Total hip replacement (THR), also called total hip arthroplasty, is a surgical procedure in which a damaged hip joint is removed and replaced with an artificial implant. It is recommended for patients with severe arthritis of the hip, osteonecrosis (bone death), or hip fractures when other treatments no longer control pain. These conditions often cause stiffness and long-term pain that make walking and daily movement difficult.
THR is one of the most common orthopedic procedures worldwide. It offers long-lasting pain relief and improved joint movement. Research in Pakistan has also shown that patients report marked improvement in their hip function after surgery, allowing them to return to daily activities with less pain.
How the Surgery is Performed?
The procedure takes place in an operating room under anesthesia. Once the patient is asleep, the surgeon positions the body to gain access to the hip joint.
- Incision and Exposure
The surgeon makes a cut on the side or back of the hip. Muscles and tendons are carefully moved aside to expose the hip joint. - Removal of the Damaged Head
The diseased or damaged femoral head (the ball of the hip joint) is cut and removed. - Preparation of the Femur
A metal stem is inserted into the hollow center of the thigh bone. The stem can be secured with bone cement or press-fit into the bone for stability. A new ball made of ceramic or metal is attached to the stem. - Preparation of the Socket
The hip socket (acetabulum) is reshaped using surgical tools. A metal cup is then fitted inside the socket. The surgeon may use screws or cement to hold it in place. - Insertion of the Liner
A liner made of plastic or ceramic is placed inside the metal cup. This liner provides a smooth surface for the new ball to move. - Closure
The surgeon repairs soft tissues and closes the incision with stitches or staples.
Surgical Approaches
Surgeons may use different approaches to perform hip replacement:
- Posterior Approach: A cut is made at the back of the hip. This is the traditional method.
- Anterior Approach: A cut is made at the front of the hip or groin. This approach allows the surgeon to work between muscle planes instead of cutting them, which may reduce early pain after surgery.
In some cases, minimally invasive surgery is performed with smaller cuts of about 3–6 inches. Special instruments are used to place the implants through these cuts. This approach aims to reduce tissue trauma and speed recovery. However, it requires special skills and equipment.
Implant Components and Materials
A hip replacement consists of two main parts:
- Femoral Component: This includes a metal stem, usually titanium, inserted into the thigh bone. A ball made of ceramic or metal attaches to the stem.
- Acetabular Component: This includes a metal cup that fits into the pelvic bone. Inside the cup, a liner made of ceramic or polyethylene (plastic) is placed to allow smooth movement.
These materials are chosen for durability and safety. With proper care, most modern hip implants last 15–20 years or more.
Recovery and Rehabilitation
Patients usually stay in the hospital for one to three days after surgery. Recovery begins soon after the operation:
- Mobilization: Patients are encouraged to sit up and start walking with help from a walker or crutches on the first or second day.
- Physiotherapy: Exercises begin during the hospital stay and continue at home or in clinics. These focus on hip movement and muscle strength. Most patients progress from a walker to a cane within a few weeks.
- Pain Management: Pain is controlled with medicines and sometimes nerve blocks.
- Monitoring for Complications: Doctors and nurses watch for problems such as infection, blood clots, or hip dislocation. Though these are not common, they are managed promptly if they occur.
Pakistani hospitals often arrange follow-up visits at six weeks, three months, and one year after surgery. X-rays are taken during these visits to check the position of the implant. Some hospitals also provide home physiotherapy or telerehabilitation services. Telerehabilitation allows patients to do guided exercises at home with the help of a physiotherapist through video calls.
Expected Outcomes
Total hip replacement provides reliable pain relief and restores mobility. Most patients notice improvement soon after the procedure and can return to daily activities without the constant pain they experienced before. Reports from Pakistan confirm that patients rate their results as good or excellent in most cases.
With modern surgical methods and high-quality implants, complications are rare. When performed with proper technique and followed by structured rehabilitation, hip replacement allows patients to walk with comfort and maintain an active lifestyle for many years.