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About Total Hip Arthroplasty

当科の人工股関節置換術の特徴はこちらから ▶

If you have a hip injury, such as arthritis or a fracture, common activities such as walking or sitting in and out of a chair can become painful and difficult. Your hip joints will become stiff and you may find it difficult to put on shoes and socks. You may also feel uncomfortable while resting.

Hip replacement surgery is considered when medications, lifestyle modifications, and the use of walking aids do not sufficiently improve symptoms. Hip replacement surgery is a safe and effective procedure that can reduce pain, improve mobility, and allow you to enjoy normal daily life.

Hip replacement surgery is one of the most successful surgeries in any medical field. Since the early 1960s, improvements in surgical techniques and techniques for total hip replacement surgery have greatly increased the effectiveness of total hip replacement surgery. According to the Agency for Medical Research and Quality, more than 450,000 total hip replacements are performed in the United States each year.

The hip joint is one of the largest joints in the body. It is a ball-and-socket type joint. The socket is formed by the acetabulum, which is part of the pelvic bone. The ball is the femoral head, which is the upper end of the femur (thigh bone).

The surfaces of the ball and socket bones are covered with a smooth tissue called articular cartilage that cushions the ends of the bones and allows them to move easily.

The hip joint is surrounded by a thin tissue called synovium. In a healthy hip joint, this membrane produces a small amount of fluid that lubricates the cartilage and eliminates much of the friction in moving the hip joint.

Bands of tissue called ligaments (hip capsule) connect the ball and socket and give stability to the joint.

Common Causes of Hip Pain
The most common cause of chronic hip pain and disability is arthritis. These include osteoarthritis, rheumatoid arthritis, and traumatic arthritis.

Osteoarthritis is the age-related "wear and tear" type of arthritis. It usually affects people over the age of 50 and is more common in people with a family history of arthritis. The cartilage that cushions the bones in the hip joint wears away. Bone rubs against bone, causing pain and stiffness in the hip joint. Osteoarthritis of the hip can also be caused or accelerated by subtle misalignments in hip development during childhood.

Rheumatoid arthritis is an autoimmune disease in which the synovium becomes inflamed and thickens. This chronic inflammation damages cartilage, causing pain and stiffness. Rheumatoid arthritis is the most common type in a group of diseases called "inflammatory arthritis."

Post-traumatic arthritis. This can lead to severe injury or fracture of the hip joint. Cartilage is damaged, causing pain and stiffness in the hip joint.

Femoral head necrosis. Hip injuries, such as dislocations and fractures, can limit the blood supply to the femoral head. This is called osteonecrosis (also called “vascular necrosis”). Lack of blood can cause the bone surfaces to collapse, leading to arthritis. There are also diseases that cause osteonecrosis.

Pediatric hip disease. Some infants and children have hip problems. Even if the problem resolves successfully in childhood, arthritis may develop later in life. This happens because the hip joint may not grow normally and the articular surfaces are affected.

Total hip arthroplasty involves removing damaged bone and cartilage and replacing them with parts of an artificial joint.

The damaged femoral head is removed and replaced with a metal stem that sits in the central cavity of the femur.

The femoral stem may be cemented or “press fit” into the bone.
A metal or ceramic ball is attached to the top of the stem. This ball replaces the damaged resected femoral head.
The damaged cartilage surface of the socket (acetabular) is removed and replaced with a metal socket. Sometimes screws or cement are used to hold the socket in place.
A plastic, ceramic or metal spacer is inserted between the new ball and socket to ensure a smooth running surface.












Is hip replacement surgery for you?
The decision to have hip replacement surgery should be a joint decision between you, your family, your doctor, and your orthopedic surgeon. This decision-making process usually begins with a referral from your primary care physician to an orthopedic surgeon for an initial evaluation.

When surgery is recommended
There are several reasons why doctors recommend hip replacement surgery.

People who benefit from hip replacement surgery often have the following conditions:

  • Hip pain that limits daily activities such as walking and bending

  • Hip pain that persists day and night, even at rest

  • The hip joint is stiff and unable to move or lift the leg.

  • When pain is not sufficiently relieved by anti-inflammatory drugs, physical therapy, or walking aids.

Patients suitable for surgery
There is no absolute age or weight limit for total hip replacement surgery.

Surgery is recommended according to the patient's pain and disability, not age.

Although many patients undergoing total hip replacement are between the ages of 50 and 80, our orthopedic surgeons evaluate each patient on an individual basis. Total hip replacement surgery has been successfully performed in all age groups, from teenagers with juvenile arthritis to the elderly with degenerative arthritis.

Orthopedic evaluation
Evaluation by an orthopedic surgeon consists of several components.

Medical history. Your orthopedic surgeon will gather information about your general health and ask about how much pain you have in your hip joint and how it affects your ability to function in daily life.
Physical examination. Assess hip mobility, strength, and alignment.
X-ray examination. These images help determine the extent of hip damage or deformity.
Other inspections. In some cases, other tests, such as magnetic resonance imaging (MRI) scans, may be needed to check the condition of the bones and soft tissues in the hip joint.

Deciding whether to have hip replacement surgery
Decide in consultation with your primary care physician.

Your orthopedic surgeon will review the evaluation with you and discuss whether hip replacement surgery is the best way to relieve pain and improve your ability to exercise. Other treatments, such as drugs, physical therapy, or other types of surgery, may also be considered.

In addition, the orthopedic surgeon will discuss the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that occur some time after surgery.

If you have any questions, do not hesitate to ask your doctor. The more you know, the better you will be able to navigate the changes hip replacement surgery brings to your life.

realistic expectations
An important factor in deciding whether to have hip replacement surgery is understanding what surgery can and cannot do.

Most people who have hip replacement surgery experience a dramatic reduction in hip pain and a significant improvement in their general activities of daily living.

With normal use and activity, the material between the hip prosthesis head and socket begins to wear away. Excessive exercise or being overweight can accelerate this normal wear and tear, causing your hip prosthesis to loosen and become painful. Therefore, most surgeons advise against high-impact exercises such as running, jogging, jumping, and high-impact sports.

Practical activities after hip replacement surgery include unrestricted walking, swimming, golfing, driving, hiking, biking, dancing, and other low-impact sports.

With proper exercise regimen, a hip prosthesis can last for years.

Preparing for surgery
medical assessment
If you decide to have hip replacement surgery, your orthopedic surgeon may ask you to undergo a full physical examination by your doctor before surgery. This is necessary to ensure that you are healthy enough to undergo surgery and complete the recovery process. Many patients with chronic conditions such as heart disease may be evaluated by a specialist, such as a cardiologist, before surgery.


Several tests, such as blood and urine samples, an electrocardiogram, and a chest x-ray, may be needed to plan surgery.


skin preparation
Make sure there is no infection or inflammation on the skin before surgery. If you have either, contact your orthopedic surgeon for treatment to improve your skin before surgery.


drug therapy
Tell your orthopedic surgeon about the medicines you are taking. Your surgeon or doctor will advise you which drugs you should stop taking before surgery and which you can continue to take.


Weight loss
If you are overweight, your doctor may ask you to lose weight before surgery to minimize stress on your new hip joint and reduce the risk of surgery.

tooth evaluation
Infections after hip replacement surgery are uncommon, but infections can occur when bacteria enter the bloodstream. Major dental procedures (such as tooth extractions and periodontal treatment) should be completed before hip replacement surgery because bacteria can enter the bloodstream during dental procedures. Postpone routine dental cleanings for a few weeks after surgery.

Urine evaluation
Anyone with a history of recent or frequent urinary tract infections should be evaluated by a urologist prior to surgery. Older men with prostate disease should consider surgery after needed treatment has been completed.

social plan
You can walk with a cane, crutches, or a walker immediately after surgery, but you may need some help with cooking, shopping, bathing, and laundry for several weeks.

If you live alone, a social worker or hospital discharge planner should arrange in advance to have someone help you at home. You can also stay in a nursing home for a short period of time during the recovery period after surgery.

planning at home
During recovery, you can make some changes to make your home more comfortable. Things like the following may help you in your daily life:

Install well-secured safety bars and handrails in shower stalls and bathtubs.

Secure all stair railings
A stable chair for early recovery with a firm seat cushion (knees lower than hips), firm backrest, and two arms.


  • toilet seat height

  • A stable shower bench or chair for bathing

  • Long-handled sponge and shower hose

  • Dressing sticks, sock aids, and long-handled shoehorns for putting on and taking off shoes and socks without excessive bending of the new hips

  • A reacher that allows you to grab things without bending your back excessively

  • Place a firm pillow on your chair, sofa, or car so that your knees are lower than your hips.

  • Removal of loose rugs, electrical cords, etc. from walking areas in the house

About surgery
You will be admitted to the hospital on the day before the operation, and you will need to stay in the hospital for about 2 weeks.

Once you arrive at the hospital or surgery center, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (putting you to sleep) or spinal anesthesia, epidural anesthesia, or local nerve block anesthesia (awake but paralyzed from the waist down). The anesthesiologist will decide which type of anesthesia is best, together with the patient.

implant component
A variety of designs and materials are currently used in hip prostheses. They all consist of a ball component (made of a highly polished, tough metal or ceramic material) and a socket component (a tough cup made of plastic, ceramic, or metal, sometimes with a metal shell on the outside). consists of two basic components:

The prosthesis components may be "pressed" into the bone so that the bone grows over the component, or they may be cemented into place. The decision to press-fit or cement is based on several factors, including bone quality and strength. A combination of a cemented stem and a non-cemented socket may also be used.

Your orthopedic surgeon will select the type of prosthesis that best suits your needs.

surgical procedure
Surgery usually takes 1 to 2 hours. An orthopedic surgeon removes damaged cartilage and bone and places new metal, plastic, or ceramic implants to restore the hip joint's position and function.

X-ray before and after total hip arthroplasty.
Radiographs before and after total hip arthroplasty. In this case, non-cementitious components are used.

After the surgery, you will be moved to the recovery room and waited for several hours while checking the recovery from the anesthesia. When you wake up, we will take you to the hospital room or discharge you home.

The success of surgery depends largely on how well you follow your orthopedic surgeon's instructions for home care in the weeks following surgery.


pain management
Medications are often prescribed to relieve short-term pain after surgery. Many types of drugs are available to manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and local anesthetics. Doctors may also use a combination of these drugs to minimize the need for opioids and improve pain relief.

Keep in mind that opioids can help relieve pain after surgery, but they are narcotics and addictive. Opioid addiction and overdoses are a major public health problem in the United States. It is important to use opioids only as directed by your doctor. Stop taking opioids as soon as your pain starts to improve. If your pain does not improve after a few days after surgery, talk to your doctor.

wound care
The wound may be stitched or stapled or sutures may be placed under the skin. Stitches are removed approximately 2 weeks after surgery.

Keep the wound dry until it is completely closed and dry. You may want to bandage the wound to prevent irritation from clothing or support stockings.

You may have anorexia for several weeks after surgery. A balanced diet, often supplemented with iron, is important to promote tissue healing and restore muscle strength. Also, make sure you are adequately hydrated.

Exercise is an important part of home care, especially in the first few weeks after surgery. You can resume most of your normal light activities 3 to 6 weeks after surgery. It is normal to have some discomfort during activity and at night for a few weeks.

Possible complications of surgery
The incidence of complications after hip replacement surgery is low. Serious complications such as joint infections occur in less than 2%. Serious medical complications such as heart attacks and strokes are even less common. However, chronic illness can increase the likelihood of complications. Although rare, these complications can slow or limit recovery.


Infections can occur superficially in the wound and deeper around the prosthesis. It may occur within days to weeks after surgery. It can also happen many years later.

Minor wound infections are commonly treated with antibiotics. Larger or deeper infections may require additional surgery or removal of the prosthesis. Any infection in the body can spread to the artificial joint.


Blood clots in the lower extremity veins and pelvis are among the most common complications of hip arthroplasty. If such a clot travels to the lungs, it can be life-threatening. Your orthopedic surgeon will outline a preventive program that includes blood thinning medications, support hoses, inflatable leg covers, ankle pumping, and early mobility.

uneven leg length
One leg may feel longer or shorter after hip replacement surgery. Your orthopedic surgeon will make every effort to keep your legs even in length, but they may lengthen or shorten them slightly to maximize hip stability and biomechanics. Some patients may feel more comfortable using a shoe lift after surgery.


Hip implant dislocation

Removal of hip implants.

The ball will come out of the socket. The risk of dislocation is said to be highest in the first few months after surgery when the tissue is healing. Dislocations are rare. If the ball is dislodged from its socket, it can usually be put back in place with closed reduction surgery and no further surgery is required. If the hip dislocation continues, further surgery may be needed.


Looseness and wear of implants
Hip prostheses can wear and loosen over time. This is most likely due to everyday behavior. It can also result from a biological thinning of bone called osteolysis. If the loosening is painful, revision surgery may be necessary.

Other complications
Nerve and blood vessel damage, bleeding, fractures, and stiffness may occur. Many patients continue to have pain after surgery.

To prevent problems after surgery
Recognize the signs of blood clots
Follow your orthopedic surgeon's instructions carefully during the first few weeks of recovery to reduce the risk of blood clots. Your surgeon may also recommend that you continue taking blood-thinning medications that you started at the hospital. Tell your doctor right away if you have any of the following warning signs:

  • Warning Signs of Blood Clots Warning signs that you may have a blood clot in your leg are:

  • Calf or leg pain unrelated to the incision

  • Calf tenderness and redness

  • new or increased swelling in the thighs, calves, ankles, or soles of the feet

  • Pulmonary embolism precautions Warning signs that a blood clot has traveled to the lungs include:

  • sudden shortness of breath

  • sudden chest pain

  • localized chest pain when coughing

Infectious disease prevention
A common cause of post-hip arthroplasty infections is bacteria introduced into the bloodstream during dental procedures, urinary tract infections, and skin infections.

After surgery, patients with certain risk factors may need to take antibiotics before dental procedures, including tooth cleanings, or before surgical procedures that may introduce bacteria into the blood. there is. Your orthopedic surgeon will consider whether you need to take prophylactic antibiotics before dental work, depending on your situation.

Infectious disease warning sign. Tell your doctor right away if you have any of the following signs that indicate possible infection from hip replacement surgery:


    Persistent fever (>100°F orally)




    Increased redness, tenderness, and swelling of hip wounds


    Drainage from a hip wound


    Increased pain in the hip joint both during activity and at rest

to prevent falls
A fall during the weeks after surgery can damage the new hip and require repeat surgery. Stairs are especially dangerous until your hips are strong and mobile. You may need to use a cane, crutches, a walker, a handrail, or have someone help you until your balance, flexibility, and strength improve.

Orthopedic surgeons and physical therapists help determine what aids are needed after surgery and when they can be used safely.

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