Dr. Dallas Vanorny, MD, PhD

During hip replacement surgery, an incision is made along the side of the hip. The surgeon may access the joint directly through this incision, or by using small tools and a lighted tube called an arthroscope to see and treat the joint. The diseased tissue is removed, and the bones are smoothed out and fitted with metal ends. The metal pieces may be cemented in place, or they may have a porous structure that encourages bone to grow into them and hold them securely. A smooth plastic cushion is placed between the two bones to replace the cartilage and allow the joint to move freely.

Hip replacement surgery takes one to two hours, and afterwards patients may stay in the hospital for several days. When patients go home, they will have to use a cane, walker, or crutches at first. Patients will likely have physical therapy to improve their ability to move with their new hip. After the first few weeks, light exercise such as bike riding or swimming will help them heal, but certain actions, such as climbing stairs or bending over at the waist, may be difficult at first. It will take several weeks before they can drive or return to work. Full recovery may take six to 12 months.

Both injection and aspiration are techniques that involve inserting a needle connected to a syringe directly into the joint. Aspiration involves the removal of excess fluid, and injection is the placement of medication directly into the joint space via the needle. Both procedures may be performed at the same time. In both cases a local anesthetic may be used, the skin will be cleaned and disinfected, and then the needle will be inserted. In some cases, especially if the injection or aspiration is in a large and deep joint such as the hip or spine, ultrasound may be used to guide the needle to the exact location desired.

In some cases, irritation to the joint can cause fluid to build up so significantly that the joint hurts and can no longer move well. Aspiration removes some of the excess fluid and relieves the pressure. In addition, aspiration can be used to provide a sample of joint fluid if it needs to be examined microscopically for the presence of white blood cells, bacteria, or crystal formations.

Certain injuries and diseases that affect joints are inflammatory in nature, such as rheumatoid arthritis, tendonitis or gout. These diseases may be helped by the local injection of anti-inflammatory medications directly into the affected joint. In this case, corticosteroids such as methylprednisone are usually used. Relief from the pain may be felt right away and may last for weeks or even months.

In some cases, such as with osteoarthritis, the cartilage buffer between the two bones wears down and pain comes from bones rubbing against each other. In this case, injection of a lubricating agent such as hyaluronic acid may be beneficial. It provides a slippery cushion between the bones to relieve pain that can last for months.

Although joint replacement is one of the safest and most reliable medical procedures available, it is still a major surgical procedure. All surgical procedures carry risks, such as infection or blood clots. For this reason, doctors try to help their patients avoid surgery for as long as they can. Taking arthritis medications, losing weight, avoiding high impact sports such as running, taking supplements such as glucosamine or chondroitin, or having joint injections may allow a patient to enjoy life without the need for surgery.

After having joint replacement surgery, patients can expect some pain the first few days as they recover. Physical therapy is an important part of recovery, and it can decrease complications and increase future mobility. As soon as possible, returning to low impact sports such as swimming, walking or biking can stretch and heal the new joint. A prosthetic joint can last 15 - 20 years and cannot be further damaged by degenerative diseases such as arthritis, so once it is done patients should be pain-free for many years.