Total hip replacement is one of the most successful and cost effective interventions in medicine with over 453,000 such procedures performed in the United States in 2010.1 The incidence of hip replacements increased by 49% between 2000 and 20101 due partly to improvements in the science of hip replacement implants, experience of surgeons, and the growing population of hip replacement patients. The success rate of hip replacements 10 years after surgery is 90-95%.3
According to the American Academy of Orthopaedic Surgeons, of all total hip replacements performed each year in the United States, more than 95 percent are successful with patients experiencing relief from hip pain, and revision surgery is not required.2 The success rate of hip replacements 10 years after surgery is 90- 95% and at 20 years is 80-85%.3 Should an implant wear or loosen, revision to a new hip replacement is possible. Modern implant materials coupled with the aid of computer navigation can boost the longevity for hip replacement up to 30 years.4
Who gets a hip replacement?
48% of hip replacement patients in the United States are over 65 years of age, and 34% are between the ages of 45 and 64.1 The largest contributing factor to needing a hip replacement is advanced arthritis, however other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, the death of bone caused by insufficient blood supply), femoroacetabular impingement (a condition where the bones of the hip are abnormally shaped), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and create the need for hip replacement surgery.2
Pain from an arthritic hip is classically located in the groin and buttocks and is the principal indication for hip replacement. After hip replacement, pre-operative arthritis pain is gone immediately and post-op pain is generally relieved as early as one week after surgery.1 Besides relief from pain, hip replacement surgery offers considerable improvement in mobility and can include a tremendous improvement in quality of life.1 New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.2
Rehabilitation as a factor in success
Hip replacement surgery is usually very successful, but the success of the procedure is partly due to the rehabilitation period that follows the surgery. For you to expect a good result from hip replacement surgery, you must be an active rehab participant. The importance of this cannot be underestimated!
Rehabilitation after hip replacement begins almost immediately. You will work with a physical therapist as soon as the surgical procedure has been performed. The emphasis in the early stages of rehab is to maintain motion of the hip replacement and to ensure that you can walk safely.
Your physical therapist will work with you to develop a rehabilitation plan of action that you can continue with at home or in a local gym. During this recovery and rehab period, it is important to follow the physical therapist’s instructions carefully and not over work your new hip joint or surrounding muscles and tissues while they are healing and becoming stronger.
The most common problem that may arise after hip replacement surgery is hip dislocation. Because the artificial ball and socket are generally smaller than the natural ones and the muscle structure has been made weaker, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous positions are rotating the leg outwards or inwards and pulling the knees up to the chest.2
What results can you expect from your new hip?
While successful hip replacement gives excellent pain relief, it does not give you a normal hip. Many patients are pain-free, but some still may have occasional aches and a feeling that it’s not their “own” joint. Most patients can get back to activities; however, high impact activities or running after hip replacement is not recommended. Some recommended activities are golf, walking, weight lifting, doubles tennis, dancing, bicycling and swimming. More dangerous activities, such as horseback riding, skiing and waterskiing are possible, but may place your joint at some risk. A fall may cause the hip to dislocate or the bone to break around the implant. These activities are not recommended unless you already are at an advanced level.5
When is revision surgery necessary?
“Revision” surgery is procedure that removes and replaces the original implant, usually due to a complication that develops after surgery. Revision hip replacement is a relatively infrequent operation. In the United States, there are approximately 18 revision hip replacements performed for every 100 hip replacements.6 The most frequent reasons for revision are:
- Repeat incidences of hip replacement dislocation
- Mechanical failure (implant wear and tear; loosening; breakage)
Fortunately, many of the contributing factors to hip replacement revisions can be prevented by mindful attention to your new joint and avoiding activities that may over-stress the implant and surrounding muscles.
What can you do to avoid the need for revision surgery?
- Follow your doctor’s recommendations for recovery post-surgery
- Learn and do the recovery physical therapy exercises as directed
- Use your new hip but do not overdo it or put unnecessary stress on the joint
The prosthesis’ natural wear and tear is generally painless. Therefore, it is very important that you have your hip replacement regularly checked. A simple physical examination and radiographs are necessary at the intervals designated by your surgeon.7
What about implant recalls and lawsuits?
There have been some (2010-2011) recalls and lawsuits concerning metal-on-metal joint replacement implants, representing a small portion of the total implant population. In 2011, the U.S. Food and Drug Administration (FDA) began increased monitoring of all metal-on-metal hip implant replacement systems in order to determine the true likelihood of problems with this type of implant. Media and negative advertising, especially by law firms to promote lawsuits, receive far more attention than successful surgeries, and give the impression to the public that recalls and lawsuits are prolific.
Joint replacement implant manufacturers are continually improving and evolving their products to better serve the patients who receive and use them, and as mentioned above success rates of the surgery remain exceptionally high.
Surgical procedures are also continually being evaluated and updated. Most joint replacement manufacturers offer specialized training in the proper implementation of their products to surgeons all over the world. That is why it’s important to discuss with your surgeon what types of implants they have had the most success and experience with, and if they have participated in any specialized training provided by the manufacturer of those implants.
- HCUPnet, a service of the US Department of Health & Human Services (hcupnet.ahrq.gov)
- NIAMS, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (niams.nih.gov)
- Haas, Steven B. MD, Chief of Knee Service, Hospital for Special Surgery, Attending Orthopedic Surgeon, Hospital for Special Surgery, Professor of Orthopaedic Surgery, Weill Cornell Medical College; Sculco,Thomas P. MD, Surgeon-in-Chief, Hospital for Special Surgery, Professor of Orthopaedic Surgery, Weill Cornell Medical College (hss.edu)
- Dorr Arthritis Institute at USC Orthopedics Keck Hospital (dorrarthritisinstitute.com)
- Johns Hopkins Bayview Medical Center (hopkinsbayview.org)
- Memtsoudis SG, Besculides MC, Gaber L, Liu S, González Della Valle A. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study. Int Orthop. 2009 Dec;33(6):1739-45. (ncbi.nlm.nih.gov)
- Revision Total Hip Replacement: An Overview; Della Valle, Alejandro Gonzalez MD (hss.edu)