Minimally Invasive Total Hip Replacement
What is a total hip replacement?
Total hip replacement is a type of surgery to replace a damaged hip joint. A minimally invasive total hip replacement uses a smaller cut (incision) than a traditional total hip replacement. It also uses special tools.
In the hip joint, the rounded head of the thigh bone (the femoral head) moves smoothly inside the round socket of the hip bone. The socket normally has a lining of cartilage, which helps the bones move smoothly. When there is damage to this joint, moving the femoral head may cause pain as the bones scrape together abnormally.
During minimally invasive total hip replacement, your surgeon makes an incision to access your hip bone and thigh bone. Next, the surgeon removes the damaged femoral head and replaces it with a smooth metal stem that attaches to the rest of the thigh bone. Your surgeon also removes the damaged bone and cartilage within the socket of the hip bone, replacing it with a metal shell. Then the new femoral head can move inside the new smooth socket of the hip bone.
Minimally invasive total hip replacement often takes place under spinal or general anesthesia.
Hip Replacement Surgical Approaches | Q&A with Savya Thakkar, M.D.
Why might I need a total hip replacement?
You might need a total hip replacement if you have significant damage to your hip joint. Different types of health conditions can damage this joint, such as:
- Osteoarthritis (most common)
- Rheumatoid arthritis
- Injury or break (fracture) of the hip joint
- Bone tumor in the hip joint
This damage might be painful and interfere with your daily activities. The procedure may help decrease your pain, improve your joint mobility, and improve your quality of life. Usually, healthcare providers only recommend total hip replacement if you still have significant problems after you’ve tried other, more conservative treatments, like pain medicines and assistive walking devices.
Talk with your provider about the benefits and risks of having a minimally invasive total hip replacement instead of a traditional procedure. A minimally invasive procedure uses a smaller incision than a traditional hip replacement. This may lead to less pain and decreased recovery time. It is not yet clear if the procedure leads to a greater risk of certain complications.
In some cases, you may have other surgical options, like total hip resurfacing. Talk with your provider about the risks and benefits of all your options.
What are the risks of total hip replacement?
Most people do very well with their minimally invasive total hip replacement. But as with any surgery, the procedure does carry some fairly rare risks. Possible complications of this surgery include:
- Excess bleeding
- Blood clots
- Injury to nearby nerves
- Dislocation of the hip joint
- Having one leg that is a little shorter than the other
- Loosening of the hip joint
There is also a slight risk that the procedure might not get rid of your pain, or that it might leave you with new pain. Your own risk of complications may vary according to your age and your other medical conditions. Ask your provider about the risks that most apply to you.
How do I get ready for a total hip replacement?
Ask your provider how you should plan to get ready for your surgery.
Tell your provider about any medicines you are taking, including:
- All prescription medicines
- Over-the-counter medicines such as aspirin or ibuprofen
- Street drugs
- Herbs, vitamins, and other supplements
Ask if there are any medicines you should stop taking ahead of time, like blood thinners.
If you smoke, try to quit before your surgery.
If you are overweight, your provider may advise you to try to lose weight before your surgery.
Don’t eat or drink after midnight the night before your procedure.
You may want to make some changes to your house, to make your recovery smoother. This includes things like adding a handrail in your shower.
In some cases, your provider might want additional tests before you have your surgery. These might include:
- X-rays, to get information about your hip
- MRI, to get more detailed information about your hip
- Electrocardiogram (ECG), to make sure your heart rhythm is normal
Follow any other instructions from your healthcare provider.
Johns Hopkins offers in-person educational sessions to help you prepare for hip replacement surgery. During your class, we'll review important aspects of your care and what to expect before and after surgery. You will be able to ask questions and meet many of the staff who will be caring for you in the hospital.
What happens during total hip replacement?
Your healthcare provider can help explain the details of your particular surgery. The details of your hip replacement surgery will depend on the nature of the injury and the surgical approach. An orthopedic surgeon and a team of specialized healthcare professionals will perform the surgery. The whole procedure may take a few hours. In general, you can expect the following:
- You will receive general or spinal anesthesia so that you’ll sleep through the surgery and won’t feel any pain or discomfort during the procedure. (Or you may receive local anesthesia and a medicine to relax you while keeping you awake.)
- A healthcare professional will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.
- You may receive antibiotics, during and after the procedure, to help prevent infection.
- Your surgeon will make an incision over the outside of your hip, cutting through your skin and muscle. Your surgeon may make 1 or 2 small incisions.
- Your surgeon will take your femoral head out of the hip joint socket. He or she will remove your femoral head and replace it with a metal one.
- The damaged cartilage and bone that is lining the socket are removed.
- A metal cup is pushed into the socket and secured with screws.
- Your surgeon will place the femoral head into the new socket.
- The layers of skin and muscle of your incision will be closed.
What happens after total hip replacement?
Talk with your provider about what you can expect after your surgery. You may have significant pain around your incision after your procedure, but pain medicines may help to relieve your pain. You should be able to go back to a normal diet fairly quickly.
You may have imaging, like an X-ray, to be sure that your surgery was successful. You might be able to go home within a day or two.
Your healthcare provider will let you know when you can put weight on your leg. You may have specific instructions about limiting your movements. You might need to use a cane, a walker, or crutches for a few days or weeks. A physical therapist can help you maintain your range of motion and strength. You should be able to go back to most light activities within a few weeks. During this time, you may find it helpful to have some extra help at home.
You might have some fluid draining from your incision. This is normal during the first few days after surgery. Let your provider know right away if you have increased redness, swelling, or draining from your incision, high fever, chills, or severe pain. Also, let your provider know if your pain is not improving. Most people have an improvement in their pain after their surgery.
Make sure to keep all of your follow-up appointments with your orthopedic surgeon, and follow all your provider’s instructions. You may need to have your stitches or staples removed a week or so after your surgery.
The mechanical parts of your hip may wear out or loosen over time. Because of this, you may need a revision surgery 10 to 20 years after your original minimally invasive total hip replacement. You may be able to extend the life of your implant by exercising regularly and taking precautions to avoid falls.