- Your hip is made out of a “ball-and-socket” joint with the “ball” being the femoral head and the “socket” being the acetabulum. Because your condition (osteoarthritis, inflammatory arthritis, etc) has reached its end stage, we plan to replace your “ball and socket” joint with artificial implants made out of metals, ceramic, and polyethylene. When all the femoral head and acetabulum are replaced as such, we call the procedure “total hip replacement.”

- If you are diagnosed with severe arthritis in your hip and your daily activities are severely affected due to pain and/or severe stiffness, you might be a good candidate. When you see a medical provider for the first time, you will likely go through nonoperative management such as weight management, physical therapy, and/or steroid injection. We usually like to try nonoperative treatments first prior to recommending total hip replacement. Of course, there are exceptions to this. Please talk to your provider whether you are a good candidate.

- Benefits are straightforward: pain relief and functional restoration. Total hip replacement is meant to provide you pain relief and more range of motion so that you can start walking more, going up and down the stairs and put on socks! Even if you are noted have terrible looking xray, if you do not have pain and functional limitation, there is no benefit of the surgery. In this case, I usually do not recommend surgery.

- Risks are not common but there are many of them.

o Leg length difference: despite my best effort to match nonoperative side’s length, your leg might feel slightly longer or shorter after the surgery

o Bleeding: can be mild (just dressing change) or rarely severe requiring reoperation

o Wound complication: wound can fail to approximate and heal properly

o Blood clot: usually asymptomatic but it can form in the leg and travels to your lung. You will be on anticoagulant and I am going to ask you to be active to prevent this

o Nerve damage: skin numbness is common around surgical area but any motor damage is very rare

o Vascular injury: exceedingly rare. If it happens, it needs immediate repair

o Dislocation/instability: the “ball” can come out of the “socket” which might require reduction in the emergency room or reoperation

o Fracture: any break in the bone during the surgery will require immediate fixation

o Abductor muscle disruption: gluteus medius/minimus (so called abductor) can tear or weakened causing limping and/or pain

o Infection: minor infection can be easily treated with oral abx but deep, severe infection requires removal of implants and IV antibiotics for at least 6 weeks

o Heterotopic ossification: bone can form in the muscle and around the surgical area afterward. Usually asymptomatic.

o Polyethylene wear: Plastic material wears over time and can cause symptoms. Less of a problem nowadays with improved technology

o Osteolysis: Implant-surrounding bone can be “chewed out” in response to wear particles, potentially causing the implant failure. Very rare these days.

o Implant loosening: implant can loose its fixation and can cause pain and possibly fracture

o Cup-liner dissociation: cup and polyethylene liner can come apart in an exceedingly rare scenario

o Implant fracture: almost never but some implants can break

o Reoperation

o Revision

o Readmission: you can be readmitted to the hospital within 90 days for various surgical and medical reasons

o Death: although very rare, death can occur due to anesthetic, medical, and surgical complications

- For 90 percent of cases, I perform anterior total hip arthroplasty. In this anterior approach, I make an incision measuring about 7-10 cm on the front of thigh/hip area (I included a picture for your reference) and go between muscles to enter the joint. From there, I remove your femoral head and work on replacing both your socket (acetabulum) and ball (femur).

- For 10 percent of cases, I perform lateral total hip arthroplasty. In this approach, I man an incision measuring about 10-15 cm on the outside of thigh/hip area. I have to take down part of your muscle (called gluteus medius or abductor muscle) and repair later in order to enter the joint. From there, I remove your femoral head and work on replacing both your acetabulum and femur.

- Anterior total hip surgery is not for everyone. If you have excessive abdominal soft tissue, the wound does not heal well which can lead to infection. I would like to avoid that. Furthermore, for certain complicated cases, I would like to go from lateral in order to obtain good visualization.

- Lateral total hip surgery is great but the recovery is slower and you can have some residual limp even after the full recovery.

- On average, it takes 90 minutes

- There are different phases of recovery. Overall, I say at least one year of complete recovery although you can achieve near full recovery much quicker than total knee replacement. However, we expect that you feel better than what you are feeling now at week 6.

o Phase I (Day 0 to week 2): First two weeks of recovery is painful! Your body goes through the highest inflammatory phase. This is the time to rest!

o Phase II (Week 2 to 6): From week 2 to 6, you will start to walk more and start gaining better range of motion and strength. For some patients who have desk jobs, you can go back to work at week 6.

o Phase III (Week 6 to Month 3): This is the time when you notice the biggest improvement in terms of strength, endurance, and ROM. You are gaining the confidence and start to do more daily activities before. Most patients can go back to work at month 3.

o Phase IV (Month 3 to Month 6): Your hip and back start to feel normalized. You are gaining more endurance. You don’t have to sit down frequently. Swelling is finally going down and you are sleeping better. 90% of recovery is complete at month 6.

o Phase V (Month 6 to Year 1): Tissues are becoming more natural. You will notice less stiffness and less discomfort. You are walking much more than before. There might be days when you might not even think about having a hip replacement.

- 25-35 years or even longer (granted that there is no complication associated with the surgery)

- Survivorship of total hip replacement up to 30 years have been reported (Reference 1). I personally have seen patients doing well after undergoing hip replacement 35 years ago. With improved technology in bearing surfaces, we expect to see well-functioning total hip implants lasting beyond 30-40 years in the future.

- There is a finite cycle that the implant can go through before it can become worn out or loose. The heavier you are, the more active you are and the younger you are, the less the implant is going to last.

- You bet. Please check out the following incredibly useful resources.

https://hipknee.aahks.org/total-hip-replacement/

https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/

https://www.hss.edu/condition-list_hip-replacement.asp

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hip-replacement-surgery