After the decision has been made to have a hip replacement and the preoperative procedure is completed, the patient is admitted to the hospital the day of the procedure. This usually happens approximately two hours before the anticipated time of surgery. After evaluation and completion of various checklists by the preoperative nurse, the patient is taken to the operating room. After the appropriate anesthetic is administered by the anesthesiologist, the patient is turned on to their side so that the affected hip is pointing up. The patient is positioned on the operating room table with special devices to hold the pelvis securely in position. The leg is prepped with special antiseptic solution and drapes for surgery are applied. An incision ranging in length from 3-1/2 to 5 inches, depending on the size of the patient, is then made. The muscle fibers of the gluteus maximus are spread apart creating an entry to the back side of the hip joint. The hip capsule is opened and preserved and the ball is dislocated out of the socket. The ball with a portion of the neck is removed with a saw and the socket is exposed. Retractors are placed around the socket that allow direct visualization of the socket even through a very small skin incision. Reamers are then used to create a perfect hemisphere, usually 1 mm smaller then the anticipated socket that will be used. For instance, if a 54 mm diameter socket is going to be utilized, the final reamer will be a 53 mm. The socket is then hammered into position using various alignment guides and/or computer-assisted techniques. This can be further stabilized with one to three screws depending on the surgeon’s preference. A trial liner is placed and attention is then turned to the thighbone or femur. The canal of the femur is entered with tapered drills and then appropriated sized broaches ranging in size from very small to very large are introduced creating a cavity in the bone that matches the size of the implant. In the majority of patients with good bone quality, press-fit techniques are utilized whereby the implant fits into the cast created by the broach and gives excellent stability allowing bony ingrowth into the porous surface of the stem. In those individuals with less dense or durable bone, bone cement is placed in the canal of the thighbone, the stem is placed in the canal, and held very still until the cement hardens. This form of fixation is called cemented fixation.
After the implants are placed, the capsule of the hip is sewn closed, the skin is closed, and the patient is transported to the recovery room. After a brief stay in the recovery room, the patient will return to the Joint Center where, that day, they will begin their recovery getting up and weightbearing as tolerated on the hip with the assistance of a therapist and walker or crutches. The amount of walking done that first day depends on the patient, their health, their strength, and their level of comfort.
