Total Hip Replacement: The Operation
Pre Operative Course
Most patients in Ireland are admitted to their local orthopaedic hospital the day before surgery or on the day of surgery, for there Total Hip Replacement. Most patient will have attended a Pre-Operative Assessment Clinic (POAC) in the preceding months, prior to surgery, for investigations. Typically these investigations are reviewed on you admission to ensure your have been passed fir for surgery. A blood sample will be taken to determine you blood type, when you are admitted, this allow you to receive matched blood if it is require during your surgery. A nurse will also measure you for Thromboembolic deterrent stocking or TED stocking, as they are more commonly known, which help to prevent clots forming in your legs, after surgery.
Prior to surgery, you will be review by both the anaesthetics doctor and an orthopaedic doctor. The anaeathetic doctors will explain the type on anaesthesia that will be used during your surgery. Typically spinal or epidural anesthesia is used, this is where you are numb below the waist, and occasionally general anaesthesia is used, in this setting you are put to sleep. The orthopaedic doctor will discuss the operation with you including the risk, benefits, and likely post operative course, this doctor will ask you to sign a consent form, to proceed with the surgery. The site for surgery is always marked in advance of surgery and is done with a marker at the time of your admission. A total hip replacement will take a few hours, to complete, between the anaesthetic surgery and initial recovery.
Once the anaethetic is working, you are moved onto your side with the hip for surgery turn to the roof. Your leg is then painted with and aseptic solution, this is use to remove bacteria from the skin, and you are given intravenous antibiotics. These measure reduce your risk of infection developing. Once your leg is painted, the leg is draped to establish a sterile environment for surgery. Before all surgeries begin, we complete the WHO checklist, to ensure the correct patient and hip for surgery is clarified.
Methods of surgical exposing the hip, or approaches, can vary between particular surgeons, however all involve incision at the level of hip joint through skin and muscle to reach the hip joint. At all times strict attention is paid to controlling any bleeding vessels to minimise blood loss. Once the hip joint is reached, it is open and worn surfaces of hip joint are removed. This is done in a controlled fashion, with electric saws and reamers, which can be noisy. Once the worn aspects, cartilage and bone, of the hip joint have been removed and the remaining surfaces prepared, the implant are place both in the femur and the pelvis. The implants can be fixed to bone in two ways, either by press fit or cement. With press fit, the implants are held by a tight fit in bone allowed by the elastic nature of bone. The type of implant used will depend on many factors including your age, with many different types of artificial hip available. All are made up of two parts, a ball component and socket component, which can be made of different materials including ceramic, metal or plastic. Your orthopaedic consultant will determine the implant that best suits your needs. Once to implants are placed and the range of motion in the new hip is tested, the wound is closed, with a dressing placed over the wound. You will then be move to a room for recovery after your operation and from their back to ward.
Last reviewed: September 2016
Peer-Reviewed by: Michael D O’Sullivan
IITOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the IITOS "Find an Orthopaedist" section on this website.