Total Hip Arthroplasty

What total hip replacement is

The hip is a ball and socket joint. The ball is the head of the femur, and the socket is the acetabulum, part of the pelvis. Both surfaces are normally covered with smooth cartilage that lets the joint move with very little friction. When that cartilage is lost, through arthritis, injury, avascular necrosis or other conditions, bone bears against bone and the joint becomes painful and stiff.

In a total hip replacement the damaged head and neck of the femur are removed and replaced with a component that sits in the canal of the femur and carries a new ball, and the worn socket is fitted with a new bearing surface. The components are made from combinations of metal, ceramic and a durable medical-grade plastic chosen to move against one another with low friction. Which combination and which type of fixation are appropriate depends on the individual, including bone quality, general health, age and activity. Surgery is not the first response to hip pain; it is considered when the joint is damaged enough that pain and loss of function are no longer managed by other means.

Symptoms that often bring people in

• Groin, buttock or thigh pain that is worse with weight bearing
• Difficulty walking any distance, or a limp that has developed
• Stiffness that makes putting on shoes and socks or getting into a car difficult
• Pain at night or at rest that disturbs sleep
• Hip pain that has not responded to therapy, activity change and other non-surgical measures

How it is evaluated

Evaluation begins with your history and an examination of the hip, assessing motion, the movements that reproduce your pain, leg lengths, gait and muscle strength. The spine and knee are usually assessed as well, because pain around the hip can arise from more than one source. X-rays of the hip and pelvis are standard, and MRI, CT or other studies may be requested where the diagnosis is unclear.

Treatment options in general terms

Non-surgical measures are explored first wherever they are reasonable.

• Physical therapy and rehabilitation. Work on motion, strength and the mechanics of walking.
• Activity modification and education. Adjusting how the joint is loaded through daily life.
• Walking aids and appliances. Support that changes how force passes through the hip.
• Injection and other office-based options. Measures that may be discussed depending on the diagnosis.

Where hip damage is advanced and other measures have not achieved what a patient needs, surgical options may be discussed.

• Total hip replacement. Replacement of both the femoral and the socket side of the joint.
• The direct anterior approach. A minimally invasive technique in which the hip is reached from the front through a small incision, working between muscle planes. See Direct Anterior Approach.
• Revision hip replacement. Surgery on a hip replacement already in place, considered where there is loosening, wear, infection or other problems. See Hip Revision Arthroplasty.

What to expect when you consult Dr. Wolfson

Dr. Wolfson, MD, FRCSC, FACS, is board certified in the United States and Canada, and he has performed over 1,500 direct anterior approach hip replacements. At a consultation he will examine you, review your x-rays with you, and explain what he believes is happening in the joint. Non-surgical options are discussed first where they are reasonable. If replacement is being considered, he will explain what the operation involves, its risks and limitations, what rehabilitation would require of you, and what the alternatives are.

This page provides general information about total hip arthroplasty and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.