Total Hip Replacement Surgery: A Comprehensive Guide

What is a total hip replacement?

A total hip replacement (THR), also known as hip arthroplasty, is a surgical procedure in which a damaged or worn-out hip joint is replaced with a prosthetic implant. Your orthopaedic surgeon will typically recommend THR when conservative management for hip pain and dysfunction, such as medication or physical therapy, has not been effective.

Many different surgical techniques for replacing a damaged hip joint are available. Learn more about them here.

Why should I consider total hip replacement surgery? 

Patients may require this surgery due to an accident, injury, or an underlying cause contributing to chronic hip pain. Total hip replacement aims to provide significant muscle strength and improved functional outcomes, ultimately enhancing the patient's quality of life. 

1) Osteoarthritis

Osteoarthritis is the most common reason for hip replacement, especially in elderly patients. In this condition, the cartilage that cushions the hip joint breaks down over time, causing pain and limited movement.

2) Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that can affect the joints, leading to inflammation, pain, and joint damage. If there is significant pain in the hip joint then this surgery is recommended.

3) Hip fractures or tumors

Certain hip fractures and bone tumours, both benign and malignant, make total hip replacement necessary to restore function and alleviate pain.

4) Avascular necrosis

It is also recommended for patients with a condition where the blood supply to the hip joint is disrupted, causing the bone tissue to die and collapse.

5) Developmental hip disorders

A congenital condition like hip dysplasia where the hip joint is poorly formed, leading to arthritis and pain over time. This significantly affects daily living and to prevent immobility, THR is necessary.

When should you see a doctor for total hip replacement surgery?

If you are experiencing any of the following signs, it is advisable to consult your doctor immediately:

• Chronic pain

  • If you have uncontrolled pain that limits your ability to perform daily activities, like walking, climbing stairs, or getting in and out of a car.

• Limited mobility

  • If you feel stiffness in the hip joint that limits your mobility and weight-bearing capability.

• Failed non-conservative therapies

  • If non-surgical treatments, such as medications, physical therapy, or injections, have not helped relieve your symptoms.

For personalised advice regarding your underlying disease, you may consult with a specialist from Thomson Medical. Request for an appointment with our specialists today.

Types of prostheses used in total hip replacement

There are several different types of prosthetic implants used as an artificial joint in orthopaedics surgery. They are chosen based on factors like your age, activity level, and bone quality:

1) Material options

• Metal-on-plastic 

  • Metal ball with a plastic (polyethene) socket, which is commonly used.

• Ceramic-on-polyethylene

  • Ceramic ball with a plastic socket, which offers reduced wear and tear.

• Metal-on-metal

  • Metal ball and metal socket, often used for younger, more active patients.

• Ceramic-on-ceramic

  • Ceramic ball and ceramic socket, which has less wear and may be used in younger patients.

2) Cemented vs cementless

• Cemented implants

  • These are used when the bone quality is poor at which bone cement is needed to attach the implant to the bone. Cemented implants are often used in older patients due to the weaker bones.

• Cementless implants

  • These implants allow bone to grow into the implant overtime. Cementless implants are typically used in younger, more active and healthier patients.

Total hip replacement procedure

The entire process of total hip replacement is divided in the following three stages. The actual surgery itself typically takes around 1-2 hours. However, before and after surgery, there are certain steps that are followed to ensure an effective procedure. 

Before the surgery

• Patient assessment

  • The surgeon will assess the patient's general health, review the medical history, conduct a physical examination, check the level of pain, take blood tests, and order health screenings such as X-rays or MRI scans to assess the extent of damage to the hip joint. 

• Treatment planning

  • Prioritising patient satisfaction, they will plan for the surgery after making sure if you are a good candidate for operation.

Surgical procedure

• Anaesthesia and sterilisation: 

  • The patient will be given either general anaesthesia (put to sleep) or regional anaesthesia (epidural or spinal block, which numbs the lower body but keeps the patient awake). Next, your area of the hip joint will be thoroughly sterilised.

• Incision: 

  • The surgeon makes an incision, usually about 8-12 inches long, over the hip to access the joint. There are different types of surgical approaches, which include:
    - Posterior approach: The surgeon works through the back of the hip, making an incision near the buttocks. This is the most common approach.
    - Anterior approach: The incision is made at the front of the hip. This method is less invasive but may not be suitable for all patients.
    - Lateral approach: The incision is made on the side of the hip.

• Removal of the damaged joint: 

  • The femoral head (ball of the hip joint) is removed from the femur (thigh bone), and the damaged cartilage and bone in the acetabulum (hip socket) are removed.

• Implantation: 

  • This is where the artificial hip joint is implanted in the patient's body. The acetabulum (hip socket) is cleaned and shaped to fit the new socket component. The femoral stem (which holds the ball) is inserted into the femur. A new metal or ceramic ball (femoral component)is attached to the femoral stem. A plastic or ceramic socket (acetabular component) is placed in the hip socket to replace the damaged cartilage.  

• Alignment and stability: 

  • The orthopaedic surgeon ensures the prosthetic joint is properly aligned to provide a stable and functional joint.

• Closing the incision: 

  • The incision is closed with sutures or staples, and a sterile dressing is applied.

After the surgery

• Monitoring: 

  • After the surgery, patients usually stay in the hospital for 2-4 days, depending on their recovery progress. During this time, the healthcare team will monitor the impact on the patient post-surgery. They will assess your vitals, help with pain management, and start physical therapy.

• Pain relief:

  • Pain will be managed with medication, including opioids for short-term pain or possibly nerve blocks, and non-opioid medications for long-term control. Ice packs are often used to reduce swelling and discomfort for the first few days.

Rehabilitation timeline

In most successful surgeries, patients can generally resume light activities approximately 3 to 6 weeks post-surgery, depending on their individual progress of rehabilitation after hip 

replacement and success of physiotherapy sessions. Full recovery after total hip replacement usually ranges from two to eight weeks, requiring ongoing physical therapy to monitor strength, flexibility, and the ability to perform daily activities.

• First 6 weeks

  • Patients are encouraged to start moving as soon as possible often on the same day or the next day after surgery. Physical therapy services help improve joint movement and strengthen the muscles around the hip. It focuses on mobility, walking aid with crutches or a walker, improving range of motion and weight-bearing tendency. 

• 6 weeks to 6 months

  • During this postoperative period, you will notice gradual improvement in strength, flexibility, and daily function. A few weeks after surgery, most patients can return to regular activities, including light walking or driving.

• 6 months and beyond: 

  • Most patients might regain their pre-operation mobility, with reduced pain and improved quality of life this far in their rehabilitation process. Low-impact activities like swimming, cycling, and walking are usually safe. Recreational activities and high-impact activities like running and jumping may not be advisable with a hip replacement.

An early surgical intervention based on your personal needs can help in speedy recovery to the hip joint and help devise a more effective plan for surgery. Request an appointment with our orthopaedic specialists at Thomson Medical today for an accurate diagnosis and a personalised treatment plan.

Precautions to follow 

To prevent dislocation of the new hip, a patient will need to follow certain postoperative instructions during the early stages of recovery.

If you follow all the postoperative instructions, you will experience successful long-term outcomes post-surgery.

• Avoid missing out on your physiotherapy sessions.

• Avoid bending your hip more than 90 degrees (e.g., don’t bend over to tie your shoes or sit in low chairs).

• Avoid crossing your legs or twisting your hip.

• Sleep with a pillow between your legs to prevent dislocation (if such hip precaution is directed by your surgeon).

• Make sure to follow all routinely scheduled follow-up visits to your doctor. 

Complications of total hip replacement

Following the total hip replacement, there are certain postoperative complications and risk factors that your healthcare providers will assess you for. These include:

• Infection: 

  • Though rare, an infection can occur around the incision or in the joint itself.

• Blood clots:

  • Deep vein thrombosis (DVT) or pulmonary embolism can occur after surgery. To avoid this, blood thinners or compression devices are often used.

• Dislocation: 

  • The new hip has a risk of dislocation, especially in the first few months after surgery, if certain movement precautions are not followed.

• Leg length discrepancy:

  • There is a small risk that one leg may be slightly longer or shorter than the other after surgery.

• Implant wear and loosening: 

  • Over time, the prosthetic components can wear out, especially in younger, more active patients. This may require a revision surgery to replace the implant.

• Nerve or blood vessel damage: 

  • Damage to surrounding nerves or blood vessels during surgery is possible, although it’s rare.

• Hip stiffness or pain: 

  • Some patients experience ongoing stiffness or discomfort after surgery, though this is usually temporary.

Total hip replacement cost

The costs of total hip replacement varies based on different factors such as the type of hospital (public vs. private), ward class, surgeon's fees, and insurance coverage

The overall costs of a private vs. a public hospital in Singapore vary as follows:

• Private Hospital: SGD 35,000 to  SGD 50,000.

• Public Hospital (Subsidised): SGD 10,000 to SGD 18,000

The information provided above is intended for general reference only. Actual costs may vary based on individual medical conditions. For detailed fee information and payment options, please consult a specialist by requesting an appointment with Thomson Medical today.

FAQ

What are the 3 types of total hip replacement?

The three types of total hip replacement are:

• Posterior approach: Incision at the back of the hip; common with excellent joint access.

• Anterior approach: Incision at the front; muscle-sparing with faster recovery.

• Lateral approach: Incision on the side; reduces dislocation risk.

Can I drive after total hip replacement?

Yes, you can typically drive again after about 4-6 weeks after surgery, assuming you can safely control the car and perform an emergency stop. Always check with your doctor before resuming driving.

When can I resume normal work activities after surgery?

For sedentary jobs, many patients return to work in about 6-8 weeks.

For patients who have more demanding physical activities at work, a longer recovery period may be needed, often around 3-6 months, depending on the level of physical exertion required. 

What is the success rate of a total hip replacement?

The success rate for total hip replacement is high, with over 90% of patients experiencing significant pain relief and improved mobility after the surgery. Most patients report high patient satisfaction with the surgery, and complications are rare. 

How long will the hip replacements last?

Hip replacements can last 15-20 years or longer, with newer materials (like ceramic and metal alloys) extending the life of the prosthesis. It also depends on the patient's age, activity level and bone quality. Make sure to follow all the postoperative instructions given by your physician to improve their functional outcomes. Younger and more active patients may experience wear on the implant sooner, potentially requiring a revision surgery in the future.

What is the difference between a total hip replacement and a partial hip replacement?

The key difference between a total hip replacement and a partial hip replacement lies in the extent of the joint replacement:

• Total hip replacement (THR): Both the femoral head (ball) and the acetabulum (socket) are replaced with artificial components. This is typically done for severe arthritis or extensive joint damage.

• Partial hip replacement (Hemiarthroplasty): Only the femoral head is replaced, while the natural acetabulum is left intact. This is usually performed for certain types of hip fractures.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist by requesting an appointment with Thomson Medical today.