What is THR?

A total hip replacement (THR), also known as hip arthroplasty, is a surgical procedure conducted to replace a partial or complete hip joint with an artificial one, called a prosthesis. Conducted on individuals 60 years of age and older, THR provides relief from the debilitating pain of severe arthritis. As with any surgical procedure, there are risks associated with THR and these should be discussed with a qualified health care professional prior to pursuing this treatment option.

Total hip replacements are most commonly conducted on individuals suffering from progressively acute arthritis that impairs their ability to function. An individual who has experienced a fracture of his or her thigh bone may also be a candidate for THR. Other diagnoses that may lead to a replacement include tumors of the hip joint and hip bone necrosis, which is the death of the hip bone resulting from a fracture, disease, or drug use.

Prior to THR a complete medical examination is conducted. The physician reviews all medications the patient is taking and conducts a physical examination and various tests. A complete blood count (CBC), urinalysis, and an electrocardiogram (EKG) are among the tests administered to ensure there are no underlying conditions present. In the event a secondary condition such as an infection or heart disease is discovered, the surgery is postponed until the individual's condition is stabilized.

The hip joint is comprised of a ball and socket. During a total hip replacement, the diseased ball is removed and replaced by a metal one outfitted with a stem, known as the prosthesis, anchored in the thigh bone with a cement-like substance called methylmethacrylate. The damaged socket is also excised and substituted with one made of an industrial-strength plastic. The surrounding tendons and muscles are mended before the incision is closed. Postoperative observation is essential to alleviating the risk of complications and establishing patient stability.

Immediately following surgery the patient is observed for several hours in recovery to make certain he or she is stable before being moved to a patient room. The patient’s lower extremities are monitored to ensure he or she has sufficient circulation and sensation. Intravenous fluids and pain medications are administered and anti-nausea medications are given as needed. Deep breathing and coughing are encouraged to avoid lung congestion. Physical therapy commonly begins the day after surgery with the patient performing minor exercises while sitting in a chair.

Prior to returning home, some patients may need to stay in a rehabilitation center for a short time. During their stay, individuals learn safe approaches to everyday functioning at home. Supportive accessories such as crutches or a walker are utilized in the immediate days and weeks following a THR. The ultimate goals of physical therapy and rehabilitation are to provide proper patient education, strengthen the hip joint muscles, and promote appropriate exercise.

The prognosis for an individual who has had a THR is very good with successful surgery and proper aftercare. As with any surgical procedure where general anesthesia is involved, there is risk of breathing difficulty, heart arrhythmia, and allergic reaction. Prior adverse reactions to general anesthetic should be discussed with a physician prior to surgery. Additional risks include blood clots, heart attack, and stroke. Postoperative risks associated with THR include infection, dislocation of the prosthesis, and injury to the nerves or blood vessels at the incision site.