Pain and limitation of function due to hip arthritis are the primary indications for total hip arthroplasty. The artificial hip is most commonly a metal-on-polyethylene design. The femoral component is a high strength metal alloy fashioned into a spherical head, which articulates with the acetabular component, a high-density cross-linked polyethylene shaped like a socket. Metal-on-metal and ceramic-on-ceramic hips are also used. The femoral component is placed within the medullary canal after preparation of the femur and the acetabular component is fixed to the pelvis. Both mechanisms are inserted using bone cement or in a “press–fit” fashion. The “press–fit” components have a porous-coated surface which allows for bone growth into the prosthesis and, therefore, permanent biologic fixation.

Total hip replacement usually takes 2 hours or less, though such complicated cases as revision of a failed replacement require much more time. Depending on surgeon and patient preference, general, spinal, or epidural anesthesia can be used. The average blood loss is 500 ml and postoperative blood transfusion is often required. Patients are asked to donate blood preoperatively based on their age and the type of surgery planned.

Usual postoperative course

Expected postoperative hospital stay

3–5 days.

Operative mortality

Less than 1%.

Special monitoring required

Neurovascular examination of the extremity should be performed in the early postoperative period. Monitoring for clinical signs of deep vein thrombosis must continue during the subsequent hospital stay.

Patient activity and positioning

The patient is mobilized and encouraged to walk on the first postoperative day.