Total Hip Replacement Surgical Procedure

Introduction to Total Hip Replacement

• Total hip replacement is a highly successful surgical procedure involving the replacement of a damaged hip joint with an artificial prosthesis to relieve pain and improve function in patients with advanced arthritis of the hip joint 1

Complications and Revision Rates

• Infection is the most common cause for revision, accounting for 19.3% of revisions, followed by instability/dislocation (17.4% of revisions), and aseptic loosening (15.8% of revisions) 1
• Other potential complications include periprosthetic fracture, leg length discrepancy, venous thromboembolism, and heterotopic ossification 1

Technical Considerations

• The American Academy of Orthopaedic Surgeons recommends meticulous attention to detail at each step of the total hip replacement procedure to ensure optimal outcomes, including proper component positioning, adequate cement technique, and careful soft tissue management 1
• The American College of Radiology suggests that improper component positioning, inadequate cement technique, and inadequate soft tissue tension can lead to complications such as impingement, dislocation, and instability 1

Postoperative Care

• Early mobilization, beginning physical therapy on postoperative day 0-1, is recommended to improve functional recovery and reduce the risk of complications 1
• A multimodal approach to pain management, including paracetamol, NSAIDs/COX-2 inhibitors, and opioids as needed, is suggested to optimize patient comfort and outcomes 1
• The PROSPECT guidelines recommend a primary analgesic approach of either general anesthesia combined with peripheral nerve block continued after surgery, or intrathecal (spinal) injection of local anesthetic and opioid, which should be combined with a step-down multimodal approach including paracetamol, conventional NSAIDs or COX-2 inhibitors, and strong or weak opioids as required 2, 3
• Effective pain management is critical for successful physical therapy after total hip replacement, enabling early mobilization and participation in physical therapy, which directly impacts functional outcomes 2, 3
• The American College of Rheumatology conditionally recommends proceeding to total joint arthroplasty without delay over delaying for physical therapy 4
• Preoperative physical therapy may provide benefits, including accelerated early functional recovery, earlier independence with stairs, toilet use, and chair transfers, and improved endurance while walking 4
• Physical therapy protocols should be implemented early and consistently following total hip replacement, with particular emphasis on weight-bearing exercises and hip abductor strengthening to optimize functional outcomes and quality of life 2, 3
• A balance between progression and protection is necessary in physical therapy, as advancing too quickly may cause setbacks, while progressing too slowly may lead to stiffness and weakness 4