mobility. Additionally, experiencing pain in the hip area even at rest is another reason for surgery. The most common cause of hip prosthesis surgery is osteoarthritis, commonly known as arthritis. Situations that require the replacement of hip components with prostheses include:

• Restrictions in physical activities due to hip pain
• Ongoing hip pain at rest
• Pain in the front of the hip and groin
• Osteoarthritis
• Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis)
• Femoroacetabular impingement
• Hip fracture
• Hip dislocation
• Legg-Calvé-Perthes disease
• Dislocated femoral head epiphysis
• Childhood hip disorders

Pain relief is the greatest benefit and primary reason for hip prosthesis surgery. The potential benefits of using a hip prosthesis include:

• Improved mobility
• Relief from pain due to hip damage
• Improved coordination of the body and leg
• Easier physical activities in daily life

How is Hip Prosthesis Surgery Performed?

Before the surgery, it is important to learn as much as possible about what the surgery entails. The doctor will make recommendations for prostheses based on the patient’s age, activity level, and bone quality. To prepare for surgery, the patient undergoes various tests. These tests assess the patient’s medical risks before the surgery. The preoperative tests conducted by healthcare professionals include:

• Measuring the strength of the hip muscles through muscle testing
• Learning the medical history
• Physical examination
• Assessing body weight
• Cardiovascular disease screening
• Electrocardiogram (EKG)

There are various surgical methods available for hip prosthesis. Minimally invasive hip prosthesis surgery is a term used for any surgery that is less invasive than traditional or open surgery. Minimally invasive hip prostheses use fewer and smaller incisions around the hip joint. Typical candidates for minimally invasive hip replacements are individuals with minimal or moderate deformities. However, open surgery is preferred when larger portions of the hip need to be replaced. Open surgeries are standard types of surgeries performed with large incisions.

When total hip arthroplasty is planned, a surgeon replaces the necessary parts of the hip with a durable implant made of plastic and metal. The head of the femur is also replaced during this surgery. Hip prosthesis surgery can be performed under general anesthesia or epidural anesthesia. Epidural anesthesia is a method that numbs the lower part of the body. This method can be used for individuals who do not need to be placed under general anesthesia. Surgeons use procedures that can be performed with incisions made from the back or front during hip prosthesis surgery. The completion of the surgery typically takes about 60-90 minutes. The stages of the surgery are as follows:

1. Anesthesia is administered to the patient before the surgery.
2. The surgeon makes an incision over the hip.
3. The problematic portions of the hip are removed through the incision.
4. The head of the femur, acetabulum, and other necessary parts are replaced with the implant.
5. The incision areas are sutured.

After the surgery, a dressing is applied to keep the hip in place for one week. The stitches that close the incision are usually removed about 10-14 days after the surgery and may be replaced with sterile strips. If your surgeon used adhesive to close the wound, the end stitches will gradually fall off about a month later.

Life After Hip Prosthesis Surgery

Everyone recovers differently from hip prosthesis or revision surgery. The key is to keep moving while supporting yourself to gradually become more active.

It may be necessary to stay in the hospital for a few days after surgery. For the first 4 to 6 weeks after surgery, the use of crutches may be required to facilitate walking and reduce pressure on the hip. Most people are encouraged to walk with the assistance of a walking aid immediately after the surgery. Patients typically show improvement and can return to normal activities within an average of 2 to 3 months. However, it may take up to a year for the entire body to return to normal activity after the implant. During the first 3 months, patients should avoid sitting in low chairs, running, squatting, and jumping.

Additionally, the patient may need to start an exercise program under medical supervision to adjust to the hip implant. The surgeon provides information about what activities the patient can engage in after the surgery and prescribes medication for postoperative use. Important considerations after the hip prosthesis is installed include:

• Proper use of prescribed medications
• Avoiding excessive weight gain
• Using walking aids
• Engaging in physical activity under doctor supervision
• Receiving therapeutic exercise support
• Starting physical therapy
• Using toilet riser devices
• Installing grab bars for the bathroom
• Utilizing a seat in the shower
• Choosing shoes that do not require prolonged bending
• Keeping the wound area clean and dry
• Communicating with the doctor if necessary

Patients should recognize that the recovery process can be time-consuming. It often takes at least 4-6 months for a patient to feel as though they have returned to their pre-surgery activity level. Individuals with desk jobs may need to take at least 4 weeks off work, and this time may be extended if complications arise. The length of time off work will be determined by the doctor, taking into account the patient's health status.