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Hip Replacement Total Hip Replacement

Presented by
Atillio Castellani, Brendan Cochren, Trevor Kelly, Shuntaro Maruyama, Mustafa Sharif

General Anatomical Overview

  • The hip is one of your body's largest weight-bearing joints.
  • Consists of two main parts:
  • a ball (femoral head) that fits into a rounded socket (acetabulum) in your pelvis.
  • Ligaments connect the ball to the socket and provide stability to the joint
  • The bone surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.

Hip Anatomy

Hip Joint (Opened)


  • All remaining surfaces of the hip joint are covered by a thin, smooth tissue called synovial membrane. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint.
  • Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.

Total Hip Replacement

  • A prosthetic hip that is implanted in a similar fashion as is done in people.  It replaces the painful arthritic joint.
  • The modular prosthetic hip replacement system used today has three components – the femoral stem, the femoral head, and the acetabulum.  Each component has multiple sizes which allow for a custom fit.
  • The components are made of cobalt chrome stainless steel and ultra high molecular weight polyethylene. Cementless and cemented prosthesis systems are available.

Statistical Overview

  • First performed in 1960.
  • Since then, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of this surgery.


Number and Distribution of Total Hip Replacement Procedures by Age Group and Sex, Canada, 2001–2002 Compared to 1994–1995
Male Female
Age group 1994-
7-year %
7-year %
<45 years 489 553 13.1% 475 484 1.9%
45-54 years 716 1,055 47.3% 630 943 49.7%
55-64 years 1,609 1,753 8.9% 1,659 1,966 18.5%
65-74 years 2,475 2,798 13.1% 3,746 3,748 0.1%
75-84 years 1,470 1,976 34.4% 2,798 3,547 26.8%
85+ years 194 315 62.4% 526 839 59.5%
Total 6,953 8,450 21.5% 9,834 11,527 17.2%
Source :Hospital Morbidity Database, CIHI

Subjective Assessment

  • Pain localized in hip region
  • Exaggerated gait pattern (limp)
  • Increase in pain when weight barring
  • Reduction in the degree of ROM
  • As the degeneration of the joint worsen, individual may be awakened at night with pain
  • Bone spurs may occur

Objective Assessment

  • Gait pattern – Adaptive walking pattern that reduces pressure on the affected side.
  • Muscle atrophy – Muscles in affected area are not used as much due to pain, therefore, use-it-or-lose-it applies.
  • Active Range Of Motion – Limited ROM, stiffness
  • Passive ROM – End feels causes severe pain
  • X-ray – clear degeneration of the bone
  • MRI – determines underlying complications (e.g. avascular necrosis)

Common Causes of Hip Pain and Loss of Hip Mobility


  • Usually occurs after age 50 and often in an individual with a family history of arthritis. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.

Hip Joint

Rheumatoid Arthritis

  • a disease in which the synovial membrane becomes inflamed, produces excessive synovial fluid, and damages the articular cartilage, leading to pain and stiffness.

Rheumatoid Arthritis

Traumatic Arthritis

  • Can leads to a serious hip injury or fracture. A hip fracture can cause a condition known as avascular necrosis. The articular cartilage becomes damaged and, over time, causes hip pain and stiffness.

Traumatic Arthritis Osteoarthritis Hip Fracture

Operation: Removing the Femoral Head

  • Once the hip joint is entered, the femoral head is dislocated from the acetabulum.
  • Then the femoral head is removed by cutting through the femoral neck with a power saw.

Removal of Femoral Head

Reaming the Acetabulum

  • After the femoral head is removed, the cartilage is removed from the acetabulum using a power drill and a special reamer.
  • The reamer forms the bone in a hemispherical shape to exactly fit the metal shell of the acetabular component.

Reaming the Acetabulum

Inserting the Acetabular Component

  • A trial component, which is an exact duplicate of your hip prosthesis, is used to ensure that the joint will be the right size and fit for the client.
  • Once the right size and shape is determined for the acetabulum, the acetabular component is inserted into place.

Inserting the Acetabular

Preparing the Femoral Canal

  • To begin replacing the femoral head, special rasps are used to shape and scrape out femur to the exact shape of the metal stem of the femoral component.
  • Once again, a trial component is used to ensure the correct size and shape. The surgeon will also test the movement of the hip joint.

Preparing the Femoral Canal

Inserting Femoral Stem

  • Once the size and shape of the canal exactly fit the femoral component, the stem is inserted into the femoral canal.

Inserting Femoral Stem

Attaching the Femoral Head

  • The metal ball that replaces the femoral head is attached to the femoral stem.

Attaching the Femoral Head

The Completed Hip Replacement

  • Client now has a new weight bearing surface to replace the affected hip.
  • Before the incision is closed, an x-ray is made to ensure new prosthesis is in the correct position.

Completed Hip Replacement

Treatment by Kinesiologist

Early Postoperative Exercises

  • Regular exercises to restore your normal hip motion and strength and a gradual return to everyday activities.
  • Exercise 20 to 30 minutes a day divided into 3 sections.
  • Increase circulation to the legs and feet to prevent blood clots
  • Strengthen muscles
  • Improve hip movement

Exercise Prescription

Early Stage

Kinesiologist’s Role

  • The patient is released few days after the surgery
  • A list of Do’s and Don’ts
  • Hip is sore and weak
  • Start with light exercises
  • Ergonomics: Rearrange furniture in the house to make using crutches easier. Setup a ‘recovery centre’, a table where u put phone, remote control, radio, medication and other essential things that you need. It makes it more accessible.

Educate Clients

Do’s and Don’ts

To avoid hip dislocation:

  • Using 2-3 pillows between your legs when sleeping (roll onto your ‘good side’)
  • Not crossing your legs
  • Use chairs with armrest
  • Not bending forward past 90 degrees
  • Using a high-rise toilet seat if necessary
  • Avoid pronation the legs
  • To avoid stairs, sleep in the living room

Exercise Prescription

Later Stages

Post-Surgery Complications

  • Thrombophlebitis
    • the blood in the large veins of the leg forms blood clots within the veins.
    • If the blood clots in the veins break apart they can travel to the lung.
  • Infection in the joint
  • Dislocation of the joint
  • Loosening of the joint


  1. What are the two structures involved in the total hip replacement surgery?
    1. head of femur (ball)
    2. acetabulum (socket)
    3. greater trochanter (femur)
    4. Ischial tuberosity
    Answer: a & b

  2. Which of the following (s) could lead to a total hip replacement?
    1. high blood pressure
    2. rheumatoid arthritis
    3. hip fracture
    4. all of the above
    Answer: b & c

  3. Which of the following (s) is a possible post-surgery complication for a total hip replacement?
    1. thrombophlebitis
    2. infection in joint
    3. dislocation of joint
    4. all of the above
    Answer: d


Related Topics: Rehabilitation After Knee Replacement
  Healthy Living with Knee Arthritis
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