Total hip replacement (THR) is a surgical procedure that relieves pain from most kinds of hip

arthritis improving the quality of life for the large majority of patients who undergo the
operation.

Patients commonly undergo THR after non-operative treatments (such as activity

modifications medications for pain or inflammation or use of a cane) have failed to provide
relief from arthritis symptoms. Most scientific studies that have followed patients for more
than 10 years have found success rates of 90 percent or more following traditional THR.

Click to Enlarge

Figure 1 - Typical hip Figure 2 - Typical hip replacement components in their

replacement components. position relative to the hip and pelvis.

Distilled to its essentials THR involves surgically removing the arthritic parts of the joint
(cartilage and bone) replacing the ball and socket part of the joint with artificial
components made from metal alloys and placing high-performance bearing surface between
the metal parts (see figures 1 and 2). Most commonly the bearing surface is made from a very
durable polyethylene plastic but other materials (including ceramics newer plastics or metals)
have been used. Patients typically spend a few days in the hospital after the procedure (3 to 5
days is most typical) and some patients benefit from a short inpatient stay in a rehabilitation
facility after that to help transition back to living independently at home. Most patients will
walk with a walker or crutches for 3 weeks and then use a cane for another 4 weeks; after that
the large majority of patients are able to walk freely.

A bewildering number of different implant designs bearing surface materials and surgical
approaches have been tried to achieve one seemingly straightforward goal: improving the
quality of life for patients who have hip arthritis. As with any important life decision it makes
good sense to get educated on those issues as they pertain to your hip.

The purpose of this article is to outline the essentials from a patients perspective: who should
think about having THR done what questions should a prospective patient ask the doctor and
why one surgical approach or type of THR implant might be good for one patient but not for
another.

Symptoms & Diagnosis

Arthritis simply means inflammation of a joint and itself is a very general term. Many of
the more than 100 different conditions that cause joint inflammation also go on to cause
permanent destruction of the weight-bearing surface of the hip which is called cartilage.

If you have ever eaten a drumstick you have seen cartilage: it is the white (or slightly yellow)
smooth surface capping the end of the bone (see figures 3 and 4). The surface of normal
human cartilage is much more slippery than a hockey puck sliding on ice.

In contrast arthritic cartilage may be cracked thinned or worn completely through to the bone.
(see figures 5 and 6). If a doctor has told you that you have bone-on-bone he or she means
that the cartilage has completely worn away. Damaged cartilage (and certainly a bone-on-
bone situation) does not glide well. As a result a severely arthritic joint may be stiff and it
may feel like it grinds catches or locks with attempts at motion.

However the main symptom most people with hip arthritis have is pain. The pain typically is
worse with activities or weight-bearing and is sometimes relieved by rest.

About 80 percent of patients with hip arthritis will have some pain in the groin or the front of
the thigh; other typical pain patterns include pain in the back of the thigh the side of the thigh
or the buttock. Sometimes with hip arthritis doesnt cause hip pain at all because the
symptoms show up as knee pain. Some patients with hip arthritis limp while walking
sometimes with a lurching gait towards the arthritic side.

Although there are many types of arthritis (over 100 in fact) fewer than a handful of
conditions account for over 95 percent of hip replacements performed. Some of these are:

1. Osteoarthritis: Sometimes called degenerative joint disease (DJD) or wear-

and-tear arthritis osteoarthritis is localized to the joint itself and does not have
any systemic (whole body) manifestations. We know that most young patients
(under age 50) with osteoarthritis of the hips have this condition as a result of
one of several childhood hip conditions--but by the time the symptoms show
up in adulthood the condition is treated as it would be for anybody with hip
osteoarthritis.
2. Post-traumatic arthritis: After a severe fracture of the pelvis or a dislocation of
the hip the joint surface cartilage may suffer damage--either because of direct
trauma or because of a loss of joint congruity (the good fit between the ball
and the socket)--leading to pain and stiffness.
3. Rheumatoid arthritis: This is a condition in which the bodys own cells attack
joint surface cartilage. It may affect any joint in the body. The result of this is
stiffness swelling and pain. The symptoms may vary over the course of the
day and may wax and wane. There are many types of rheumatoid arthritis
including some that affect children and young adults. Most patients with
rheumatoid arthritis should be followed by a special kind of physician called a
rheumatologist since there are so many new and successful medical therapies
that can help control this disease. There are a large number of types of arthritis
that are somewhat similar to rheumatoid arthritis; as a group these are called
inflammatory arthritis and they include conditions like systemic lupus
erythematosis (SLE or lupus) psoriatic arthritis and others.
4. Avascular necrosis (or steonecrosis) of the Femoral Head: This is not exactly a
type of arthritis but rather a condition in which the circulation to the ball of
 the ball and socket part of the hip joint becomes impaired. This causes the
bone in a portion of the ball (called the femoral head) to die and collapse. The
process can be quite painful. In addition the femoral head loses its round shape
and flattens. Since the hip depends on a symmetric and congruent fit of the
ball into the socket the resulting poor fit causes further stiffness and pain
and leads to loss of the remaining joint surface cartilage (arthritis).

Many conditions cause pain in the area of the hip and most are not related to the hip joint at
all. Some of these are:

1. Spinal stenosis (or spinal arthritis): This condition commonly causes pain in
the lower back that radiates to the buttocks (see figure 7). It may cause
symptoms on both sides or just one. Many patients with this find that walking
slightly stooped forward as with a shopping cart causes some relief of pain.
Your orthopedic surgeon can easily tell this from hip arthritis with a good
physical examination and some basic X-rays.
2. Bursitis of the hip (greater trochanteric bursitis): Patients with this condition
often have pain and tenderness over the point of the hip--the prominence on
the outside of the thigh about 3 to 4 inches below the beltline (see figure 8).
This condition may keep one from sleeping comfortably on that side. Bursitis
is not in the hip joint at all but rather is an inflammation of a structure called a
bursa which is a fluid-filled sac between next to the femur (thigh bone) that
helps tendons to glide smoothly over the bone. Again an orthopedic surgeon
can readily distinguish this from hip arthritis with a good physical
examination.
3. Non-orthopedic conditions: Many diverse conditions can cause pain in the
hips thighs or buttocks. Peripheral vascular disease (hardening of the arteries)
can sometimes cause buttock or leg pain that is worse with activities or
walking. Referred pain from intra-pelvic conditions in women (such as
ovarian cysts) can cause pain in the groin and mimic hip joint symptoms as
can inguinal (groin) hernias. A good family doctor can make sure none of
these conditions are present using simple physical examination techniques.

According to the most recent statistics from the U.S. Centers for Disease Control and
Prevention nearly 70 million Americans suffer from some form of arthritis or chronic joint
symptoms.

Treatments

History and physical examination

An orthopedic surgeon will begin the evaluation with a thorough history and physical exam.
Based on the results of these steps (s)he may order plain X-rays.

X-rays

If you have arthritis of the hip it will be evident on routine X-rays of the joint. X-rays taken
with you standing up are more helpful than those taken with you lying down as the way your
joint functions under load (i.e. standing) provides important clues about the severity of the
arthritis to your physician.
Other tests

If your orthopedic surgeon suspects a problem with the hip joint but does not identify the
source of the problem on plain X-rays (s)he may decide to order another test such as a
Magnetic Resonance Imaging (MRI) study or a bone scan. These are more commonly
ordered in the evaluation of conditions that are related to arthritis--such as avascular necrosis
(osteonecrosis)--but are not always treated using the same techniques.

It is important to distinguish broadly between two types of arthritis: inflammatory arthritis

(including rheumatoid arthritis, lupus and others) and non-inflammatory arthritis (such as
osteoarthritis).

Although there is some level of inflammation present in all types of arthritis conditions that
fall into the category of true inflammatory arthritis are often very well managed with a
variety of medications and more treatments are coming out all the time. Individuals with
rheumatoid arthritis and related conditions need to be evaluated and followed by a physician
who specializes in those kinds of treatments called a rheumatologist. Excellent non-surgical
treatments are available for these patients; those treatments can delay (or avoid) the need for
surgery and also help prevent the disease from affecting other joints.

So-called non-inflammatory conditions including

Surgical options: bearing surfaces

Polyethylene metal or ceramic?

All hip replacements share one thing in common: they include a ball-and-socket joint. Which
materials are used in the ball and in the socket--which together is called the bearing like a
bearing in a car--has the potential to affect the long-term durability of the joint replacement.

This is another area where technology may radically change the outcome of an operation;
depending on how the research goes in this area hip replacement may look very different in
10 years than it does today. Or it may not.

Many bearing surfaces have been tried in the 40 or so years that hip replacements have been
done. And many more have failed than succeeded. That is one reason to proceed with caution
given that we now have a bearing surface (metal-on-polyethylene) that has a track record
going back to the 1960s.

Polyethylene is a durable high-performance plastic resin. It is slippery (which is why it does

well in a mobile joint like the hip) but it is known to wear out. In fact while more than 90% of
metal-on-polyethylene bearing hip replacements (this is the most common bearing in use
today) will be in service in 10 years many of those will not last 20 years. And when the
plastic wears out it sometimes results in a destructive reaction causing bone loss around the
joint. This can make repeat hip replacements (called revisions) more difficult.

Many types of plastics have been used in total hips but only one (ultra-high-molecular-weight
polyethylene) has stood the test of time. Teflon (like the non-stick material used in frying
pans) was tried and abandoned because of severe reactions by surrounding tissue. Other
modifications of polyethylene have been tried (including carbon-reinforced plastic) and
abandoned because of durability problems. In fact there is a new type of polyethylene gaining
wide use today called highly-cross-linked polyethylene which shows promising results in the
lab--but little if any data are available in people.

Ceramic bearing surfaces are sometimes used. These have been more popular in Europe than
they have been in the United States. They may result in less aggressive wear but it is not
known whether the wear they do cause will be more or less of a problem than wear from the
traditional plastic bearings. Also fractures of ceramic bearings have been reported; as a result
some of these bearings have been taken out of service at the direction of the FDA.

Finally metal-on-metal bearings have become popular. Interestingly they were tried early on
in the history of hip replacement but problems related to their manufacture led to surgeons
moving on to other designs. Now those problems have been overcome and they offer the
potential to reduce bearing wear to almost immeasurable amounts. Some scientists question
whether these devices will lead to increased amounts of metal ions or corrosion products
being released in the body but to date these concerns have not been proved to be serious.
However because the renewed interest in these designs is fairly recent there is comparatively
little follow-up published in scientific journals about the longevity of hip replacements using
metal-on-metal bearing surfaces.

The choice of which bearing to use is still somewhat controversial and reasonable scientists
surgeons and patients will sometimes disagree. This is one of the most exciting areas of
research in the field of hip replacement surgery. But as with surgical approach it is worth
considering the high likelihood of long-term success using traditional metal-on-polyethylene
bearings when deciding whether to try another design that does not have results published
beyond 10 years.

Surgical options: Hemiresurfacing hip arthroplasty

This is a technique that can be used for some patients with avascular necrosis (also called
osteonecrosis) of the femoral head. As mentioned previously that is an arthritis-like condition
of the hip; it may also affect the shoulders knees or ankles. It is caused by an interruption of
the blood circulation to the ball (the femoral head) of the ball-and-socket hip joint. This may
be caused by trauma to the hip excessive alcohol use use of medical steroids like prednisone
or any of numerous disorders of blood clotting.

When avascular necrosis is allowed to run its course the result is usually severe degenerative
joint disease and the treatment is usually traditional total hip replacement. Sometimes when
the disease is caught early a joint-preserving procedure may be performed such as osteotomy
(see below) core decompression or bone grafting.

In an intermediate stage of the disease avascular necrosis affects only the ball and not the
socket; sometimes the top of the ball collapses resulting in a loss of roundness and this causes
pain. At this stage a resurfacing hip replacement may be an option. This involves putting a
round metal cap on the ball and keeping the patients own socket.

Advantages of this include the fact that it does not take away much bone (perhaps leaving
more options available for subsequent reoperations) and that it is reasonably durable. Two
studies have found that between 60% and 70% of these devices remain in service 10 years
after the surgery. This doesnt sound great compared to total hip replacement which has more
than 90% success at that same time period but one must remember that patients with this
stage of avascular necrosis are often quite young--anywhere from their 20s to 40 or so--and
so total hip replacement is not considered an ideal approach for them.

The main disadvantage to this procedure apart from the failure rate is that pain relief is
somewhat less than with traditional total hip replacement--perhaps 80% as good--so many of
these patients are left with some discomfort even after the surgery although most patients feel
much better with the hemiresurfacing arthroplasty than they did before.

Patients with avascular necrosis have a complex set of choices to make and so it is best for
them to find a surgeon who is extremely comfortable and experienced with a wide array of
options to treat the painful hip.

Surgical options: Pelvic osteotomy and hip fusion

About osteotomy and hip fusion Osteotomy is a procedure in which the bone around the
socket of the hip joint is surgically cut so that the socket itself can be re-oriented. This is best
suited for young people with relatively early stages of arthritis particularly if the arthritis was
caused by a childhood hip condition called developmental dysplasia of the hip.

Hip fusion is an operation that was more popular in the days before hip replacements were
widely performed. This consists of surgically attaching the femur (thigh bone) to the pelvis
and causing the two bones to heal together to become one. It results in loss of motion at the
hip joint which is obviously a disadvantage but it is very reliable at relieving pain. It is
seldom done anymore because most patients prefer to maintain motion about the hip but in
the right circumstances it can still be a good choice. Patients who are otherwise poor
candidates for hip replacement--such as young people who plan to continue doing heavy
manual laborer for a living or young patients with prior hip joint infections--may decide that
hip fusion is right for them.

Effectiveness
Current evidence suggests that traditional total hip replacements last more than 10 years in
more than 90% of patients. More than 90% of patients report having either no pain or pain
that is manageable with use of occasional over-the-counter medications. The large majority
of hip replacement patients are able to walk unassisted (i.e. without use of a cane) without
any limp for reasonably long distances. Many have no distance restrictions at all and resume
hiking golfing bicycling and other non-impact recreational activities (see figure 9).

As mentioned there are no studies to date documenting the short-term or long-term

effectiveness of minimally-invasive hip replacement and there are no studies that have proved
that the joint replacement components can be reliably inserted with equal success or safety
through the smaller incision used in minimally-invasive hip replacement techniques.

In the event that a total hip replacement requires re-operation sometime in the future the
results are generally good--although often not as good as one typically gets with an
uncomplicated first-time hip replacement. The results of repeat hip replacements (called
revisions) often depend on a number of factors that are not in the surgeons (or the
patients) control such as: infection bone loss and condition of the muscles and other soft
tissues around the hip joint. But in general revision hip replacement can achieve a durable
result and provide substantial relief of pain.
There is good evidence that the experience of the surgeon correlates with outcome in all
kinds of joint replacements including total hip replacements. It is important that the surgeon
performing the technique be not just a good general orthopedic surgeon but an expert
experienced total hip replacement surgeon as well. It is reasonable to ask a surgeon whether
(s)he concentrates his/her practice on joint replacements or whether (s)he does all kinds of
orthopedic surgery.

Urgency
Total hip replacement for arthritis is elective surgery. With few exceptions it does not need to
be done urgently and can be scheduled around your other important life events.

Risks
Like any major surgical procedure total hip replacement is associated with certain medical
and surgical risks. Although major complications are uncommon they may occur. The
possibilities include infection blood clots bleeding or blood transfusion and anesthesia-related
or medical risks. Certain hip-specific risks like infection at the surgical site (typically less
than 1.5%) dislocation (where the ball comes out of joint; less than 1% with one popular
surgical technique) or other problems may also occur. However the overall frequency of
major complications following total hip replacement is low typically less than 5 percent (one
in 20) depending on the individuals medical risk factors.

Later risks include the possibility that the device may loosen from the bone; late infections
and dislocations may also occur. But again numerous studies have shown that a technically
well-performed total hip replacement is more than 90 percent likely to be in service and
functioning well more than 10 years after the surgery.

Managing risk
Most of the major risks of total hip replacement can be treated. The best treatment though is
prevention. At the UW orthopedic surgeons will use antibiotics before during and after
surgery to minimize the likelihood of infection. They will take steps to decrease the
likelihood of blood clots such as early patient mobilization and use of blood-thinning
medications in some patients. Patients are evaluated by a good internist and/or
anesthesiologist in advance of the surgery in order to decrease the likelihood of a medical or
anesthesia-related complication. Great care is taken to be certain that the technical elements
of the operation that are so important to success are correctly performed.

Again the overall likelihood of a severe complication is generally less than 5 percent when
such steps are taken.

Preparation
Patients undergoing a total hip replacement performed at the University of Washington
Medical Center usually will undergo a pre-operative surgical risk assessment. When
necessary further evaluation will be performed by an internal medicine physician who
specializes in pre-operative evaluation and risk-factor modification. Some patients will also
be evaluated by an anesthesiologist in advance of the surgery.

Routine blood tests are performed on all pre-operative patients; chest X-rays and
electrocardiograms are obtained in patients who meet certain age and health criteria as well.
At the University of Washington surgeons will spend time with the patient in advance of the
surgery making certain that all the patient's questions and concerns as well as those of the
family are answered.

Timing
Total hip replacement for arthritis is elective surgery. With few exceptions it does not need to
be done urgently and can be scheduled around your other important life events.

Costs
The surgeon's office should provide a reasonable estimate of:

the surgeon's fee

the hospital fee and
the degree to which these should be covered by the patient's insurance.

Surgical team
Total hip replacement requires an experienced orthopedic surgeon and the resources of a
large medical center. Patients have complex medical needs and around surgery often require
immediate access to a multiple medical and surgical specialties and in-house medical
physical therapy and social support services.

Finding an experienced surgeon

There is good evidence that the experience of the surgeon performing total hip replacement
affects the outcome. It is important that your surgeon not only be an experienced orthopedic
surgeon; (s)he also should have a high level of skill and experience with total hip
replacements.

Some questions to consider asking your knee surgeon:

Are you board-certified in orthopedic surgery?

Have you done a fellowship (a year of additional training beyond the five years
required to become an orthopedic surgeon) in joint replacement surgery?
Does your practice focus on joint replacement surgery and the problems of joint
replacement patients?

Facilities
A large hospital usually with academic affiliation and equipped with state of the art
radiologic imaging equipment and intensive medicine care unit is clearly preferable in the
care of patients with hip arthritis.

Technical details
Because there are now so many techniques that are used to perform total hip replacements
and because the issues pertaining to those techniques have been reviewed earlier in this
article (need t link to prior sections) this section will summarize the basics of traditional
total hip replacement.

Any of several techniques for anesthesia are possible: general (going to sleep) spinal or
epidural. After anesthesia has been successfully achieved total hip replacement surgery
begins by performing a sterile preparation of the skin over the hip to prevent infection.
Next a well-positioned incision is made down the side of the hip. As already discussed the
location and length of the incision varies widely by approach and based on the patients own
anatomy.

Deeper tissues (muscles and tendons) are either spread or incised and prepared for later
repair. The hip capsule (a thick covering directly on top of the ball and socket joint) is then
opened. The ball is gently levered out of the socket and the arthritic ball is removed using a
saw.

At this point the damaged arthritic cartilage on the socket is removed using a scraping tool
called a reamer and the socket (which may be misshapen from arthritis) is shaped to form a
hemisphere. An artificial socket (called the acetabular component) is now inserted usually
without using bone cement. Sometimes additional screws are used to hold the component
firmly to the bone during the critical weeks following surgery when the patients bone will
attach itself to the metal on the artificial socket.

Next the inside of the thigh bone (femur) is prepared using motorized and hand-held tools to
shape it to accept a stem at one end of which is the new artificial ball called the femoral head.
Once the stem is inserted leg length and joint stability are verified and the final components
are inserted.

The tissues are cleaned with sterile saline solution (liquid) any deep tissues that were incised
are now repaired and the skin is closed. A surgical drain may be used at the surgeons
discretion.

Anesthetic
As mentioned total hip replacement may be performed under epidural spinal or general
anesthesia. The choice is made in consultation with the surgeon and anesthesia provider.

Length of total hip arthroplasty hip resurfacing and minimally-invasive hip surgery

No two hip replacements are alike and there is some variability in operative times but the
range is typically between one and two hours of actual operative time.

Pain and pain management

There are several options for pain control. Most commonly a patient will have control over
his/her own pain management using a Patient-Controlled Anesthesia (PCA) device. Using an
electronic device programmed with a safe but effective dosing approach the patient uses a
button to tell the machine when to administer a dose of painkiller either through an intra-
venous (I.V.) tube in the arm or through the epidural catheter in the lower back if one was
used.

Use of medications
Following discharge from the hospital most patients will take pain pills (usually Percocet
Vicoden or Tylenol #3) for an average of two to six weeks after the procedure mainly to help
with physical therapy and home exercises for the hip. Some patients dont even need the
medications for that long.

Effectiveness of medications
Most patients report that although there is some post-operative pain it is quite manageable
with the PCA device. Most patients also report that the pain steadily declines with each
passing day.

Hospital stay
The average hospital stay is three days in length after a total hip replacement.

Recovery and rehabilitation in the hospital

Physical therapy is started on the day of (or the day after) surgery. Patients generally are
encouraged to walk and to bear as much weight on the leg as they are comfortable doing.
Other exercises to help with balance and getting into and out of bed are initiated on the day of
surgery or the next morning.

At the UW Medical Center The physical therapist is an integral member of the team
approach and the patients own high level of motivation and enthusiasm for recovery are very
important elements in determining the ultimate outcome.

Hospital discharge
Patients are encouraged to walk using a walker crutches or cane as needed. Immediate weight
bearing is permitted in most cases depending on other surgical circumstances.

Patients are allowed to shower following hospital discharge provided that there is no drainage
coming from the incision site. We do not recommend that patients drive while taking
narcotic-based pain medications; on average patients are able to drive between two and four
weeks after the surgery.

Each patient will be instructed in Hip Precautions after surgery. This is a short list of
restrictions on particular motions designed to prevent dislocation of the joint replacement.
Which specific precautions are used in an individual case depends on the approach used but
in general patients are encouraged to avoid the extremes of hip rotation (twisting motions of
the leg) and flexion (bending forward). Low chairs low couches and swivel chairs should be
avoided. After about six weeks some of those restrictions are relaxed--for example most
patients can easily put on shoes and socks once theyve recovered from surgery and the
surgeon gives them the OK--but others including extreme flexion and rotation should always
be limited to be on the safe side.

Convalescent assistance
Patients who live alone or who feel they would benefit from the extra support or attention
usually are able to go to an inpatient rehabilitation hospital or an extended-care facility after
hospital discharge. At UW that rehab hospital is on-site so the switch to rehab doesnt even
require going in a car or ambulance.

Sometimes younger patients or patients who have enough help at home will decide to go
straight home after hospital discharge.

Physical therapy
Following hospital discharge (or discharge from inpatient rehabilitation) patients who
undergo total hip replacement will participate in either home physical therapy or outpatient
physical therapy to a location close to home.
Depending on the surgical approach used that therapy can begin right after discharge or it
will start at six weeks after the surgery (the time when tissue healing of an important tendon
has taken place). The surgeon will help you make the necessary arrangements.

The length of physical therapy varies based on patient age fitness and level of motivation but
usually lasts about a month. Two to three therapy sessions per week are average for this
procedure.

The specific therapy procedures vary with surgical approach but balance safe walking and
reviewing hip precautions are emphasized early and muscle strengthening are goals later on.

Can rehabilitation be done at home?

As mentioned this depends on each patients individual circumstances. Age fitness level and
having adequate help around the house are some of the elements that guide the choice.

All patients are given a set of home exercises to do between supervised physical therapy
sessions and the home exercises make up an important part of the recovery process. However
supervised therapy--which is best done in an outpatient physical therapy studio--is extremely
helpful and those patients who are able to attend outpatient therapy at the appropriate times
after hospital discharge are encouraged to do so.

For patients who are unable to attend outpatient physical therapy home physical therapy is
arranged.

Usual response
On average patients walk with a walker (or two crutches) for about 3 weeks then a cane for
another month or so.

The deep pain from the arthritis is usually noticeably absent right after surgery; the post-
operative pain gradually improves and most patients have quit taking narcotic pain tablets by
about a month after surgery.

The large majority of patients are able to walk without a limp and to resume reasonable
personal and recreational activities gradually in the weeks and months following surgery.

Returning to ordinary daily activities

The goal of total hip replacement is to return patients to a good level of function without hip
pain. The large majority of patients are able to achieve this goal. However since the joint
replacement components have no capacity to heal damage from injury sustained after surgery
we offer some common-sense guidelines for athletic leisure and workplace activities:

Recommended:

Swimming
Water aerobics
Cross-country skiing or Nordic Track
Cycling or stationary bike (see figure 10)
Golf
Dancing
Sedentary occupations (desk work)
Permitted:

Hiking
Gentle doubles tennis
Light labor (Jobs that involve driving walking or standing but not heavy lifting)

Not recommended:

Jogging/running
Impact exercises
Sports that require twisting/pivoting (aggressive tennis basketball racquetball)
Contact sports
Heavy labor

Since the joint replacement includes a bearing surface which potentially can wear walking or
running for fitness are not recommended. Patients generally feel well enough to do this and
so need to exercise judgement in order to prolong the life-span of the implant materials.
Swimming water exercises cycling and cross country skiing (and machines simulating it like
Nordic Track) can provide a high level of cardiovascular and muscular fitness without
excessive wear on the prosthetic joint materials (see figure 10).

As mentioned certain precautions should be maintained for life in order to minimize the
likelihood of dislocating the ball from the socket. Avoiding extreme twisting and bending
from the hip are the most important of these.

Costs
Most insurance plans cover the costs of total hip replacement (including anesthesia surgical
fees hospital stay lab tests and medications). Many also approve inpatient rehabilitation
following the surgery. Most cover home or outpatient physical therapy following hospital
discharge.

Many insurance plans have deductibles or co-payments; the only way to be sure in each
individuals case is to contact your insurance provider. UW has expert social workers who
can help guide patients through the process.

Medicare pays 80% of the costs and good Medicare supplemental programs usually cover the
balance. Again the only way to know what your supplemental covers is to ask. UW social
workers can help with this as well.

Summary of total hip arthroplasty hip resurfacing and minimally-invasive hip surgery
for hip arthritis
Total hip replacement is a reliable operation in which the arthritic portions of a hip joint can
be replaced with an artificial bearing surface. Pain is substantially improved and function
regained in more than 90% of patients who have the operation.

Like any major procedure there are risks to total hip surgery and the decision to have a hip
replacement must be considered a quality-of-life choice that individual patients make with a
good understanding of what those risks are.
Hip replacement is a surgical technique that has many variables; like most areas of medicine
ongoing research will continue to help the technique evolve. It is important to learn as much
as possible about the condition and the treatment options that are available before deciding
whether or how to have a hip replacement done. While many of the changes now being
explored in the field of total hip replacement may eventually be shown to be legitimate
advances perhaps including so-called minimally-invasive surgical techniques as well as
alternative bearing surfaces it is important to compare them carefully to traditional total hip
replacement performed using well established techniques which we know are 90-95% likely
to provide pain relief and good function for more than 10 years after the surgery.

http://www.orthop.washington.edu/?q=patient-care/articles/hip/what-is-hip-replacement-a-
review-of-total-hip-arthroplasty.html